MaineHealth has received a $1.2 million grant from the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) for a statewide overdose and infection prevention program focused on harm reduction.

The program, Distribution of Harm reduction Access in Rural Maine Areas (Project DHARMA), is a collaboration among MaineHealth and several community organizations including public health agencies, syringe service programs, academic institutions and other treatment providers. Its goals are to provide clients of syringe service programs in Maine’s rural counties with harm reduction supplies and to connect them with care for infectious disease prevention and treatment, wound care and substance use.

“As overdose deaths are at an all-time high in Maine, we feel an urgent need to improve the health of people in our communities,” said Kristen Silvia, MD, in a MaineHealth news release. Silvia is an addiction medicine specialist who is co-leading Project DHARMA with infectious disease and addiction specialist Kinna Thakarar, DO, MPH. “Harm reduction is an evidence-based set of strategies that reduces the risk of overdose and the infection complications of substance use. Anyone can have a substance use disorder. These are mothers, fathers, sons and daughters. They are our friends, our neighbors and our patients. These are people we care about and who deserve care and everything we can do to keep them alive. No one should have to die from a substance use disorder.”

Harm reduction outreach specialists embedded in local syringe service programs will dispense fentanyl test strips and wound care kits, as well as naloxone to rapidly reverse opioid overdose. They also will partner with Colby College to use spectrometry-based drug checking to help identify how much fentanyl and other contaminants are present in drugs circulating in Maine communities.

Collaborators include Maine Office of Behavioral Health, Maine CDC, 14 Federally Qualified Health Centers, academic partners and treatment providers throughout the state, as well as a Harm Reduction Advisory Council.

“Project DHARMA has the potential to facilitate access to harm reduction supplies and services to people in Maine who need it the most,” Thakarar said. “Harm reduction outreach specialists at the syringe service programs are essential to the success of the project and to improving the health and safety of people using drugs. They are also ideally positioned to help link clients to healthcare and services”

Project DHARMA will focus on clients deemed at high risk for HIV/hepatitis outbreaks as well as underserved populations such as those who identify as LGBTQ+ and those who are unhoused and use drugs. The program will promote awareness of Pre-exposure Prophylaxis (PrEP) – taking anti-retroviral therapy as a means of preventing HIV – in people who use substances through several avenues, including training primary care providers in PrEP and expanding awareness of a PrEP hotline through increased messaging delivered by syringe service providers. The project also will involve broader community health efforts, such as expanding the capacity of syringe service providers to screen clients for the blood-borne infections HIV, hepatitis B (HBV), and hepatitis C (HCV).

“The decision by SAMHSA to fund the DHARMA project will enhance the harm-reduction and overdose prevention activities specified in the state’s Opioid Response Strategic Action Plan.  We appreciate the work done by MaineHealth and its several partners and look forward to getting the project started,” said Gordon Smith, director of opioid response for the state.

Participating local harm reduction and syringe service providers include Amistad, based in Greater Portland, the Church of Safe Injection, which operates in Oxford, York and Androscoggin counties and Maine Access Points, which serves clients in all 16 Maine counties. 

By collaborating with syringe service providers, Project DHARMA expects to serve more than 6,500 clients over three years, in addition to making 7,500 client referrals and 9,000 linkages to health care and support services.

“Amistad is energized to be part of a team of partners that is dedicated to elevating the quality of public health and harm reduction programming throughout the state, and to reducing barriers to critical resources for under-served and vulnerable populations,” said Brian Townsend, Amistad’s executive director.

“Church of Safe Injection staff, volunteers and board members are so proud to be a part of this incredible team offering innovative and life-saving resources,” said Zoe Brokos, executive director of the Church of Safe Injection. “We are excited for the opportunity to work in collaboration with our harm reduction partners to provide essential connections to health care resources for people who use drugs in Maine.” 

“At MAP we are truly excited to be working in this collaborative model to increase harm reduction services in Maine,” said Hilary Eslinger, a member of the Maine Access Points leadership team. “It is crucial that we build our understanding of the drug supply and how it relates to both experiences of overdose and infection across the state, including rural and historically isolated parts of Maine. By building our capacity for drug checking, infectious disease testing, wound care services, and linkage to care we will be able to build a network of support based in the dignity and respect of people who use drugs in Maine.”

Thakarar and Silvia said they are dedicating the work of Project DHARMA to two project collaborators who recently lost their lives. Jessi Gilbert was a project administrator for Maine Access Points and Kari Morissette was the executive director of the Church of Safe Injection.

About MaineHealth:

MaineHealth is a not-for-profit integrated health system whose vision is “Working together so our communities are the healthiest in America.” It consists of nine local health systems, a comprehensive behavioral healthcare network, diagnostic services, home health agencies, and 1,700 employed providers working together through the MaineHealth Medical Group. With approximately 22,000 employees, MaineHealth provides preventive care, diagnosis and treatment to 1.1 million residents in Maine and New Hampshire. It includes Franklin Memorial Hospital/Franklin Community Health Network in Farmington, LincolnHealth in Damariscotta and Boothbay Harbor, Maine Behavioral Healthcare in South Portland, MaineHealth Care at Home in Saco, Maine Medical Center in Portland, Memorial Hospital in North Conway, N.H., Mid Coast-Parkview Health in Brunswick, NorDx in Scarborough, Pen Bay Medical Center and Waldo County General Hospital in Rockport and Belfast, Southern Maine Health Care in Biddeford and Sanford, Spring Harbor Hospital in Westbrook and Stephens Memorial Hospital/Western Maine Health Care in Norway. MaineHealth Affiliates include Maine General Health in Augusta and Waterville, New England Rehabilitation Hospital in Portland and St. Mary's Regional Medical Center in Lewiston. It is also a significant stakeholder in the MaineHealth Accountable Care Organization in Portland.