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Why ‘Harm Reduction’ Could Be a Tool for Managing and Minimizing Drug Addiction

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Editor's Note

If you or a loved one is affected by addiction, the following post could be triggering. You can contact SAMHSA’s hotline at 1-800-662-4357.

The opioid epidemic in the United States is unequivocally a disaster. But there are ways of mitigating the death and destruction a drug like heroin or OxyContin reaps.

The Biden administration announced last month $2.5 billion in funding for states to combat the urgent opioid and mental health crisis that has only exacerbated during the COVID-19 pandemic.

Across the country, fatal overdoses have hit a record high, burgeoning during the pandemic and hitting 81,230 in the 12-month period that ended in May 2020, according to the Centers for Disease Control and Prevention (CDC).

Indeed, some habits are extremely hard to kick.

People who struggle with addiction dream of being able to control their consumption, but it takes Herculean strength to do so. Many believe it is not possible, while others — proponents of what’s called “harm reduction” — think there is no one-size-fits-all approach to recovery.

Recovering opioid addict and pop star Demi Lovato made news last week with her brand-new YouTube docuseries and new video and album “Dancing With the Devil,” which features a song that alludes to harm reduction titled “California Sober.”

Lovato has opted to minimize her use of mind-altering substances. Instead of the oxycodone and fentanyl she overdosed on back in 2018, the singer has decided to continue her drug use, confining it to marijuana and moderate drinking. It’s called “California sober,” and it originated in an article on VICE.

“‘California Sober’ is just a way of rationalizing — giving yourself permission to get intoxicated to escape from your problems, rather than learning how to cope with them in a safe and sustainable way,” says Aaron Weiner, a licensed clinical psychologist based in the suburbs of Chicago. “It’s truly unfortunate that the phrase is growing in popularity, because ultimately I believe the concept is going to harm far, far more people than it will ever help.” 

A big proponent of harm reduction is David Poses, an author, activist and a recovering addict himself. Poses says “drug abstinence” programs traditionally employed by rehabs and Alcoholics Anonymous, for example, have high rates for relapse and overdose. 

He is a big believer in buprenorphine, a drug that is indeed an opioid but only partially activates pleasure centers in the brain. It can be used to treat opioid addiction. He kicked heroin 13 years ago and takes buprenorphine to this day.

Depression was my gateway to heroin,” Poses says. “I started using at 16 and spent the next 16 years trying to stop, until I found buprenorphine at 32.” he continues. “It would be a gross understatement to say buprenorphine saved my life. [It] gave me my life by lifting my emotional pain threshold above basement level — without the constant distraction of trying to find and hide heroin or avoid thinking about it.” 

Poser has a memoir — “The Weight of Air: A Story of the Lies About Addiction and the Truth About Recovery,” due in June.

The question of whether or not to reform all drug addicts, criminalize them or to allow them to continue using in a “safer” way is a controversial one. Personal choice as well as treating addicts like human beings is a factor. 

And the philosophy behind “harm reduction” is to either minimize pain that goes along with withdrawals for users who want to quit, or to merely offer a secure space for addicts to “shoot up.”

Injection centers — safe spaces for people to inject illicit drugs like heroin — have been extremely successful in Europe. There are currently none in the United States.

Injection sites “greatly reduce the spread of HIV and other infectious diseases. They almost entirely eliminate the risk of overdose and give drug users access to healthcare and recovery tools,” says Michael Damioli, social worker and director of the outpatient addiction treatment center CMAR, or Colorado Medication Assisted Recovery.

His program integrates harm reduction and, unlike an institution like Alcoholics Anonymous, Damioli does not necessarily believe abstinence is the only option. He thinks there should be injection sites in every major American city. 

“Criminalizing drug use has not shown any effectiveness at reducing rates of addiction,” he says. “Treating drug users like human beings is the answer to the epidemic and safe injection sites is one step in that direction.”

The idea is simple: Plot out parts of a city where opioid overdose is rampant and open up facilities, also known as overdose prevention centers, where on-site nurses can monitor users and offer clean needles and Narcan — the opioid antagonist used to revive a person when they overdose. These centers also offer counseling aimed at easing people off dangerous drugs.

Narcan blocks the effects of opioids and it is becoming increasingly more available throughout the U.S. Until recently, the drug has been available only at hospitals, and on-hand in ambulances and with law enforcement. 

An injection of the drug prevents respiratory depression, which occurs when a person takes fewer than 12 breaths a minute, thus failing to provide enough oxygen to the body. It also comes in a nasal spray. The effects are immediate — reviving a person within two minutes of administration.

About 120 injection centers already exist in 66 cities and nine countries: Spain, Germany, Switzerland, the Netherlands, Luxembourg, Norway, Denmark, Canada, and Australia. Vancouver, BC, was the first city in North America to offer the service.

At the Vancouver locations, there have been 3.6 million visits by people to inject and 6,440 overdoses without death. Critics say injection sites will only promote drug use and increase crime in neighborhoods. 

Another central tenet of harm reduction is to offer replacement therapy, nursing users off by administering less dangerous and less addictive drugs such as methadone and suboxone. Methadone may be available for free at state-run clinics throughout the country.

Handing out condoms to teenagers used to be considerably controversial, especially among some conservative religious groups. Now it’s de rigeur in many parts of the country. If teens are going to have sex — and trust me, they are — then they should be given the tools to have safe sex.

Injection centers are also controversial, but I believe these cities that are pioneering the programs are on the right side of history. 

One way to look at the topic of harm reduction is that anything you do to minimize your substance abuse is better than nothing. That is the opinion many doctors and social workers I’ve spoken with recently.

I’m all for everything that can reduce overdose deaths. Addiction is a disease and its victims are stuck in a death spiral of needing one more fix after another. It is an ugly epidemic of outstanding proportions.

Addicts are going to shoot heroin regardless of whether there are overdose prevention centers. So, why not provide a service that saves lives rather than leave addicts dying in the streets?

Since no injection sites exist in the U.S., if you’re using, you might want to get ahold of some Narcan. Or quit altogether. Some options are to go detox in a hospital and then go to rehab. Or if you can’t afford rehab, you can find a Narcotics Anonymous meeting.

Addiction and mental health are topics explored in my memoir, “The Bipolar Addict,” available now on Amazon. 

Photo by Leonard von Bibra on Unsplash

Originally published: April 9, 2021
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