When we talk about addiction, everyone is always in a hurry to point fingers and say that nothing is being done to address the issue. The problem is that so much of treating addiction comes down to harm reduction, rather than harm elimination, and the average person on the outside of the issue does not understand this concept and because they do not understand it, they therefore do not support it.
Harm reduction is simply offering a safer option to a dangerous idea or activity as it relates to addiction. Unfortunately, the solutions offered are themselves still risky or dangerous. Because of this fact, the general community often balks at the ideas presented to help protect addicts. People are quick to call harm reduction strategies “enabling” or “switching addictions”, not recognizing that the addiction already exists and the objective is to provide a better option in the effort to save lives.
We see examples of harm reduction in our daily lives all the time. Sunscreen, seat belts, condoms, and nicotine patches/vaping are all examples of harm reduction strategies that we believe in and practice as a society. These strategies take a dangerous activity and seek to make it safer, as an alternative to not engaging in the activity at all. Laying out in the sun is dangerous due to the risk of skin cancer. We all know that we shouldn’t do it. However, wearing sunscreen makes this dangerous activity a little bit safer for those who are going to do it anyway. The same theory applies when we talk about addiction and substance abuse.
The reason we try to implement harm reduction strategies is because people cannot get treatment and maintain any kind of sobriety if they are dead. In order for someone to eventually succeed in recovery, they need to remain alive long enough to receive the message of recovery and get to the place in their disease where they are ready and able to achieve it.
Medical Maintenance for the long term treatment of opioid dependence is the most basic example of harm reduction. Options like Suboxone and Methadone are not free from consequence. They are both still forms of opiates, whether partial or full agonists, and still effect the brain long term. They have side effects and can be inconvenient as far as time spent at the doctor or clinic. Ideally, addicts would get sober and stay sober through abstinence alone. However, because addiction is a brain disease that affects the pathways in the limbic system of the brain, in many cases they are just unable to control their cravings and urges to continue using. Utilizing these medications is exactly what harm reduction is about: It’s less dangerous, less risky, and a step in the right direction. It is better than the alternative of actively using opiates to get high, though it may not be the ideal solution.
Narcan is another great example of harm reduction. Narcan (naloxone) is the medication carried by paramedics and used by doctors to reverse the symptoms of an opioid overdose. Common objections to the push to make this drug more widely available sound a lot like conservative arguments against birth control. There is an insane idea out there that if addicts know that their overdose could be reversed, that they are more likely to take the risks that lead to overdose. There is even a rumor going around that addicts get together and have “Narcan parties”, intentionally overdosing themselves so a partner can administer Narcan and revive them.
The reasons that this is false and extremely unlikely are many, starting with the excruciating pain of instant withdrawal that follows the administration of Narcan. This medication is a method of harm reduction because it allows addicts to have another chance, another day on this earth, to hopefully work towards recovery. Making it widely available increases the chances of more overdoses being reversed and more lives being saved.
Another example of harm reduction strategies are needle exchanges. These facilities are available to known addicts who must present their used syringes in order to receive new, sterile ones in their place. Objections are of course raised anytime an addict is provided the means to use. The issue here that you need to keep in mind is that these addicts are already using. They have to prove that by presenting their used needles to the facility in order to receive the new ones.
The risks of sharing needles are not only obvious but extremely dangerous. The spread of potentially fatal diseases such as HIV/AIDS and other blood borne illnesses such as hepatitis are extremely common among needle users and completely unnecessary. The proliferation of these illnesses creates even more problems for the medical community to solve at the expense of taxpayers due to the large number of uninsured addicts in this country.
This is and has always been a tremendous problem in the community and could easily be solved by making clean needles readily available to anyone who requests one.
Aside from sharing needles among multiple users, there is also the issue of individuals reusing syringes time and time again because they do not have access to new ones or cannot afford to purchase them. Reusing a syringe can lead to serious infections and permanent tissue damage from abscesses at injection sites. In Connecticut, the law currently allows pharmacists to dispense up to ten syringes to an individual without a prescription at the discretion of the pharmacist. This is problematic because it allows pharmacists to deny citizens their legal right to possess those syringes. It is important that we increase the availability of clean syringes to those who use them if we want to stop the unnecessary spread of disease and the instances of dangerous abscesses and infections among needle users.
More extreme instances of harm reduction come in the form of safe injection sites. These facilities are staffed by nurses, doctors, EMTs, and other medical professionals. Addicts can come to the facility and are offered a safe, semi-private place to prepare and administer their drugs. They are provided with clean syringes, cotton, cookers, tourniquets and other supplies to help keep them as safe as possible while using. This is easy to mistake for enabling, but what you need to remember is that these are known addicts who are already planning on using their drug of choice.
The only difference is that instead of shooting up in a public bathroom or park, where your kids might be washing their hands or playing on the swings, these people are removed from the general public into a private location where the community doesn’t have to watch them, and they don’t have to worry about being watched. Most importantly, the medical staff is available in case of an overdose or other issue that arises related to using. Often these facilities are staffed with counselors and people who can provide intervention should an individual be seeking help or treatment.
In communities where these facilities have been implemented, fatal overdoses have dropped and in some cases been eliminated all together.
Once the general public becomes more understanding of the nature of the disease of addiction, it will be easier for harm reduction strategies to be implemented across the country. Unfortunately, the communities we are in tend to dictate what they will tolerate in terms of advances in harm reduction strategies. This can be a deadly situation, when people with no actual knowledge of the disease of addiction can dictate what kind of options will be available to those suffering in their communities. Even the seemingly helpful possibility of a treatment center being established in a community leaves residents up in arms. Everyone wants something to be done about the problem, but they don’t want to see it or hear about it. They want a magical solution where the problem just goes away, and unfortunately, that just isn’t how epidemics like this work. The more we fight for methods of harm reduction to be made available in our communities, the more lives we save, and the more people have a chance to access treatment.
So I ask you, on behalf of the progressive addiction advocacy community, please be open minded when you hear about harm reduction strategies being proposed in your community. Please remember that addicts cannot get into recovery if they’re dead. It’s our prerogative to keep them alive long enough to get and stay sober. Harm reduction strategies help keep addicts alive, giving them better and safer options in active addiction, until they are ready and able to stay sober.
©Copyright 2017 In Angel’s Arms and Lauren Goodkin