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Harm Reduction: Where Do You Stand?

Harm Reduction

Harm Reduction: Where Do You Stand?

Now that the Federal Government has thrown its support behind Harm Reduction, it’s time we find out all that such programs entail, as well as just what they may mean — to everyone. It also might be a good time to find out just where you stand on the issue. Because Harm Reduction comes loaded with controversy, no matter how innocuous the phrase may sound.

Indeed there are even folks in recovery who believe Harm Reduction Programs amount to nothing more than coddling the addict. Granted, they’re a small minority. Nevertheless, they’re there. And if people in recovery are against such programs, just imagine what those outside recovery think about the issue.

But should Harm Reduction even be an issue? That’s the $64 million question.

Numbers Don’t Lie

The bad news is that overdose deaths rose by nearly 30 percent over the 12-month period that ended in October 2020. That’s right. Nearly 30%. What does that equal? Almost 92,000. That’s 92,000 Americans who won’t be enjoying this summer. And 92,000 American families who quite likely won’t be enjoying their summer either.

The good news is that the Biden-Harris Administration has seen the numbers and are taking appropriate steps to address them. In fact, Team Biden-Harris is set to do more than any other Administration in history. That’s how a White House Press Release plays out anyway.

“The President’s Budget increases funding for preventing and treating substance use disorders,” said Regina LaBelle, Acting Director of National Drug Control Policy. And it does so “at a time when we must urgently implement evidence-based policy priorities and deploy historic amounts of resources to curb the overdose epidemic. [Furthermore] this Budget shows the Biden-Harris Administration’s firm commitment to ensuring that the Federal government promotes evidence-based public health and public safety approaches, while also addressing the racial inequities in our Nation’s drug policies, from treatment to enforcement.”

And how. The President’s FY2022 $41.0 billion national drug program investment is a $669.9 million increase over last year. The largest increases are for critical public health interventions like treatment and prevention services, including a historically high 57.3% for demand reduction programs. Broken down, that adds up to $30 million specifically set aside for Harm Reduction.

This is all part of the Biden-Harris Administration’s Drug Policy Priorities for Year One, which highlights:

  • expanding access to evidence-based treatment
  • advancing racial equity issues in our approach to drug policy
  • enhancing evidence-based harm reduction efforts
  • supporting evidence-based prevention efforts to reduce youth substance use
  • reducing the supply of illicit substances
  • advancing recovery-ready workplaces and expanding the addiction workforce
  • expanding access to recovery support services
  • Ramping Up Harm Reduction

    Now $30 million might not sound like a lot of money. In fact, it’s a rather modest amount. A point that the New York Times’ Abby Goodnough is careful to make. Yet the Grey Lady’s Deputy {Policy Editor is also careful to note that this is $30 million more than ever before. That makes it “a victory for the programs, both symbolically and practically, as they often run on shoestring budgets.”

    Vital Strategies’ Director of Drug Use Initiatives Daliah Heller seconds that emotion.

    “It’s an enormous signal, recognizing that not everybody who uses drugs is ready for treatment,” said the CUNY-connected global public health organization operative. “Harm reduction programs say, ‘OK, you’re using drugs. How can we help you stay safe and healthy and alive first and foremost?'”

    Therein lies the rub. Not every drug user is at the endstage in their addiction. Whether that’s because they’ve yet to hit rock bottom or simply haven’t wisened up doesn’t matter. They’re just not ready to get clean. And no amount of pushing or shoving or pleading or threatening will make them ready either. So you can send them away and hope they’re able to stay alive till the time is right, or you can help keep them safe until they’re ready to get clean. After all, you can’t treat a dead person right? And harsh as it sounds, that’s the grim reality. Today’s addicts are far more likely to die while they’re out there ripping and running. Harm reduction simply endeavors to make sure they don’t rip and run themselves straight into the grave.

    Perhaps it’ll be more palatable if we consider harm reduction to be the equivalent of a car’s safety features. The seat belts and airbags that help mitigate a crash, as well as the horn, lights, mirrors and turn signals which prevent an accident from ever happening in the first place. Surely you wouldn’t want to get rid of any of those assets, would you?

    Enabling on Steroids

    Unfortunately a lot of folks don’t quite see it quite that way. A whole lot of folks. Important folks too. Those who pass the laws and control the public purse strings. A syringe is not a car horn, they say. And Narcan is not the same thing as an airbag. More importantly, say the naysayers, drug use is illegal. Driving is not.

    Heck, some folks consider Harm Reduction to be more akin to steroid-strength enabling. Take Scott County (Indiana) Commissioner Mike Jones for instance, who had some choice words for Goodnough.

    “I know people who are alcoholics, and I don’t buy them a bottle of whiskey,” he said. “And I know people who want to kill themselves, and I don’t buy them a bullet for their gun.”

    Fair enough. But since you know so many people, then surely you know someone who became addicted to opioids after an injury and were forced to turn to heroin once the doctors cut ’em off. Sports, perhaps? A car crash? Wouldn’t you want these people to know whether or not they’re about to take a lethal dose of fentanyl?

    Of course you would. Jones’s position might be excused if he wasn’t armed with all the facts. But Scott County had a syringe exchange program that helped curb a major HIV outbreak back in 2015. Yet Jones and the Commission still voted to shut it down. Really.

    Jones said “that he feared the syringes it distributed could be contributing to overdose deaths.” We say, not so fast. Naloxone is provided with those syringes. So those syringe-exchanging folks are likely to have the overdose-reversing drug on hand. Something that wouldn’t be possible without public Harm Reduction programs.

    And yet. “West Virginia just passed a law making it far more difficult for syringe service programs to operate,” writes Goodnough, “even though it is seeing a surge in HIV cases driven by intravenous drug use. [And] North Carolina’s legislature weighed a similar proposal this spring.”

    It doesn’t seem to make much sense.

    Hens Running the Henhouse

    Another criticism calls out the folks on the front lines. Some people apparently believe that having the hens run the henhouse means nothing but hen parties all night long. Not so. Granted “many harm reduction programs are run by people who have used drugs in the past or still sometimes do.” Goodnough even points that out. She also notes that those folks’ “own struggles with addiction, mental illness or other health issues also flared up during the pandemic.” Worse (and tragically), “in Baltimore, Boston, New York, Washington and elsewhere, beloved leaders of the [harm reduction] movement have themselves died from overdoses, chronic health problems and other causes over the last year, their deaths leaving holes in efforts to keep providing services.”

    Those losses in no way mean people were partying away their days though. They also don’t mean that having access to syringes contributed to the deaths. If anything, they mean just the opposite. Almost every Harm Reduction Program was closed during Covid. And those that did manage to stay even slightly open were limited to the occasional pick up or drop off. All of the other support programs were shut tight as a drum. Consequently those frontline folks were without their own usual support network, just like everybody else. So it only makes sense that their overdose numbers would also rise during Covid. Sad and tragic sense perhaps, but sense nevertheless.

    Louise Vincent was one of those frontline workers who was driven back out during Covid. Vincent is Executive Director of the North Carolina Survivors Union, a Harm Reduction Center in Greensboro. That of course didn’t make her immune to the pandemic’s severe isolation, nor the utter absence of support. If anything, Vincent’s active engaging may have even made her more vulnerable.

    Whatever the case, Vincent found herself “anxious to stave off withdrawal after trying unsuccessfully to switch from methadone to buprenorphine.” But in so doing she got a hot shot. A real hot shot. In fact, “she later learned that the small amount of fentanyl she used was mixed with xylazine,” the latest and deadliest cut of choice among dastardly dealers. Vincent “landed in the hospital, her hemoglobin level so low she needed a blood transfusion.”

    We recently sounded the alarm about xylazine. It’s nasty stuff. Used by even nastier people. And it can easily kill you. It doesn’t respond to Narcan either. Wouldn’t you want people to know if their drugs were mixed with such poison?

    Harm Reduction: Do We? or Don’t We?

    Healing Properties most definitely would want folks to know if their drugs have been poisoned. So yes, we want them to have ready access to test strips; just as we want them to have ready access to clean needles and naloxone. We’re also behind an environment that provides mental health therapy, as well as open pathways to addiction treatment and sober support, in any and every capacity. Would we rather folks go straight for abstinence? You bet. But we’d also rather they be alive. Like Daliah Heller says, not everyone is ready for treatment. So why not keep them safe until they are?

    Why not indeed. And Harm Reduction Programs seem to be the best way to do just that. If you’re seeking harm reduction services, reach out to the National Urban Survivor’s Union (or its North Carolina chapter). You may also want to try SAMSHA or NIDA. If you’re seeking addiction treatment or a sober facility, then please give us a ring. We’d be honored to get you properly sorted out. Really.

    (Image: Harm Reduction)

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