Harm Reduction

Recovering Slow Turkey

I was watching tv the other day when I saw a commercial for a medication used to help people quit smoking. The ad was a play on the old “cold turkey” method, and advocated instead for the use of their medication to quit “slow turkey” instead.

We often hear it takes 29 days to make a habit, or that change doesn’t happen overnight. So, it got me thinking, why do we expect substance users to change their behavior in an instant?

We expect those with substance use disorder (SUD), which is the appropriate terminology in today’s language, to enter treatment and stop using substances on the same day. This thinking is asinine, and it makes no practical sense for the average substance user.

Using is not just part of our day, it’s the entirety of our lives.

Using and finding ways and means to get more encompasses every minute of our waking hours, and even some of our sleeping hours, too. I can’t tell you how many times I went to sleep with no plan for the next day’s use, and woke up the next morning with a plan in my head that my brain worked on while I was asleep. Using is everything to us, and it takes up the vast majority of our time. For most of us, we can’t just stop using on a dime and jump into recovery with both feet.

Why is it that when it comes to smoking, people understand medication assisted treatment? People understand that ANYTHING is better than smoking. If someone wanted to wear the nicotine patch, or take that medication from that commercial to quit smoking, no one would hold that against them. Even if they had to use those methods for YEARS, maybe even the rest of their life, nobody could possibly say that they would rather see their loved one still smoking. We want someone who smokes to do anything in their power to quit and stay quit, even if it means using a nicotine replacement therapy like the patch or gum.

Medication Assisted Treatment (MAT) for opioid use is the same principle. It’s a medication that assists the person with substance use disorder in finding a way to let go of their illicit use. These therapies use opioid and partial opioid agonists to bind to the receptors in the brain where heroin used to bind. It tricks the brain into thinking it has what it wants, so the brain and body no longer crave the drug with such severity and frequency. It allows the brain to repair slowly over a very long period of time. For some people, they are able to continually lower that dose and eventually get off of MAT. For others, the cravings are too severe because their use was too severe. They may need to stay on MAT for the rest of their lives.

The question is, why does anyone care?

If someone is no longer waking up every day with their entire existence focused on using, then who cares if they’re on MAT? If they can hold down a job, pay their rent, raise their family, then who cares if they’re on MAT? If they have changed their lives so completely and become a productive member of society, then who cares if they’re on MAT?

I see people saying they don’t agree with MAT and I ask myself the same question every time: Why is it any of your business how someone else chooses to recover? Why are you judging someone else’s path?

I have no shame about being on methadone and if you are too, then you shouldn’t either. My addiction was so severe that there were no other options for me. I didn’t have time to keep trying the natural way, the twelve step way, the inpatient way. I was going to die if I kept trying to treat my medical brain disease without a medical treatment.

My recovery is as slow turkey as it gets. I’m not in any rush to get off medication assisted treatment. Why? Because IT WORKS. Methadone is the most effective treatment for opioid use disorder by leaps and bounds over any other method. I don’t know about you, but I’m betting on the winning horse. I’m betting on science. I’m betting on what has worked for me and millions of others. Actually, forget the winning horse. I’m betting on the slow turkey.

©Copyright 2019 In Angel’s Arms and Lauren Goodkin

Harm Reduction: The Answer to Community Drug Issues

There has been a lot of talk lately about the effects addicts have on the community. Especially when it comes to addicts using in cars parked in neighborhoods, syringes and other paraphernalia being found around our communities, and theft of personal belongings especially from cars. People in the community are up in arms about it. They want it dealt with, they don’t want to see it, they don’t want their children to see it.

The problem here is not that we don’t have solutions to these problems. We absolutely do. Progressive societies, especially the Nordic ones, have come up with some great alternative solutions to these exact problems. So why don’t we implement them? The answer is that people who have absolutely nothing to do with addiction, are not addicts themselves, do not work in the field, but live in the community, feel that they know what’s best for us and are so vocal to town administrations that it prevents these solutions from being utilized.

The issue is that these progressive solutions are not understood by the community at large. Harm reduction strategies seem “soft” or “counterproductive” or “enabling” to people on the outside, and even to some people on the inside. They are not ultimately fixing the problem, they are reducing the harm associated with the problem, which is why we call it harm REDUCTION.

If you don’t want to see active addiction in your community, you have to give it a place to go.

There are three big harm reduction strategies that address the problems our communities are facing.

1. Needle Exchanges

Needle exchanges are the easiest to implement, and the less invasive of all the harm reduction strategies I’ll be addressing. They can be mobile or stationary and there are advantages to both. Mobile exchanges are great because they can go to high traffic areas for drug users and meet them where they are, which makes it easier for many addicts to access their services. This works best in larger cities. In smaller communities, especially those that are more upward socioeconomic areas, a stationary facility can be a good option as well. Being stationary can provide more space for more services, so that the facility can possibly employ other agents who can assist addicts in other ways.

This directly deals with the issue of drug paraphernalia being left in streets, parks, parking lots, and other areas of the community. This is becoming an issue in a lot of towns, so why not confront it head on by creating a safe place to dispose of dirty works? Most towns have no place where people can safely dispose of syringes, even for diabetics! These facilities typically give one syringe for every one that is turned in. Even in the instance that they do provide syringes without exchanging them, people need to understand that syringes are not hard to come by. They can be purchased in bulk on the internet, and can be picked up in quantities under ten at many pharmacies. It’s not that these facilities are giving out contraband that cannot be obtained any other way. Addicts have always, and will always, find what they need when they need it. Needle exchanges are the answer to used and dirty paraphernalia in our communities.

2. Safe Injection Sites

Another big problem we are seeing in our communities is people parked in cars on neighborhood streets, people in public restrooms, parking lots, and other public places using drugs. Many addicts cannot go home to use because they are hiding from their families or the people they live with. I know many addicts who unfortunately have children in the home, whether the children are theirs or a relatives, and they don’t want to bring drugs into the home. Worst of all, many addicts are homeless and don’t have a safe place to use.

Providing these facilities gives addicts that safe place they need to take care of their business. It keeps addicts out of public places where they can be seen by residents, especially children. This also contributes to the work of needle exchanges in that it keeps works off the streets.

The best and most useful part of these facilities is that they virtually eliminate overdose deaths. They are typically staffed with medical professionals who can intervene in the event of an overdose and administer Narcan and life saving measures. Furthermore, they typically have counseling staff on hand to help those who are ready to get clean. They can fast track addicts into treatment and eliminate many of the barriers to getting clean.

Of course, no one wants one of these facilities in their neighborhood.

We have enough trouble opening methadone clinics in our communities. People seem to believe that these facilities bring addicts to the area, not understanding that addicts are ALREADY THERE. These facilities help addicts to stay alive long enough to hopefully get clean when they are ready.

3. Heroin Assisted Treatment

The most controversial of all the harm reduction strategies that exist in the world is heroin maintenance, or Heroin Assisted Treatment (HAT). Many countries utilize this program in a similar way to how the United States utilizes methadone maintenance programs. The clients are provided with a safe, synthetic heroin several times throughout the day and must use it at the facility. These programs are sometimes used in conjunction with methadone.

While this seems contradictory, it has had incredible success in Europe. Statistics show a decrease in illicit drug use overall, a lack of appeal of heroin to young people, and of course a virtual elimination of overdose deaths. Many people reduce their dose over time, just as with methadone, and eventually get their lives together. The idea is to taper addicts off over a long term, while providing counseling and other resources to help them eventually get off the drug all together.

While methadone works perfectly well for millions of people, some do have an aversion to the medication. Many people continue to use heroin in the early stages of methadone therapy, so these programs are basically providing addicts with a safer way to do what they’re already doing anyway. That’s what harm reduction is all about: Making addicts’ lives safer until they are ready to get clean.

Programs like HAT, while controversial, solve the problem of neighborhood crime. Our communities are seeing more and more petty theft such as car break ins, theft of landscaping equipment off trucks in neighborhood streets, and the theft of building materials from construction sites. This petty theft is how many addicts support their habits. HAT programs provide the narcotics that addicts need to prevent dope sickness, and are a reliable alternative to tainted street heroin. These programs keep people alive, period, and that should be enough in and of itself.

 

People hate the idea of harm reduction strategies because they see it as enabling. However, these strategies exist to help people be safer while engaging in behaviors that they are already going to engage in, regardless of whether the harm reduction strategy is implemented or not.

Something to consider while you’re rolling your eyes at these life saving strategies is that what the United States does and has done to deal with drugs has not and will not ever work. Incarceration doesn’t work. Making an addict a felon will not help them to live in sobriety. Prohibition has never worked. Police crack downs have never worked.

We really need to look at other progressive countries who have the actual science and statistics to back up their policies. Our insistence as a country of doing things our own way, despite plenty of evidence that illustrates that our way is not working, is allowing people to die in record numbers. Eventually, these programs will be proposed in your town. When that time comes, please ask yourself if you want to be part of the problem, or part of the solution. Trust science. Trust statistics. Be willing to open your heart and change your mind.

©Copyright 2017 In Angel’s Arms and Lauren Goodkin