Harm Reduction, What’s The Harm?
Addressing and debunking some of the more common objections to life saving public policy reform.
In 2020, there were over 100,000 drug overdose deaths in the United States, an increase of over 25% than the year before.
The COVID-19 pandemic has without a doubt played a role in this increase. The pandemic decreased in-person supportive services such as 12-step meetings, as well as in-person treatment options. Medication-assisted treatment services were delayed, and in some cases cut off, leaving people to experience withdrawal. Not to mention - the amount of stress and trauma we have all as a society been experiencing. I can honestly say I have heard countless times, “I was sober for a while… until the pandemic hit.”
Forever, naloxone and medication-assisted treatment (such as Vivitrol, Suboxone, Methadone) have been difficult to prescribe, stigmatized, and access varies by community. Read more about each of those medication-assisted treatment types by clicking on them.
We need to stop looking at this as someone else’s issue, or “not my problem.” Our friends, our family - people - are dying. It shouldn’t have to happen to you for it to matter to you.
Before the pandemic, overdose deaths had begun to slightly decrease. There was an increase in access to naloxone and treatment, at least it had increased from years prior. Other than this, I don’t know that things had much improved, or if these were just coincidences. Overdose death numbers are consistently underrepresented and inaccurate. A medical examiner determines the cause of death when a death is a result of unnatural causes. Due to high cost, loved ones attempt to intervene as a result of stigma, and other nuances, many deaths remain listed as unclassified. So again, it is unclear whether things truly began to improve, however it is abundantly clear now that things have worsened and they aren’t going to get better until we make specific and real changes as a society.
Harm reduction is just that, a reduction of harm, and in this case, death. We have seen harm-reduction in many other aspects - condom use to prevent sexually transmitted diseases and unwanted pregnancy, not drinking and driving to prevent accidents and death, heck even wearing a seatbelt can be seen as harm reduction.
Here are some illicit drug specific harm-reduction efforts and a brief explanation of what they are:
Naloxone: Name brand: Narcan: a medication that rapidly reverses the effect of an opioid overdose and prevents death
Fentanyl test strips: Strips used to test drugs to identify if the deadly opioid fentanyl is present in them
Clean syringe access services: Distribute sterile syringes, safer drug supplies, etc. to reduce infectious disease.
Safe/supervised injection sites: Medically supervised facilities designed to provide a safe environment for people to use illicit drugs.
Portugal, though not the first country to make strides in harm reduction, has certainly been an amazing example of the change that can occur.
So, why do we have the pushback against harm reduction that we do?
“Addiction is a choice!”
Okay, there are some people who think that addiction is a choice, so let’s talk about that first.
Initial drug use IS in fact a choice, but addiction is a disease. According to ASAM, American Society of Addiction Medicine, addiction is a treatable, chronic, medical disease. ASAM goes on to state that addiction is a disease of the brain. Now, people can dispute this all they want, but the reality is they are wrong, and this is a fact.
How many of us made a choice to experiment with marijuana, alcohol, or even other drugs recreationally? This is sort of “normal” or at least standard and common. The addiction that can and does follow for some, is not a choice.
Those that think addiction is a choice then proceed to think that death is then a natural consequence of this drug use, and subsequently don’t believe the need for harm-reduction exists. So, let’s call it like it is: what they are saying is those with addiction issues don’t deserve to live.
Okay. Now that we have gotten through that -
“These things are just enabling! We can't let our society just use drugs!”
There’s others that believe that harm-reduction will promote or enable drug use. On the surface I can understand that, but it’s just not the case, and has been proven wrong by other countries that have been seeing it work.
Think of it like this - if your family had the life-saving drug naloxone on hand, and you had access to clean needles - would you just decide to start using heroin if you hadn’t already? Would you take up crack/cocaine use simply because you have somewhere to do it safely, if you were not using previously?
Could it enable drug use? Could it stop folks from entering treatment or otherwise entering sobriety / recovery? Research has shown other countries that have implemented harm-reduction strategies - it does the opposite. Allowing people access to these things in turn preserves life which gives people the opportunity for change and thus possible recovery. Recovery is not always everyone’s goal, and it is not ours to make for others either.
“So what, we should just give people places to shoot drugs?”
I know the idea of “allowing” people a safe place to use drugs seems wild to many. The reality is that the people who would be utilizing a safe/supervised injection site are already using drugs. The safe injection site would provide them access to people who can reverse an overdose should it occur, as well as provide resources and other supportive services, such as treatment access, should they want it.
I know safe/supervised injection sites seem way ahead of our time, but man do they save lives. New York City opened the United States’ first safe injection site in late November 2021. Many other big cities such as San Francisco, Portland, and Seattle all had plans to open safe injection sites previously, but experienced delays as a result of the pandemic. Within less than one week of New York City’s two sites being open, they reversed nine overdoses. That’s nine lives that otherwise would have likely been lost. Read more about NYC’s safe injection site here.
We need harm reduction. The bottom line is harm reduction saves lives and dead people can’t recover. People with addiction deserve to live.