Written By: Fiona Stockard
What is Harm Reduction?
The first time a woman approached me on the street and asked if I wanted clean syringes, I thought I was dreaming. Turns out this wasn’t some addict fantasy or dream, rather I’d just been introduced to harm reduction.
Harm reduction is an often-controversial type of addiction treatment for iv drug use, such as heroin, cocaine, methamphetamine, opioid painkillers, and prescription stimulants. At its most basic, harm reduction aims to provide care, and in some cases rehabilitation, to active addicts.
To put it another way, harm reduction operates under the belief that reducing the self and societal damage of addiction is of the utmost importance. Guess what? It is!
Is harm reduction helping or hurting addicts, though? Does it provide much needed support or enable destructive behavior? Let’s explore some common types of harm reduction and see if we can figure out the pros and cons.
Needle exchanges are probably the most recognized form of harm reduction. This was my introduction and, I bet, countless other addicts introduction to harm reduction.
Needle exchanges are places where an addict can go and trade in dirty syringes for clean ones. Advocates say this reduces the spread of blood-borne diseases. This is accomplished by providing access to unused syringes (reducing the chance of sharing needles) and by properly disposing of used syringes (reducing the chance an unlucky person might stick themselves with a discarded needle).
Some needle exchanges are buildings, others are nothing more than vans with a permit and clean needles. The one I went to offered soup, second-hand clothes, and educational classes.
It’s kind of funny actually – I went from college classes about addiction from a sociological perspective, to needle exchange classes about how to avoid contracting HIV. Black humor was always my favorite!
Now that we know the pros of needle exchanges, what’re the cons? Well, opponents of needle exchanges argue they perpetuate addiction. They argue that illegal drugs are, well, illegal and needle exchanges allow illegal behavior to continue. However, a 2001 study done by harm reduction advocates reported needle exchanges reduced the spread of HIV in New York City by as much as 70%. That sounds pretty impressive to me!
Opioid Replacement Therapies (ORT)
Opioid Replacement Therapy is another well-known form of harm reduction. It’s often called methadone maintenance. This is when opioid addicts are given access to methadone or buprenorphine, in an effort to wean them off street drugs.
Before we go any further, there are a few important points to make! To be enrolled in an ORT, you must take drug tests. This ensures participants aren’t abusing heroin, or pain pills, while receiving medication. Also, you go to an ORT clinic to receive medication. Doctors don’t hand out drugs on the street!
Sometimes, ORT clinics offer health and educational services, though this isn’t always the case. Advocates of Opioid Replacement Therapy say it’s a powerful way to wean addicts off of heroin and other illegal opioids.
They cite studies which show between 40% and 60% effectiveness of ORT’s, although this number is often debated. After all, it’s hard to determine what qualifies as effectiveness. Is it a year of abstinence from illegal drugs? Is it steady employment? Is it stable housing? Is it all of these things and more?
Opponents of ORT say it offers addicts a way to beat the system. They say rather than facing the consequences of their actions, addicts are given free drugs. They say ORT’s are too lenient in how they enforce drug screens.
The truth’s probably somewhere between the two. Opioid Replacement Therapies certainly help a lot of suffering addicts. They also offer a way out of active addiction, as opponents say. Isn’t that the goal, though? Don’t we, as recovering addicts and caring normies, want active addicts to get the help they need?
Naloxone is an “anti-overdose” drug. It’s a remarkably effective way to treat opioid overdoses. Naloxone can completely bring someone out of an overdose within two to eight minutes. In fact, Naloxone is thought to be so beneficial that it’s listed as one of the World Health Organization’s Essential Medicines.
Trial programs have distributed Naloxone to active addicts, their loved ones, police, and social service agencies. This distribution sometimes takes place at needle exchanges and opioid replacement therapy clinics.
Advocates of Naloxone say it gives addicts, quite literally, a second chance at life. If an addict overdoses on the street, their peers are more likely to give them Naloxone than take them to a hospital. If a police officer witnesses an overdose, either on the street or in jail, it’s quick and easy to give the overdosing individual Naloxone.
Opponents of Naloxone say that, once again, it’s too soft on addicts. They say addicts should be held responsible for their actions, should feel their consequences. They say if an addict overdoses, they should deal with the repercussions.
I think any sane person can agree that Naloxone distribution is a good idea! It gives addicts, and those who deal with addicts frequently, one more tool against an unfortunate and tragic death.
Safe Injection Sites
Safe injection sites are without a doubt the most controversial form of harm reduction. At their most basic, safe injection sites offer a legally sanctioned clinic for IV users to inject drugs.
Safe injection sites offer various services already mentioned. They provide access to clean syringes. Their staff is equipped with Naloxone. They offer basic health care assistance and educational classes. They have programs for addicts who’d like to receive treatment. They even have clothes and food for homeless addicts.
Advocates of safe injection sites argue that they offer an invaluable service to addicts. They offer a safe, government sanctioned location to use IV drugs. They’re equipped to combat overdose, infection, abscesses, and other common medical problems. They offer education, medical services, and rehabilitation services.
Opponents of safe injection sites argue this is simply too much. They say it’s not enough to have other options, but now addicts want a place to use illegal drugs with impunity. They say safe injection sites encourage and promote drug use. Basically, they make the same argument they’ve been making all along – that addiction should be treated as a crime, rather than a disease.
It’s worth noting there are no safe injection sites in the US. So far, they’re in various European countries, Australia, and Canada.
Basic Healthcare Services
Basic healthcare services are exactly what they sound like. They consist of things like: physical exams, HIV and other infectious disease testing, distribution of Naloxone, distribution of contraceptives, distribution of sterile injection supplies, and more.
Basic healthcare services are important because many addicts don’t have access to doctors or other forms of primary healthcare. Advocates of harm reduction argue that basic healthcare services are a human right. Everyone, regardless of their addiction(s), should have access to healthcare.
There aren’t many opponents of basic healthcare services. Even among those who contest harm reduction strategies, few think that addicts shouldn’t have access to healthcare.
So, Does Harm Reduction Help or Hurt Addicts?
Ultimately, this question can only be answered by the one asking it.
There are a lot of benefits to harm reduction. A lot of benefits. Harm reduction provides addicts with safe injection supplies. It offers many ways to escape the cycle of active addiction. It give addicts access to basic drug education and healthcare services. In the case of Naloxone and safe injection sites, harm reduction even saves lives.
There are also some drawbacks. It can propagate addiction. Addicts may find it easier to rely on harm reduction than to get sober. Note that I said may. This hasn’t been proven. Certainly, addicts need to feel the consequences of their use. That’s the only way we heal.
When weighing the pros and the cons, it’s clear that harm reduction does more good than bad. However, addiction is a complicated disease. What’s good for one addict may be harmful to another.
You have the facts, now you can decide for yourself. Is harm reduction good or bad? Feel free to leave your thoughts in the comments below. Having an educated and balanced discussion about harm reduction is the only way we can decide, as a group of sober individuals, if it helps or hurts.