Harm Reduction
 

Hi, everyone,

I'm not sure if this is the right place to post this, but I'm sure people on this forum will have some opinions on this subject. My question requires some preliminary facts. I'm sure many of you know that heroin overdose deaths increased nationally 39% in 2013 over 2014; you probably don't know that heroin OD deaths in Michigan increased 66% during the same time period. And with the DEA reclassification of certain prescription pain meds from Schedule III to Schedule II in Oct 2014, making them more difficult to get from docs and therefore more difficult to get (and more expensive) on the black market, heroin use is likely to increase even more, which will undoubtedly result in another increase in numbers of heroin OD deaths.

Recently, I saw an article advocating for Safe Injection Sites, and just saw one suggesting "heroin-assisted treatment." Putting the obvious legal hurdles aside, I'm having a hard time figuring out what I think about these ideas. Both seem SO contrary to the accepted mandate to NOT ENABLE someone's addiction. Providing safe injection sites and heroin-assisted treatment sound a lot like enabling heroin use ... and yet the articles' arguments seem to make sense. So I'm confused.

Below are links to two of the articles that are troubling me. What do you think about this?

Why Heroin Overdoses Are Rising and How We Can Prevent Them | Amos Irwin

Can Medical Professionals Safely Administer Heroin to Treat Addiction? The Evidence Says Yes | Drug Policy Alliance

Interesting articles. I actually agree with them. The biggest reason is because when you eliminate the stigma of addiction and provide a safe environment for continue use I think it becomes easier for addicts to seek recovery.

NJ has become one of the state's that has training programs for first responders and family members to train in administering the reversal med. One problem. The medication has become so popular the pharma companies have raised the prices hundreds of fold. It is now becoming unaffordable.

I read an article about Spain. They decriminalize drugs and discovered it actually resulted in a reduction in addictions.

I think in the U.S. we have become brainwashed by the AA and NA programs which state their way is the only way and must be done with quick and total elimination of the drug of choice. I think other ways can be as or more effective

Amazing insight, Happy. I never thought of it that way. but I agree, by eliminating the stigma of the addiction you also eliminate the stigma of recovery. And there is a huge stigma of recovery, I see that with my H.

I wish I knew the answer. H addiction is horrible and deadly. However, abuse of pain meds and doctor shopping is terrible also, and inhibits those that really do want recovery.

That being said, I think it's like most things, lack of funds. We could have more successful substance abuse treatment, however, where are the states going to get the money to do so.

I don't know what to think. It's very scary times out there, that is for sure.

Thank you for sharing.

Hi SeekingGrowth,

I appreciate the articles you share on SR, they make me think and question things. I had to think on this a while before responding.

Ive seen a couple articles published recently and they talk about the various ways addiction is handled in other countries. I feel like the United States has made a lot of errors because until recently addiction hasnt been viewed as a medical/psychological, behavioral issue. I dont think we are in a place to ignore the successful ideas and programs implemented by other nations, and a lot of these are based on harm reduction.

When you mentioned enabling it made me think, a lot of people feel the only option is to try to force people to a rock bottom where they will come crawling, completely defeated, demoralized and willing to accept whatever help is available. This would mean clinics that offered to aid an addicted person with safe injections, clean needles would be creating an environment where using would be seen as safer and more appealing ? Or somehow represent a sign drug used is acceptable and therefore more appealing? My thought is, the person would still be suffering many other negative consequences due to the addiction so this wouldnt alleviate those problems.

In other countries these models have shown to prevent overdose, reduce blood transmitted disease, encourage reduction of use, and acceptance of available counseling and treatments.

I dont think most people want to be addicted. I think they dont know how to stop, and cant cope with the pain comes along with making major life changes.

In the Community Reinforcement Approach it DOESNT talk about this type of situation, but it does emphasize how negative consequences paired with positive incentives create the best atmosphere for change to occur. I think this may be why many of these programs work. People with addiction often feel very horrible about themselves, society often views addiction as a failure of the person, something coming from weak willpower, or other negative personal characteristics. How can you not feel bad about yourself when these are the thoughts going through your mind? So when they are shown respect, and offered positive solutions I think it often motivates a change. I guess I would ask if they offer medications, counseling, and other support services? If they did then I can see how a transition could come about gradually and it would be reducing the harmful effects prior to this.

One problem I think is the views held in the United States have developed over decades of misinformation and its ingrained into societies ideas now. With relapse you see clearly the idea of abstinence only. One slip up and tough love kicks in, and the idea of enabling, and rock bottom arise because obviously the person didnt want recovery bad enough and needs harsher consequences. The idea of their being a place they could go to use without consequences of being arrested, would require a totally different understanding of addiction. .

There are arguments on both sides.
I don't think it's enabling.

Generally these are folks who would be using anyway - this way they use clean needles etc.

A recovery programme is no good to you if you're dead - I think it's hoped some of these folks will find their way eventually into recovery thanks to these kinds of rooms.

D

I think these are valid approaches, but I have to admit I would be uncomfortable having one near my home, mostly because of my little boy. But having said that .. I also wouldn't want many things near him including sober houses, etc.

I posted an article a long time back similar to this by Dr Gabor Mate... its on this forum somewhere.. Kindness beats tough love I think was the title given by the author. His studies showed it helped too; in Canada I think it was.

Harm reduction is one small part of the whole and does have its place somewhere.

In the age of HIV/HEPC offering clean needles/needle exchanges to help stop the spread seems normal. This wasn’t put into place to stop one from using and it wasn’t going to make anyone use. Couldn’t it even be said that this might have had some positive impact on the families of addicts and on the public in general.

Wet houses which we do have in the states, also were not put into place to stop anyone from using. But wet houses have also shown that while some have reduced intake, most have not. Occupants of these homes are still dying and it is rare if one stops drinking, but a few have so … I think the same result would be found with any safe using site for heroin addicts or with a heroin dispensary if it was set up the same way, to provide support medically and mentally.

These are societal and economic based harm reduction programs.

When talking NJ and the availability of Narcan. This is a whole different issue and a man made one at that. Once the formula changed for oxy to make it harder to abuse heroin use rose 300 percent across the board fairly quickly and is still rising and will continue to rise as the classifications change on a pharmaceutical level for other pills in the class.

I still wonder did anyone really think the change would stop a person from using.

Five years ago most pills were still dispensed in doctor’s offices fairly freely and readily available on the streets. And 10 years ago even more so and frankly no one was really caring about how many addicts were od-ing in the Camden area then with heroin. Oxy was already killing a lot of kids then, but not to any degree that the heroin is now. Narcan in NJ now is a reaction to the new state created from the oxy change/pill regulations and because of the more prominent areas seeing a huge rise in overdoses and deaths from those overdoses. No one wants to talk about how many were already pill users or addicts in general before. While it seems a bit weird in this day and age not to have narcan in all ambulances from the get go and yes some areas didn’t. I don’t find it bad for it to be in police cars but I don’t know how I feel about it being in homes. Now the price spike … well is that normal commerce, high demand meaning higher prices? Or could it be a greed thing, preying on the fear of?

My husband is a recovering heroin addict. Would I keep narcan in my home if he went back out, no. I’ve thought about this and even if I hung around a bit to watch I know 100 percent I cannot save him. I cannot give him any will to live. He must want to live because he just does. He knows the risks of using heroin. He also is well aware of the benefits of not using heroin. I can’t even imagine anyone not knowing heroin’s truth. Heroin has always proved it can and does take the lives of those who venture in.

The eliminating stigma comments maybe over time publically views will change more, but in an addicts head that stigma is much harder to address no matter how well the person is so called treated.

That paragraph just shocked me. I assume if he relapsed and overdosed you would (hopefully) call the police/ambulance and hope he makes it, but you wouldn't keep narcan in the house that could save him in the worst case scenario? I really, write this with full respect, but i simply cannot understand it. Like it's his own fault, so i'm not gonna help him? that seems very cruel to me. I kind of understand the not enabling, but risking someone's life just to not enable him? I cannot understand that.

Again, i don't mean that in an offending way. I just cannot understand it.

No offence taken.

Don’t be shocked. It is ok that I won’t have narcan in my home. And of course I would call if I suspected an overdose with anyone.

I don’t at all play any blame, fault or victim games and this has nothing to do with enabling or punishment. Not sure why you thought that.

I fully understand what it is like to be ran by a drug. I also fully understand what it is like to sit and watch someone breathe all night, repeatedly taking their pulse to make sure they are ok. The full reality of heroin addiction has not escaped me at all. And I can’t give him a will to live. It doesn’t have to make sense to you and trust me when I say you don’t want to have a stroll in my shoes.

What is one realistically going to do if they have narcan? Follow the addict in their lives around 24/7 while they are awake and then not sleep and watch them sleep.