Comments on
Harm Reduction or Mixed Messages?


addiction treatmentReady 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,

10 thoughts on “Harm Reduction or Mixed Messages?

  • May 16, 2011 at 1:23 am

    Harm reduction is a relatively new concept for me and the first time I heard the term was in reference to relaxing laws on marijuana use as well as lowering the legal drinking age.

    Thank you for bringing this topic to light. I would like to see evidence concerning whether this application of harm reduction has been helpful or detrimental to other countries that have implemented it.

    The area that I am having the most difficulty with is the provision of safe locations to shoot up. Even if we spent taxes on them, would these locations be used by addicts? Would such locations not become permanently surveilled by police? If so, the addicts would surely avoid them.

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  • May 16, 2011 at 10:19 am

    I came to harm reduction a bit slowly, since the extreme edge of the movement seems to be saying: If you have one less (shot, pill, snort, toke) today than you had yesterday, you’re a winner, and an icon of harm reduction. Plus there is always a dynamic tension over abstinence. Harm reductionists dislike sobriety as a goal, because they believe it discourages people from even making an attempt at using less. I think what gets missed in these arguments is the return of the Holy Grail–controlled drinking and drugging. Harm reduction holds out that promise to addicts–a false promise, in most cases of serious addiction.

    Politically, socially, I’m completely down with harm reduction as a way of moving from law enforcement to treatment. But I think harm reductionists are conflating heavy drinking with alcoholism, which confuses things.

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  • May 16, 2011 at 12:07 pm

    It seems to me that although supplying safe needles, etc., to addicts sounds like an expense taxpayers shouldn’t have to foot, in the long run it would probably decrease public expenditures. The cost of treating cellulitis, endocarditis, embolic vascular disease, HIV, hepatitis, etc., far exceeds the likely cost of preventative programs. So pragmatically, the strategy makes sense.

    As someone who went through a period of opioid dependence due to Oxycontin prescriptions for chronic pain, I do not believe a life of addiction to be a full life. So I think we would be selling addicts short if we accepted harm reduction as the highest goal. But as an intermediate step, and one which might expose sufferers to other resources and role models, it could be very valuable.

    The problem with addiction treatment in this country is that moralizing is always a part of it. It seems very difficult for our culture to simply look at a problem and consider its sensible management without moral judgments. A striking example is the failure of anti-abortion activists to embrace the promotion of birth control practices, which would surely be the most effective way to reduce abortion rates. Instead they demand unrealistic behavioral purity, according to their own standards, and so undermine their goal of preventing terminated pregnancies.

    Addiction is a big, big problem that needs to be combatted on several levels. Some people are only ready for harm reduction. Others might be open to Suboxone. Others might be ready to completely quit. We have to meet people where they are, and not demand what is currently impossible for them. This is the best way to serve addicts, and society.

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  • May 19, 2011 at 5:05 am

    Some addicts are too dumb and don’t want to take the time to use a micron filter with balist water and inject X amount of drug into a clean vial. some do. I do think if there where education before you could get your gear , then the addict would take the time for prepping (especially pills with all these waxy new fillers- i think they(these centers) should teach proper injection so addicts wont eventually be shooting in the neck due to collapsed veins. i believe in harm reduction and education-then over time the addict can see how they are bloody playing with fire and some will go to bupe OR methadone and get of this injection of pill kick-remember;this is an epidemic and with the old OC form gone…addicts think they are chemist LOL (really sad) EDUCATION, EDUCATION,EDUCATION

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  • May 19, 2011 at 5:28 am

    i think there should be stations that provide needles, water, vials, injection techniques,nurse?, BUT only after EDUCATION- the addict needs to know exactly the harm that could arise. i asked someone (shooter) other day if he new what talc was. he said “why?”. i said what about bacteria infections? same reply,”why” I think too many addicts play ‘chemist’ or think EVERYTHING can be made into an aqueous solution and they don’t think OR KNOW about the consequences. scared me strait to bupe

    remember: NOBODY started shooting into their veins. someone taught them. that’s what they(addict) know. then they adopt their own little ritual(technique)-generizing
    usually youger generation have poorer technique, because they think they are immortal.
    OC was a relatively easy drug for the younger generation to learn with and now they need to be re-taught.some are going to do it anyway. we probably are saving money and lives in the scheme of things. especially peoples health! drop in HIV, hep C etc.

    I think the UK is far ahead of us on this one especially with their liberal stance. JMO

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  • May 19, 2011 at 1:36 pm

    “A decade or so ago, a new approach to addiction treatment was developed under the general heading of ‘harm reduction.’”

    Actually, most scholars agree that harm reduction originated in Britain as a result of recommendations of the Rolleston Committee of the 1920s.

    However, our species (and a few others) has been consuming psychoactive substances since pre-history, so it is a safe bet that we have been trying to reduce the harms from this practice for about as long.

    “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.”

    Close. “Harm reduction is any program or policy designed to reduce drug-related harm without requiring the cessation of drug use.”

    Most psychoactive drug use is non-problematic and most consumers are not addicted. Harm reduction is not just applicable to addicts and addictive drugs.

    Despite anecdotal evidence from room mates, there is no evidence that syringe exchange programs promote or perpetuate drug use. On the contrary,
    syringe exchange and supervised injection promote intake into rehab and treatment and raise community awareness of drug-related harm.

    “After reviewing all of the research to date, the senior scientists of the Department and I have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs, as part of a comprehensive HIV prevention strategy, are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs.” – US Surgeon General Dr. David Satcher, Department of Health and Human Services, “Evidence-Based Findings on the Efficacy of Syringe Exchange Programs: An Analysis from the Assistant Secretary for Health and Surgeon General of the Scientific Research Completed Since April 1998,” (Washington, DC: Dept. of Health and Human Services, 2000), p. 11.
    http://home.mchsi.com/~apclc/8fedstudies2.pdf

    The science supporting supervised injection sites is also quite robust. Indeed, the Supreme Court of Canada is currently reviewing the peer-reviewed research, has found it sound and observed that
    critics of the site were unable to submit any
    evidence to suggest that Vancouver’s SIS, Insite, is not achieving its goals or causing any of the problems they predicted.

    http://www.communityinsite.ca/science.html

    Heroin maintenance programs have also yielded very positive results.

    http://www.drugwarfacts.org/cms/Heroin_Maintenance

    “Should we provide clean syringes and needles for drug addicts at taxpayer expense?”

    It turns out that doing so reduces downstream health and social costs, such that every tax dollar invested in harm reduction saves several.

    The opposite it true of drug law enforcement, where the lion’s share of our drug control budgets are allocated. Every tax dollar invested in drug law enforcement results in more crime, violence and drug-related social costs.

    http://www.rand.org/pubs/research_briefs/RB6007/index1.html

    Reply
    • May 31, 2011 at 12:32 am

      I am aware of the data that supports your position– and glad that you took the time to provide the ‘other side’. I’ll repeat the point suggested in the title of this post– that such programs offer mixed messages, the influence of which will never be accounted for without conscious and unconscious embellishment of the ‘science’, depending on who is supporting the study.

      There are many similar arguments among those who combine science with policy decisions. Giving condoms to 13-year-olds probably prevents a few pregnancies– but is surely confusing for the kid who still believes in storks. By the way, I don’t take a position on THAT issue either– other than to say that like the needle issue, it is a lot more complicated than what can be determined by a scientific study or three, whether or not deemed adequate by the Canadian Supreme Court. And for that matter, many US citizens would not see the opinion of the US Surgeon General– whether the political appointee of this or the past administration– as the best place to find unbiased information!

      Thanks for your comments.

      Reply
  • May 31, 2011 at 8:33 pm

    Thank you for your thoughtful, if somewhat condescending response Dr. Junig.

    There have actually been 40+ peer-reviewed papers on InSite, looking at both the positive and potentially negative effects, including the quite understandable and anticipated concern that it sends “mixed messages” and might encourage or perpetuate drug use.

    The quotation I shared supporting syringe exchange was just an example.

    I agree that scientific evidence, including peer-reviewed papers published in reputable medical journals, can be skewed, biased and spun, however, in the case of harm reduction, you can be sure that the evidence has been very skeptically critiqued and independently reviewed, for reasons I am sure you understand. This is especially so of InSite.

    For example, the RCMP commissioned not one but four studies with the intent of proving that InSite causes more harm than it prevents. Only one came to the conclusions they sought. It was not peer-reviewed and was “published” on a website operated by the Drug Free America Foundation. The RCMP have since conceded that the “paper” did not meet conventional academic standards.

    Similarly, the Canadian government, who are opposed to InSite, commissioned an expert advisory panel to review and find fault with the evidence, and they too did not reach the conclusions the government sought.

    With all due respect, providing condoms to youngsters who lack any sex education or experience is not analogous to providing clean syringes and supervision to established or addicted injection drug users.

    Thanks for raising the topic and remaining both skeptical and open-minded.

    Reply
    • June 1, 2011 at 10:56 am

      Thank you for your reply– and I apologize for the tone. I wear several hats, and it can be hard to shift out of ‘smart-a** mode’ some days. You and I would likely find much more to agree on than to disagree.

      You are clearly passionate and educated about this issue– I assume you have a role, somewhere, in shaping drug policy? If not, you should–

      Reply
  • August 10, 2011 at 3:26 am

    To me it’s unfathomable that anyone is more worried about sending a message than they are about saving people’s lives. I understand the assumption that sending these messages will cause people to do things they wouldn’t otherwise do because they now think it’s okay but there is nothing to support that assumption and based on what we know about human behavior it makes little sense.

    Clearly we don’t want anyone to inject illegal drugs but fact is that they do and preventing access to safe ways to do so is not going to stop it or even decrease it. Your roommate is the exception to the rule.
    I was an IVDU for 9 years and during that time I lived in two different cities. The first one did not subscribe to any kind of harm reduction. If you wanted to buy rigs you had to buy them for a buck a piece on the street whenever someone had some. As a result I used mine for weeks to the point where the needle was dull and the plunger was dry. I used to lubricate the plunger with my chapstick, probably shooting some of the stuff into my veins which can’t possibly be good. My arms were often bruised from jamming in that dull needle and since it was old and dirty I got several infections. On one occasion I got an infection in my hand so bad that I had to be admitted to the hospital.
    I rarely sought help for my infections because I knew that they medical staff would treat me like crap and often I was just too busy raising money to score my next fix.
    I didn’t have access to sterile water and sometimes no water at all so I used rain water or melted snow at times. I’m sure this also added to the infections.
    For the most part I could get my old, well used rigs to work but on a few occasions when I hadn’t seen the rig-guy around for a while they got so old that the needle broke off or became blocked. On those occasions I actually ended up borrowing someone else’s rigs and contracted Hep-C in the process. I’m just plain lucky that I didn’t get HIV.

    In the second city I lived in during my junkie career, Chicago, there was good harm reduction programs available. There is one mobile needle exchange that goes around the city ran by a non-profit organization and another regular needle exchange ran by the University of Chicago. The latter offered other services in addition to the needle exchange like medical services, education, help with getting into treatment and just a nice place to hang around and people to talk to. Having access to these places really improved my life. I didn’t have anywhere near the infections and crap I used to and on the couple of occasions I had abscesses I got help right away from the people at the needle exchange where I was going anyway.
    I always had clean, sterile water in the little bottles that were handed out at the needle exchange and never had to shoot snow. I had clean cotton balls. I was given condoms so not using that was never an issue.
    I was always in contact with social workers and medical staff which were people I never saw living in the first city. A lot of people got help with a number of different situations by the social workers at the needle exchange. And if someone was wanting to get into treatment they would be right there to help you.

    Needle exchanges do much more than just handing out needles and they are essential in keeping addicts healthy and stopping the spread of HIV and Hep-C. I’ve been clean for seven years now and I have a future. Had I contracted HIV while I was using that may not be the case. Why someone would want to prevent people like me from getting these services just so that they can send a message that they are not condoning what I’m doing is beyond me. I know society don’t condone it. I know it’s bad. I know it’s dangerous. You don’t have to send that message to the point where it kills me. Is it really that important?

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