Analyzing the impact of SB 511, Oklahoma’s harm reduction law
In the three years since the Oklahoma Legislature passed Senate Bill 511, legalizing harm reduction services statewide, harm reduction organizations have reported over 1,000 overdose reversals using the opioid overdose reversal drug naloxone and served nearly 9,000 clients with sterile syringes, drug-testing kits, referrals to treatment, and other critical interventions.
When communities implement harm reduction programs, they see benefits like reduced spread of infectious diseases and fewer used needles in public spaces, in addition to preventing overdoses. Undoubtedly, SB 511 has already saved lives in Oklahoma, but it will take time for the state to fully realize the long-term public health and safety results of this law.
However, without further action from lawmakers, SB 511 will expire in 2026, threatening Oklahoma’s progress in addressing an epidemic of drug overdoses and cutting short opportunities to see the law’s public health benefits come to fruition.
In this paper, we explore the impact of SB 511 since it was passed in 2021, the public health and safety benefits of syringe service programs and other harm reduction strategies, as well as the broader landscape of harm reduction services in Oklahoma.
Key takeaways
- Since Oklahoma passed SB 511 in 2021, harm reduction organizations have delivered tens of thousands of doses of naloxone and hundreds of thousands of sterile supplies. Naloxone distributed by these organizations reversed over 1,000 opioid overdoses, which are often fatal.
- Oklahoma lawmakers should act to extend or eliminate the sunset provision for SB 511, given the law’s lifesaving impact since it was passed. Without action from lawmakers, SB 511 will expire on July 1, 2026.
- Harm reduction programs, like those authorized through SB 511, prevent overdose deaths and the spread of bloodborne diseases by providing education around substance use, distributing supplies, and offering connections to treatment services.
Responding to an epidemic of drug overdoses
States have implemented harm reduction strategies since the 1970s, but adoption of these strategies has accelerated over the last few decades because of the opioid epidemic, which has claimed over a million lives in the U.S. since 1999.
The opioid crisis has evolved over the last few decades, starting with a wave of opioid deaths driven by an oversupply of prescription opioids. As regulatory measures were taken to stem overprescribing of opioids, these deaths fell, but heroin-related overdose deaths began increasing around 2010. By 2014, synthetic opioids such as fentanyl were driving most opioid-related deaths, marking a third wave.
Today, the U.S. is in a fourth wave of the opioid epidemic, characterized by the co-use of opioids and stimulants. In Oklahoma, the stimulant driving this fourth wave is methamphetamine — the co-use of meth and opioids (namely fentanyl) has caused a significant increase in overdose deaths involving both substances.
Related: Guidance for Oklahoma communities' use of opioid settlement funds
In 2022, Oklahoma recorded over 1,200 overdose deaths, with the vast majority including opioids, meth, or both. Of Oklahoma’s 732 meth-related overdose deaths, about 41% involved an opioid, and rates of meth overdose deaths that involved opioids are even higher in Oklahoma and Tulsa counties.
Beyond overdose deaths, Oklahoma also has high rates of substance use disorders. Nearly one in five Oklahoma adults — about 584,000 people — had a substance use disorder in the past year, according to a 2024 Mental Health America report.
Oklahoma's increasing overdose death rates
Opioids and methamphetamine can both be injected, underscoring the importance of syringe service programs — which allow people to access sterile injection supplies and safe syringe disposal, as well as offering testing for infectious disease and connections to treatment — and other harm reduction strategies authorized by SB 511.
Oklahoma was far from the first state to legalize harm reduction services when it passed SB 511. As of July 2023, 38 states, as well as Washington, D.C., and Puerto Rico, have authorized syringe service programs, or SSPs.
Among Oklahoma’s neighboring states, Colorado, Louisiana, and New Mexico formally permit SSP operations; Kansas, Missouri, and Arkansas do not. Texas prohibits SSPs, with an exception for a pilot program in Bexar County that was established in 2007 and is set to expire in April 2025, barring legislative action.
States with operational syringe service programs
Harm reduction and syringe service programs
Harm reduction is a public health strategy designed to minimize the negative outcomes associated with substance use disorders, like overdose deaths, and reduce social harms, such as first responders’ needle-stick injuries. It is an approach to community-driven public health strategies — including prevention, risk reduction, and health promotion — to “empower people who use drugs and their families with the choice to live healthier, self-directed, and purpose-filled lives,” according to the Substance Use and Mental Health Services Administration, or SAMHSA.
A defining feature of harm reduction is that it focuses on preventing harm to a person’s health and wellbeing, rather than preventing substance use itself — understanding that people who use drugs may not be ready or able to stop using substances at a given time. Using a framework that prioritizes keeping people who use drugs alive, harm reduction strategies typically include education around safer drug use, connections to treatment, overdose prevention and reversal tools, needle and syringe service programs, housing, fentanyl test strips, and medication assisted treatment.
Harm reduction organizations prioritize building relationships with people who use drugs and acknowledge that seeking treatment sometimes comes second to preserving lives by preventing overdose. These organizations recognize the need for high-quality substance use disorder services and aim to protect their clients from stigma when seeking treatment by making referrals and warm handoffs to care.
SSPs embody the principles of harm reduction by working to alleviate negative health consequences for people who use drugs by offering substance use education, sterile supplies, naloxone distribution, and connections to treatment services.
Impact of SB 511 in Oklahoma
In 2021, the Oklahoma Legislature passed SB 511 by Sen. John Michael Montgomery (R-Lawton) and Rep. Carol Bush (R-Tulsa). This bill allows certain entities in the state to legally provide harm reduction services until July 2026, when the law will “sunset” or expire unless lawmakers take additional legislative action.
Highlights of the law
SB 511 defines harm reduction services as “programs established to reduce the spread of infectious disease related to injection drug use, reduce drug dependency, overdose deaths and associated complications, and increase safe recovery and disposal of used syringes and sharp waste.”
The law allows government entities, religious institutions, nonprofit organizations, for-profit companies, non-government entities partnering with a governmental agency, and tribal governments to engage in harm reduction services and SSPs. Organizations must register with and report certain data to the Oklahoma State Department of Health (OSDH).
SB 511 allows harm reduction providers to offer services including:
- Referrals and resources for treating substance use disorders
- Education on disease transmission risks
- Rapid testing for HIV, HCV, and sexually transmitted infections
- Referrals for medical and mental health services
- Safe disposal of used needles
- Legal possession and distribution of hypodermic needles, cleaning kits, testing kits, and opioid antagonists (such as naloxone, also known by its brand name Narcan)
- Rapid testing of drugs for detecting harmful contaminants like fentanyl
Oklahoma data
From 2022 to 2024, four harm reduction organizations in Oklahoma served 8,896 clients, according to data collected by OSDH. They distributed 578,330 syringes, 23,532 fentanyl test strips, 50,250 doses of naloxone (25,125 kits), and reported 1,212 overdose reversals using naloxone obtained from the registered harm reduction organizations.
Additionally, 1,528 participants accepted referrals for additional services, such as testing for HIV and sexually transmitted infections, as well as substance use education.
Supplies and referrals provided by Oklahoma harm reduction organizations
These data are self-reported by organizations and likely underrepresent actual figures. Harm reduction organizations generally avoid collecting extensive identifying information about clients to protect them from stigma and criminalization, which can create barriers to meeting reporting requirements.
Harm reduction organizations in Oklahoma
Although SB 511 explicitly legalized harm reduction in 2021, harm reduction organizations and practices have been operating in Oklahoma for much longer. SB 511 protected harm reduction providers from certain drug paraphernalia laws and enabled them to secure additional funding that could be used to bolster their staff capacity. This was especially significant as many SSPs rely heavily on volunteer staff.
The passage of SB 511 also created opportunities for harm reduction nonprofits to partner with the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS). Supporters of harm reduction programs believe the state should do more, such as advocating for general liability insurance for harm reduction organizations, funding data collection and reporting, and protecting SSP participants — not just providers — from drug paraphernalia charges.
Before SB 511, the HOPE Testing Clinic in Tulsa mainly provided clinical services and point-of-care tests for HIV and hepatitis C. The legislation allowed HOPE to directly supply syringes to participants, rather than relying solely on partnerships with other SSPs that were unregistered with the Oklahoma State Department of Health (OSDH).
In 2022, HOPE launched a public health vending machine offering safer injection kits, fentanyl test strips, naloxone kits, HIV self-tests, wound care kits, and basic first aid supplies. Although funders require demographic data like the participants' age and zip code, HOPE keeps the vending machine access low-barrier to encourage use.
The vending machine serves to both provide harm reduction supplies and bring participants into the clinic, creating opportunities for discussions about testing and treatment.
Public health benefits of syringe service programs
Decades of research has shown that SSPs prevent overdose deaths and the transmission of bloodborne infections. Furthermore, studies show that these harm reduction programs also increase the likelihood of participants entering substance use treatment by five times and triple the chances that participants will cease drug use.
SSPs also protect first responders and the public by reducing the number of used syringes in the community: one study of Connecticut police officers revealed a two-thirds reduction in needle stick injuries after implementing SSPs. Additionally, research shows that SSPs do not increase crime rates in their communities.
Reducing the spread of bloodborne diseases is especially urgent in Oklahoma, which in 2021 had the highest hepatitis C virus (HCV) death rate in the country, according to the Centers for Disease Control and Prevention. Oklahoma’s hepatitis C death rate of 11.05 per 100,000 people is more than triple the national average of 3.18 per 100,000. Oklahoma also had the highest rate in the nation of new HCV infections in 2022.
Given that harm reduction programs registered with the state in 2022 and the most current disease surveillance data available is from 2023, we cannot yet quantify the impact of the programs on infection rates in Oklahoma. However, the CDC attributes a 50% reduction in HCV incidence nationwide to syringe service programs, given that injection drug use is the primary risk factor for transmission and infections of the virus in the U.S.
Similarly, people who inject drugs account for about 1 in 10 new HIV diagnoses nationally. SSPs effectively reduce HIV prevalence through education and providing supplies that decrease risky injection behaviors like sharing and reusing needles.
In Oklahoma, approximately 7,600 people have been diagnosed with HIV. While these cases are primarily concentrated in Oklahoma City and Tulsa, people in rural areas also account for some of these diagnoses. In fact, in 2022, Oklahoma ranked among the top seven states in the U.S. with the highest rural burden of HIV.
HIV cases are costly to the state, with an individual’s treatment valued at nearly $510,000 over a lifetime. By reducing the transmission of HIV, SSPs can provide cost savings, benefiting the state as Medicaid is the largest source of insurance coverage for people living with HIV. In a study spanning 10 years in Australia, SSPs were found to provide a return on investment between 1.3 and 5.5 times the initial investment in the program, as well as reducing HIV incidence by up to 74%.
Recommendations for Oklahoma
Harm reduction programs, like those authorized by Oklahoma’s SB 511, are proven, effective tools to combat drug overdose deaths and other public health harms that stem from substance use. In the three years since it took effect, SB 511 has significantly advanced harm reduction efforts, leading to substantial numbers of reversed overdoses and the distribution of lifesaving supplies across Oklahoma.
Policymakers, public health officials, and community advocates should take action to secure and continue Oklahoma’s progress through harm reduction programs authorized by SB 511. Extending or eliminating the law’s expiration date is necessary to sustain the positive outcomes of these programs, which are key to Oklahoma’s ongoing work to address the harms of the opioid epidemic on communities across the state.
Still, challenges remain around enhanced data collection and reporting. To build on the state’s momentum — and be able to measure it into the future — policymakers should also consider increased funding for data collection and support for harm reduction organizations.
Healthy Minds presented data in this report at an Oct. 10, 2024 legislative study. Download the slides here:
