Harm Reduction or Mixed Messages?
Ready for a little controversy? A decade or so ago, a new approach to addiction treatment was developed under the general heading of ‘harm reduction.’ Proponents of the approach realized that many addicts will never achieve total sobriety from all intoxicating substances, efforts were best focused on reducing the most harmful consequences of addiction—drunk driving, overdose deaths, and the use of the most addictive substances.
Treatment centers focused on the use of opioids, and reduced emphasis on marijuana. Other harm reduction approaches include clean needle exchanges, and some proponents have even argued for the development of ‘shooting galleries’ where addicts can use heroin in a ‘safe’ environment.
Last week an article in Drug and Alcohol Review suggested that syringes be required to contain micron filters. Some medications, including Suboxone and the ADHD stimulant Adderall, contain significant amounts of talc. When the medications are dissolved and injected, the talc causes significant damage to the lungs by clogging the capillary beds that would otherwise be available to absorb oxygen and release carbon dioxide at the lungs. The filters would add considerable costs to the manufacturing process for syringes, but would prevent a significant cause of morbidity for intravenous drug addicts.
As I read more about the issue, I came across a couple internet companies that produce the filters and other harm reduction devices. To harm reduction proponents, America is behind the curve; Heroin is not only stocked in European pharmacies; it is administered to opioid addicts to reduce illicit use of opioids, similar to the use of methadone here. National boundaries lose some of their power in the internet era; the owner of one of the companies that sells syringe filters assured me that they ship to the US, although ever now and then a package is intercepted by customs.
I have mixed feelings about needle exchange programs and syringe filters. When I was in treatment ten years ago, my roommate told me that finding needles was often the rate-limiting-step for drug use by him and his girlfriend. They cared about themselves enough to never share needles, and used needles eventually became so dull that the pain of injection was an actual deterrent to shooting. No clean needles meant snorting, not shooting—and snorting is s measure safer than shooting. I realize that he was more careful about needles than many addicts; there are addicts who would strain flies from tap water if the liquid contained opioids! But the filters, too, seem to send mixed messages, at least to the more-naive addicts; never divert and inject an oral medication… but if you do, use this filter system, now an sale for $5.99!
I’m curious what readers think about needle exchange programs, dosing rooms, and other means of harm reduction. Should we provide clean syringes and needles for drug addicts at taxpayer expense? Should the needles incorporate filters to protect people who dissolve and inject Suboxone—at the same time when many patients wait in line to get into a buprenorphine program in order to use the medication properly?
I would also appreciate comments from anyone who is making use of needle exchange or similar programs—and from any readers who are diverting Suboxone. Set up a free, anonymous e-mail account and let me know why you are doing what you are doing—instead of using the medication properly and leaving the using days behind. If you are nervous about leaving an I.P. address on the Psych Central site, send me an e-mail—to firstname.lastname@example.org .
Photo by ZaldyImg, available under a Creative Commons attribution license.
Junig, J. (2011). Harm Reduction or Mixed Messages?. Psych Central. Retrieved on April 19, 2015, from http://blogs.psychcentral.com/epidemic-addiction/2011/05/harm-reduction-or-mixed-messages/