Targeting Outreach and Access for Harm Reduction Tools and Services Through Employer Partnerships

State: OH Type: Promising Practice Year: 2023

Hamilton County is located in the southwest corner of Ohio and is the third most populated county with over 800,000 residents. General demographic information: 75% white, 16% Black, 48% male and 52%  female. Hamilton County Public Health (HCPH) serves and partners with the cities of Cincinnati, Norwood and Springdale to provide public health services to all county residents.  HCPH service area covers 482,059 residents. HCPH's mission is to educate, serve and protect the community for a healthier future.  

HCPH was founded in 1919 and provides public health services for 48 political jurisdictions with 100+ employees. Staff addresses the well-being of Hamilton County residents through a community-focused approach, the examination of health and disease trends, healthcare coordination, inspections, education, and by providing assistance to communities to cope with disease and emergencies.

Among the 10 essential services, public health is responsible for monitoring health status, informing and empowering, mobilizing, developing policies and plans, providing linkages, assuring services, and evaluating effectiveness. These are the cornerstone strategies of our newly developed Harm Reduction Division, which houses all efforts aimed at curbing the addiction crisis.  This division embraces the public health approach to improve health, enhance social well-being, and overall quality of life by reducing negative consequences associated with drug use. 

The Harm Reduction Division was established in 2019 when it received funding for the Overdose Data to Action Grant through the Centers for Disease Control. This grant has advanced evidence-based interventions and has allowed for greater progress in addressing the opioid crisis. The Harm Reduction division's primary goal is to reduce or elimante preventalbe deaths or injury as a result of drug overdoses. The fundamental principles of the Harm Reduction work is based on the promotion of safety, health and wellness rather that is in active drug use or in recovery. 

Harm reduction is an approach that emphasizes engaging directly with people who use drugs to prevent overdose and infectious disease transmission, improve the physical, mental, and social wellbeing of those served, and offer low-threshold options for accessing substance use disorder treatment and other health care services.(

Here is data to assist in understanding the scope of the overdose issue within Hamilton County:

Overdose Deaths 

Year                       Totals

2020                       366

2021                       393

2022                       239 (as of end of November 2022)

Overdose Deaths by Sex

Year              Female        Male        Total

2020             127               239          366

2021             118               275          393

2022 (YTD)  76                163           239

Total             321              677           998

Overdose Death by Race

Year                  Asian          Black             White          Other Asian             Other             Total

2020                 1                 87                   270             0                             8                    366

2021                 0                 116                 269             2                             5                    392

2022 (YTD)      1                 89                   137             0                            12                   239

Total                 2                292                  676            2                             25                   997

Overdose Deaths by Age Group

Year                 18-24            25-34            35-44         45-54              55-64          65+              Under 18           Total

2020                19                 79                  97              86                   66               18                 1                        366

2021                18                 87                  102            99                   70               17                 0                        393

2022 (YTD)     8                   55                   57             54                   44               19                 2                        239

Total               45                  221                 256           239                 180             54                 3                        998


Public Health Practice- Framework

The adulteration of many drug supplies with the potent synthetic opioid fentanyl poses a serious risk for people who use illicit drugs of all kinds. But those who use substances other than opioids are more likely to be unaware of the risk or how to mitigate it. Use of fentanyl test strips can provide the knowledge to make safe and informed decisions related to drug use. Target groups of recreational drug users, but don't utilize existing harm reduction services are often missed by current outreach programs.

Community Need:

Since 2016, there has been a faster national increase in fentanyl-and-cocaine-related deaths than in fentanyl-and-heroin deaths (Lekhtman, 2020). This issue is more consequential for cocaine users as they lack awareness of the possibility of fentanyl in their drugs, and have not acquired any tolerance as opiate users. This population also may not  about have access to vital resources like fentanyl test strips or naloxone.

For people who use heroin or other drugs, test strips represent a chance to make an informed choice. Test-strip provision, as with other harm reduction services, also provides an important opportunity for outreach to engage drug users in conversations about safe drug use practices and other harm reduction services.

The goal of this practice is to engage businesses in the distribution of fentanyl test strips to their consumers. Our goal is to widen the scope of access to this harm reduction tool to a greater number of people that may be at risk of overdose.  Our objectives are greater access, education on safer drug use (i.e. FTS, having nalxone, how to get naloxone, never use alone) and an opportunity to provide this education in partnership with businesses that can help us to address issues of stigma. 

In 2019, HCPH developed partnerships with 5 businesses.  These businesses were all entertainment venues (i.e. bars/restaurants).  Through these establishments we were able to distribute 2365 FTS in 2021.  In 2022, we reached out to 57 businesses ranging from entertainment, barbers, record stores, to laundry mats.  Of these 57, 21 agreed to distibute FTS's on our behalf.  In 2022, Twenty seven businesses distributed 15,935 FTS's. This is for a total of 18.300 FTS's via businesses partnerships. 

In no way can this practice assume credit or direct correlation for signficant decrease in overdose deaths from 2021 to 2022, However this was an addtional point of access and impact to those at risk of overdose death.  Businesses and patrons of these businesses via the number of FTS's distributed show the willingness for the community to have harm reduction tools accessible.  Through our FTS distribution, we provided access to a FTS survey.  This survey demonstrated that 75% of the time respondents reporting changing their behavior due to access to FTS (i.e. using less, having narcan, using with a friend, choosing not to use). 66% reported that having access to FTS helped respondents to make safer decision around drug use.  Attempted to engage and target businesses that would predominately serve people of color in order to address health equity.


From 2020 to 2021, Hamilton County experienced a 7% increase in overdose deaths.  Based on this information and data being reported statewide and nationally regarding predicted significant increases in overdose deaths, HCPH Harm Reduction Division was seeking new opportunities to distribute harm reduction tools, services and education to any resident using illicit drugs. HCPH wanted to target any resident that may use illicit drugs: encompassing recreational use, experimental use, targeted drug seeking like Adderall intended for focus as opposed to social illicit drug use, and addiction. HCPH overdose death data from 2020 and 2021 age ranges from 18-65+ with the highest numbers of overdose deaths in the 25-54 age range.  As demonstrated in the data below.








Under 18





















HCPH was seeking an opportunity to broaden the scope and accessibility of harm reduction tools and services while also developing community relationships among employers in our county.  HCPH developed a protocol and process to approach businesses whose patrons  may be at risk of overdose based on illicit drug use.  In 2021, five businesses agreed to partnering with HCPH to distribute fentanyl test strips (FTS).  Four of the five businesses were bars and entertainment venues.  FTS were packaged in clear plastic bags with the HCPH logo, clearly marked as FTS and a QR code for instructions and a short survey. There were 5 FTS in a package.  These packages were then placed in a clear distribution box- predominately in restrooms.  Also, clearly labeled with HCPH logo, FTS and QR code.  HCPH distributed 2365 FTS's through these five establishments in 2021. In 2022, HCPH expanded the number of businesses to 27 and also expanded the type of businesses that were willing to distribute FTS.  In 2022, HCPH and business establishments distributed 15,935 FTS.  Theoretically reaching 3,187 individuals in 2022 and 473 individuals in 2021. The current process is low barrier access, no induvial information is collected, and HCPH is not able to account for  duplicates in this count. That marks a significant increase in number of individuals utilizing this harm reduction tool.   

HCPH creative use of this existing practice addresses health equity by reaching far more individuals in the general population and the target population of ages 25-54 that may be at high risk of overdose and not be aware since they had not encountered or previously encountered illicit drug supplies being infiltrated with fentanyl.  HCPH also began to strategize focusing on businesses owned by people of color or specifically catering to a minority population in order to better address health equity issues.

By building business partnerships, HCPH is better able to serve our county residents. This is a novel approach for harm reduction tools, services and education to be disseminated to the general public.

Fentanyl test strips utilized for harm reduction is an evidence based practice as provided by the Center for Disease Control (CDC) :

  4. Fact Sheet: Fentanyl Testing to Prevent Overdose – Information for People Who Use Drugs and Healthcare Providers

Goal: to provide low barrier access to fentanyl test strip, harm reduction tool, in partnering businesses 


to target illicti drug users that may be unaware of overdose risk due to recreational, experimental use or had not encountered infilterated fentanyl in the drug supply in the past

easy access, visible and distinct distribution boxes

promoting a culture of community wellness based on safety, health, and wellness through education and access to harm reduction tools 


In 2021, HCPH approached several businesses predominately bars and entertainment venues.  Five businesses agreed to distrbute FTS at their establishment as a service to their patrons. HCPH provided harm reduction training to staff including addtional resources and links to care. 2365 FTS were distributed theroetically touching 473 indivudals. 

In 2022, HCPH approached 50+ business and 21 businesses agreed to partner with HCPH as FTS distribution sites. 15,935 FTS were distributed through these establishments. Having the potential to reach 3,187 indivuduals. 

Practice begain in 2021 and remains in practice. 

HCPH took the intiative to reach out to businesses in our county.  Provide harm reduction trainings, resources, and links to care.  By engaging employers, we are better able to educate, address stigma and prmote indivudal and community wellness. 

Currently, receiving funding from CDC through the OD2A grant. This work represents about .25 of an FTE.  FTS cost about $1/per strip, though there are more options now, supplies for packaging, display distribution and marketing materials (i.e. flyers, etc.) are addtional fudning considerations. 


FTS Survey was conducted in 2022. Based on this survey 75% of particpants were choosing to alter their behavior by having access to FTS that empowered them to make safer drug use choices. 

Question: Where did you receive your most recent fentanyl test strips?

Syringe access program   7.14%  16

Bar/Restaurant   2.68%   6

Other    6.70%    15

Quick Response Team  33.04%   74

UC Health - UCMC ED/EIP    50.45%    113

Question: What substance(s) were tested?

Cocaine   11.74%   27

Heroin   16.09%   37

Methamphetamine   13.48%   31

Marijuana    15.22%   35

Other   41.30%    95

Xanax/Alprazolam    0.43%   1

Ecstasy/MDMA   0.43%   1

Fentanyl   1.30%   3

*Many ‘Other' answers stated Have not tested yet” or Pills”



Question:Did the results change your behavior?

I didn't make any changes    25.13%    50

I used less    12.06%    24

I made sure I had Narcan available    26.63%    53

I used with a friend    20.60%    41

I did not use    15.58%    31

Question: Having access to FTS allows me to make safer decisions around drug use?


Strongly agree   35.98%    77

Agree    23.36%     50

Somewhat agree    7.01%    15

Neither agree nor disagree    27.57%     59

Somewhat disagree     0.47%    1

Disagree    3.27%    7

Strongly disagree    2.34%    5

Question: I regularly use fentanyl test strips

Strongly agree   9.62%    20

Agree    17.31%    36

Somewhat agree     9.13%    19

Neither agree nor disagree    48.08%     100

Somewhat disagree     3.37%     7

Disagree     3.37%     7    

Strongly disagree     9.13%     19






We have built this practice into our program design and activities. Once process, protocols and tools were developed this has been a low lift for staff to maintain and grow. HCPH intentionally slowed business partnerships to ensure that the FTS inventory (a finite resource with limited funding) would be able to meet our partners needs.