How Harm Reduction Is Saving Lives

I'll never forget meeting Mary outside of a talk I was giving in Ohio, a state that is at the eye of the storm when it comes to the opiate overdose epidemic. She came up to me afterward and asked me my opinion regarding Suboxone. From the look on her face, I could tell that something was bothering her deeply. It was then that she shared what she had been going through, that she had had three sons but had lost two of them to opiates. The third, her youngest, was now taking Suboxone. This wasn’t her problem, however. Some of Mary’s close friends and family had been repeatedly telling her that her son should stop taking the medication because it's just replacing one addiction for another substance and that he isn't really sober. I asked her how he liked being on Suboxone, “While he wants to get off of it eventually, it’s keeping him from cravings for heroin right now and giving him space to get help.”

And this is what harm reduction is all about — minimizing harm, reducing the negative impact addiction has over someone’s life, and keeping people alive long enough for them to get help. Mary had already lost two of her sons to addiction. While Suboxone may be controversial in that it is a substance, it is also keeping Mary’s son alive, something that traditional, abstinence-free rehabilitation programs have a hard time with.

"This is about saving lives. We know people take drugs. We don’t have to condone it but nor should we judge people or bury our heads in the sand. It’s our job to do whatever we can to help people make informed choices about the risks they’re taking.”—Roz Gittins, Addaction's Director of Pharmacy

Harm reduction is all about minimizing the harm, or impact addiction has on someone’s life, rather than punishing them or forcing them into a treatment that may or may not work.

Why is harm reduction important for recovery?

Apart from what I mentioned above, there are many roads that lead to addiction—Adverse Childhood Experiences, environmental factors, biology, etc.—and there are also many roads to recovery. No one arrives at addiction in the exact same way, which is why a one-size-fits-all approach doesn't work and why I advocate for more individualized paths to recovery. But what happens when society doesn't support any path to recovery besides the Abstinence Only approach?

Let’s look at the facts. Drug overdose death rates in the U.S. are 3.5 times higher on average when compared to 17 other Western countries. What does this tell us? People with drug addictions are dying, and you can't help someone recover who's dead. So we need to do more to help people access treatment and feel confident in how they are treated.

We wouldn't criminalize a diabetes patient for eating a doughnut, so why do we chastise those who choose medically assisted recovery options even though they've been proven to help?

It's time we stop viewing addiction as a moral wrong and instead treat those struggling with addiction or mental health issues with the compassion they deserve. Life is hard enough as it is, but it's especially harder for those who have had traumatic upbringings or who may be genetically predisposed.

Data from the U.S. and around the world suggest that treating problematic drug use as a health issue, instead of a criminal one, is a more successful model for keeping communities healthy and safe.

There are already so many barriers to recovery. Let's make sure local and national policy don't drive a wedge even further in between the haves and the have nots.

Let's educate ourselves on the systemic barriers that may also be working against those seeking help and be more open-minded to the harm-reduction initiatives that are minimizing the impact addiction has at an individual, family and community level.

What harm reduction principles are actually working?

1. Medically-assisted treatment

Medication-Assisted Treatment (MAT) is the use of medications (FDA approved) to treat substance use disorders in combination with counseling and other psychological therapies. The aim is to provide a holistic approach to drug and alcohol addictions. MATs are most often used for treating addictions to opioids and alcohol.

In opioid treatment, the three most commonly used MATs are methadone, naltrexone, and buprenorphine. Alcohol use disorders can be treated with Disulfiram, Acamprosate, Baclofen, or Naltrexone. None of these drugs provide a cure for the disorder, but they are most effective in people who participate in a MAT program.

How does it work?

MAT is commonly believed to work through a drug substitution pathway - replacing one addictive drug with another. However, what these medications actually do is relieve the withdrawal symptoms and cravings experienced by people with a substance use disorder. In fact, naltrexone doesn't provide any high whatsoever.

Not only are MATs regulated, controlled, and administered in a safe environment but they help people overcome their addiction by removing associated risk issues such as access, overdose, and social and occupational consequences. MATs help restore the chemical imbalances in the brain that is caused by addiction which allows the person’s brain to adjust, with time, to reduced doses and a new way of living. MAT helps people lead a relatively normal life while on the path to recovery. Not only that, but it increases social functioning and helps people remain engaged in psychological therapies with more success than people who are not receiving medically assisted treatment.

"Studies have shown that outcomes are much better when you are on medication-assisted therapy. For one, it decreases risk of relapse — significantly. Second, MAT has also been shown to be effective in preventing infectious diseases like HIV. Third, medication-assisted therapy has been shown to be effective in preventing overdoses,” Dr. Nora Volkow, the director of the National Institute on Drug Abuse.

One research study has found that deaths from opioid overdoses significantly declined as treatment with buprenorphine became more popular in recovery programs in Baltimore. Heroin overdoses reportedly dropped by more than a third during the study period.

In pregnant women with an opioid use disorder (OUD), women on MATs (methadone or buprenorphine) had better outcomes for their babies (reduced symptoms of neonatal abstinence syndrome and reduced stay in hospital) than women with an OUD who were not on medication treatment.

2. Needle + Syringe Programmes (NSPs)

Needle and Syringe Programmes (NSPs) are a type of harm reduction initiative that provides clean needles and syringes to people who inject drugs.

Policies that support access to clean needles and syringes allow for the legal sale of needles without prescriptions and include programs to distribute clean needles and safely dispose of used needles. The policies that authorize the legal sale and exchange of clean needles and syringes are usually enacted at the state level. Sixteen states have passed laws authorizing needle and syringe exchanges.

NSPs help overcome barriers to prescriptions and legal restrictions around needle possession and distribution so that people can access clean needles and syringes. The purpose of these policies is to reduce the transmission of blood-borne pathogens, including HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV).

How does it work?

Last year there were more than 150 countries where people were reported to be using drugs intravenously. However, only 86 of these countries have NSP programs. Unfortunately, in the past couple of years, some countries (such as Bulgaria, the Philippines, and Laos) have shut down NSP programs in favor of more tough disciplinary responses to drug use.

That's despite the fact that NSPs have been associated with decreased rates of HIV and HCV.

In New York, longitudinal studies examining the effects of the legalized syringe exchange program from 1990 to 2002 found HIV rates had decreased from fifty percent down to 17 percent.

In the District of Columbia, a syringe exchange program was introduced in 2016 and has since shown a 70 percent decrease in new cases of HIV among intravenous drug users.

On a side note, did you know that the lifetime cost of HIV treatment is more than $370,000 per person? That’s a huge impact on the health sector, so it’s important to consider the evidence of NSPs in reducing rates and therefore reducing the economic impact on public health. In other words, international research shows that NSPs make drug-taking safer and minimize the risk of contracting serious illnesses. NSPs are not only a social investment in protecting lives but a significant economic investment that we cannot ignore.

3. Decriminalization of drugs offenses

There are more than 1.6 million people arrested for drug-related offenses in the United States every year. A majority of those arrests are for possession only. The criminal justice system produces deep ethical inequalities for this reason. While African-Americans use drugs at similar rates to other racial groups, they account for 13% of the U.S. population but they make up 35% of those incarcerated for drug possession.

The economic burden of having people in jail is enormous, but if we offer reprieve to those in jail due to drug offenses by offering them help instead of punishment- then we could drastically reduce the rates of people incarcerated on minor drug-related offences.

Decriminalization of drug offences, which means removing criminal penalties for drug possession, means that people will not get arrested or go to prison for possessing small quantities of drugs for personal use.

As detailed in a new Drug Policy Alliance report, there’s an emerging public, political, and scientific consensus that otherwise-law-abiding people should not be arrested, let alone locked in cages, simply for using or possessing a drug.

By removing criminal penalties for drug possession and low-level sales we would:

• Save money by reducing prison and especially jail costs and population size
• Free up law enforcement resources to be used in more appropriate ways
• Prioritize health and safety over punishment for people who use drugs
• Reduce the stigma associated with drug use so that problematic drug users are encouraged to come out of the shadows and seek treatment and other support
• Remove barriers to evidence-based harm reduction practices such as drug checking, heroin-assisted treatment, and medical marijuana

How does it work?

Around thirty years ago, one in every 100 Portuguese had a heroin addiction. The rate of HIV infection sky-rocketed and was the highest in the European Union at that time. In the late 80s, early 90s- one in every 100 Portuguese was battling a problematic heroin addiction, but the number was even higher in the south. The rate of HIV infection in Portugal became the highest in the European Union.

But everything changed when Portugal changed their mindset on how they approached addiction. In 2001, it became the first country to decriminalize drug use. Rather than arresting and punishing people who were caught with a small personal supply, they were given a fine or told to seek treatment. What was the result? Rates of addiction infectious disease (HIV, hepatitis) rates dropped dramatically by 2015. That’s quite the impact in just four years!

Not only that, but Portugal’s drug use rates now sit well below the European average and much lower than in the United States. Research into the initiative also showed:

• The number of people who accessed drug treatment programs increased by 60% between 1998 and 2011.
• Drug overdose fatalities dropped by more than 80%
• The rates of drug-related arrests dropped by 60%
• The rate of people incarcerated in Portugal for drug-related violations also decreased

Sounds too good to be true?

It isn't...

Why did it work? Portugal's decriminalization reduced stigma and shame around addiction, its humanized people from ‘drug addicts’ to people who use drugs. It focused the attention on the relationship with drugs, not so much on the person using the drugs. When we can pull apart the difference, then we can be more compassionate rather than contemptuous toward people who need help.

4. Harm reduction-informed psychotherapy

Harm reduction counselors employ nonjudgmental, directive techniques (such as motivational interviewing, cognitive-behavior therapy, dialectical behavior therapy, etc.) to allow the person with a substance use disorder to explore their own individual change process. In harm reduction therapy, any step in the right direction is supported and celebrated. By celebrating success and not shaming clients around slip-ups, this approach allows the person to move toward recovery on their own terms

How does it work?

In traditional, abstinence-based therapies it is considered a failure if a person has five drinks in one evening. However, if that same person used to drink ten drinks every day, harm reduction therapists would consider this a success, celebrating the improvement.

Although abstinence may be the end goal, the harm reduction counselor accepts where the client is at and is respectful of where the client is at in life. The counselor also works with the client to set realistic goals, identify triggers and alternative behaviors, and provides relapse prevention education. Not only that, but harm reduction counselors can support people struggling with addiction to address the underlying issues behind the addiction as well as address related social issues such as housing, work, and relationships.

There is substantial evidence to support the effectiveness of harm reduction therapy for people with a range of alcohol and substance addictions.

Become a harm reduction advocate!

Are you a harm reduction expert?

Are you struggling with mental health issues/addiction?

Give us your feedback.

If you were running for office, what harm reduction tactics would you add to this list? What is your community missing? What could your community do better?

What can be done? We can become advocates for harm reduction policies that actually work. We can call our senators and our representatives and demand that they enact harm reduction policies. We can start local meet-ups that educate the public on the facts in this article. We can campaign for leaders that uphold harm reduction policies. We can follow Harm Reduction advocates.

As we head into the election madness, let's make sure we are electing local and national leaders that make decisions based on factual evidence, and who have the best interest of all of us, not just those who were born into privilege.