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Heroin and harm reducation

Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

The Overdose Epidemic: Should We Revisit ‘Harm Reduction’?

June 19, 2014 | Addiction | Comments
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Few people in our nation are unaware of our overdose epidemic. In fact, just last month, Hillary Rodham Clinton spoke to 4,500 healthcare stakeholders at the National Council Conference. Top of her mind? The heroin epidemic: “The number of people dying from heroin overdoses is the highest it’s been in at least a decade. In small towns, suburbs, and rural communities all over America, an evolving epidemic of addiction and overdose is claiming new victims — part of a toxic cocktail of economic and social pressures that’s fraying the social fabric and making it harder and harder for too many Americans to live the lives they dream about and deserve.”

This spate has led to increased use of treatments like Naloxone/Narcan to reverse heroin and other drug overdoses and to the consideration of policies that broaden use of these medications. In fact, Clinton announced that the Clinton Health Matters Initiative has, since 2012, worked with a wide swath of partners to expand access to Naloxone to reduce overdose deaths.

With such a high level of attention around Naloxone, it’s not surprising the conversation has broadened to one about “harm reduction,” a phrase that was once banned by the Bush administration because it was considered tantamount to promoting drug use. Now, however, some once verboten policies are being embraced.

Needle exchange programs, for example, now receive funding in many cities to try to curb the spread of HIV and Hepatitis C. These programs provide drug users with sterile equipment, offer an opportunity for brief interventions, treatment referrals, and, in some cases, connect people with mobile methadone vans if they want treatment right away. While some think of methadone (and similar opiate replacement medications) as harm reduction, most medical experts assert these medications are treatments, pure and simple. In any event, the “harm” being reduced is not necessarily drug use, per se, but the adverse consequences to the individual, families, and the public.

Consumption reduction is another example of a harm reduction strategy. For example, instead of drinking to excess every day, someone may want to cut back — and can get support to do so.

Overseas, some European countries have gone further in their efforts to reduce harm. For people addicted to heroin, there are “injecting rooms” for people to use. Even in the United States, where such a policy would be illegal because heroin is illegal, there are similar safe places — at least based on an in-depth article I read on BuzzFeed. One such place is a bathroom at the Corner Project in New York. When their staff realized people were injecting heroin in the bathroom, they didn’t shut it down — they tried to make it safe. They listed group meetings on a chalkboard, hung posters for good vein maintenance, and provided a hazardous waste disposal box for used needles. People have overdosed in that bathroom, and staff members have reversed the overdoses with Naloxone — saving at least 30 lives since 2009.

There is no agreement on the concept of harm reduction. Some treatment providers believe abstinence is the only safe route to recovery. Others see harm reduction as a step forward to mitigate personal, legal, medical, and societal problems.

I’m curious what providers, advocates, and people in recovery from alcohol and other drug additions think about “harm reduction” approaches. Is it a tool that we should support? Does harm reduction encourage greater drug use? Share your thoughts with me?