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Harm Reduction Should Aim to Interrupt the Cycle of Abuse

The opioid epidemic is getting worse with no end in sight. With over 107,000 overdoses in 2021 (per the CDC), accidental overdose has become the leading cause of death for people aged 18-45. In response, our nations lawmakers and municipalities are adopting new laws and “harm-reduction” measures to try and stem the tide of overdose deaths.

Some of these measures are controversial, like decriminalizing opioid use and even providing “safe drug spaces”, which are legal injection sites where intravenous drug users can at least be monitored and, in the event of an overdose, possibly revived with Narcan nasal spray.

Discouraging Statistics in New York and Oregon

A recent Washington Post article pointed out the unfortunate fact that “normalizing” opioid use by decriminalizing possession and providing safe drug spaces has led to increased overdose fatalities in New York and Oregon.

The writer, and most of the comments in the article point out the obvious fact that drug use is dangerous and posters about fentanyl in the New York subway seem to encourage people to continue use rather than stop.  One poster reads, “Don’t be ashamed you are using, be empowered that you are using safely.”

To the person who has never experienced addiction, or worked with addicted populations, the message on this poster might seem very counter-productive.  As someone who has almost had my life destroyed by addiction, and spent the last 38 years helping people recover, I can see the purpose that these posters serve.

“Normalizing” Drug Use is Bad, but De-Stigmatizing is Good

This is acomplex public health issue, far from being a ‘black and white’ problem, with obvious answers. As we navigate the grey areas of the opioid epidemic, we need to make it a priority to de-stigmatize drug use.

The stigmatization of having a substance use disorder (SUD) causes people to be ashamed of their drug dependence, and keeps people in the shadows, far from help.  When it comes to the deadly drug fentanyl, this increases the likelihood that the person will die a lonely (and preventable) death, by using alone.

Addiction is now universally accepted as a disease of the mind, and one that is treatable.  The posters in the New York subway give the opioid dependent user the message that they are seen, they are not alone, and there is a safe place to go to get help.

We Need to Be More Proactive About Intervening on the Substance Using Individual

There is a glaring omission from what I’ve seen about harm reduction measures like safe drug spaces: we need to provide more access and encouragement for the participants to seek treatment.  We should be able to provide ‘micro-interventions,’ like conversations with a licensed drug counselor before they get the use of the harm-reduction space or materials (like fentanyl test strips or clean needles).  Perhaps we require the individual acknowledge that there is low cost (or even no-cost) treatment available in their area.

Help for an SUD is Everywhere and Better than Ever

As discouraging as the opioid epidemic is, there is actually a lot to be grateful for.In particular, I am grateful for the advances we have achieved in treating SUDs.  Not only are there more therapeutic tools available than ever before, the advances we’ve made in medication-assisted treatment (MAT) have made the process of getting off opioids easier than ever before. MAT is the use of medications (like Suboxone) which reduce the cravings and discomfort for opioids which have traditionally made early sobriety very unpleasant.  With the use of Suboxone, our field has seen amazing increases in success rates, which studies have shown range from 50% up to 83% success rates (as measured by continued participation in a program of recovery one year later).

Evidence Shows that Harm Reduction Works

When it comes to the controversy around safe drug spaces or the controversial posters described in the New York Post article, one thing needs to be made clear: keeping someone alive for one more day is required for us to help them. We cannot hide this problem any longer, or let people suffer in the shadows. We need to take action to get them help, and these harm reduction measures have been evidenced to save lives.  While we should strive to improve their implementation, and more successfully help those who are participating in these programs, we cannot return to an outdated “Just Say No”approach to the opioid epidemic.

Where to Get Help

There is more help available for persons struggling with an SUD than ever before, and a lot of the support can be accessed at a low cost (or eve no cost). A starting point is the The Substance Abuse and Mental Health Association (SAMHSA) Treatment Locator, which is a toll-free number that is staffed 24/7. SAMHSA can be reached at 1-800-662-HELP (4357)

About the Author

Harm Reduction Should Aim to Interrupt the Cycle of Abuse

Scott H. Silverman was mentally and physically addicted to alcohol and illegal drugs when he “hit bottom” and pursued treatment in 1984. He’s been helping others recover from addiction ever since. In 2014, he founded Confidential Recovery, a drug treatment program in San Diego that specializes in helping adults achieve long-term recovery.



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