Harm Reduction in Addiction
For many years, abstinence-based recovery has been the go-to method for helping those struggling with a substance use disorder achieve sobriety and maintain peace of mind. But for the last several decades, the idea of harm reduction has gained some steam. Many in the recovery world are hesitant to embrace the ideas behind harm reduction techniques. Some of them, initially, are not based on complete abstinence. Rather, harm reduction strategies make the process of using drugs safer in order to improve a drug user’s life and give them additional chances to seek treatment.
At TruHealing Centers, we provide addiction treatment resources that include harm reduction for people who are ready to make a positive change in their lives. For more information about our mental health treatment options, contact our team today by calling 833.631.0525 or completing our online form.
Harm Reduction Strategies
SAFE INJECTION SITES
Safe injection sites, also known as supervised injection sites, overdose prevention centers, or drug consumption rooms, are a still uncommon form of harm reduction where drug users have access to clean needles and tourniquets, drug testing supplies, and support from clinicians in order to immediately respond if someone overdoses. Safe injection facilities also offer primary care for those using drugs, provide HIV and AIDS tests, pregnancy tests, immunizations and care for wounds. In addition to preventing overdoses, staff may build rapport with the clientele and eventually convince them to seek treatment for their addiction. Safe injection sites do not provide substances for clientele. According to the Department of Nursing at the University of Southern California, as of September 2018, news outlets have reported zero deaths occurring at safe injection facilities. As many as 70% of the people who register at safe injection sites have no previous connection with healthcare services.
NEEDLE EXCHANGE PROGRAMS
Syringe services programs (SSPs), also known as syringe exchange programs and needle exchange programs, offer services similar to safe injection sites, only without supervision. Many SSPs operate out of vans or in centers that do not allow a person to use in the facility. In SSPs, sterile syringes are provided for those who need them. Used syringes are properly discarded, decreasing the risk for HIV and Hepatitis C infections, among others. According to the Centers for Disease Control and Prevention (CDC), people who participate in SSPs are more likely to seek treatment for their Substance Use Disorder than those who do not.
Medication-assisted treatment uses medication in conjunction with therapy to overcome a substance use disorder. Although most MATs are used to combat opioid dependency or overdose, there are also medications to combat alcohol use disorder.
Medications used in MAT include:
- Methadone – Methadone reduces opioid cravings and blocks the effects of opioids such as heroin, prescription painkillers, codeine, and morphine. Methadone is an example of an agonist, which blocks opioids by attaching to the brain’s opioid receptors while not activating them.
- Buprenorphine – Buprenorphine, also known as Suboxone, is an example of a partial opioid agonist. When taken at low doses, Buprenorphine decreases euphoric feelings of opioid use and physical dependence. It is usually only prescribed as part of a treatment program, including counseling, therapy, and support groups.
- Naltrexone – Naltrexone is an antagonist, meaning it blocks the effects of opioids, including euphoria and pain relief. It is prescribed for both opioid use and Alcohol Use Disorder and decreases cravings.
- Naloxone – Naloxone is an opioid antagonist that is used to reverse opioid overdoses. The drug only works if opioids are present in one’s system. There is no potential for abuse. Doses of Naloxone restore normal breathing to people experiencing slowed or arrested breathing due to an overdose.
- Acamprosate – Acamprosate is a calcium medication used in conjunction with counseling in order to help people with Alcohol Use Disorder stop drinking. The medication restores the balance of neurotransmitters in the brain, therefore reducing cravings for alcohol. Like all MATs, Acamprosate is not a cure for alcoholism.
- Disulfiram – Disulfiram is an oral medication used to treat chronic alcoholism. The medication is meant to be a deterrent from consuming alcohol or binge drinking. If one drinks alcohol while on Disulfiram, side effects include nausea, vomiting, weakness, anxiety, and other unpleasant symptoms.
Harm Reduction Principles
On its website, Harm Reduction Coalition lists the following principles as central to harm reduction practice:
- Accept, for better and or worse, that licit and illicit drug use is part of our world and choose to work to minimize its harmful effects rather than simply ignore or condemn them.
- Understand drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledge that some ways of using drugs are safer than others.
- Establish quality of individual and community life and well-being as the criteria for successful interventions and policies.
- Call for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
- Ensure that drug users and those with a history of drug use routinely have an authentic voice in creating programs and policies designed to serve them.
- Affirm drugs users themselves as the primary agents of reducing the harms of their drug use and seek to empower users to share information and support each other in strategies that meet their actual conditions of use.
- Recognize that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.
- Do not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.
Harm Reduction International features its own four principles, including respect for the rights of people who use drugs, a commitment to evidence, a commitment to social justice and collaboration with networks of people who use drugs, and the avoidance of stigma.
History of Harm Reduction
A timeline produced by the Department of Nursing at University of Southern California states that the first “drug consumption room” opened in 1986 in Bern, Switzerland. Between the 1990s and early 2000s, safe consumption sites opened in the Netherlands, Germany and Australia. In 2003, the first North American safe consumption site, called Insite, opened in Vancouver, British Columbia, Canada. In 2011, the Supreme Court of Canada ruled that safe consumption sites are exempt from federal prosecution. Although no safe consumption sites currently exist in the United States, major cities such as San Francisco, Denver, Seattle and Philadelphia have considered opening sites.
Controversy Surrounding Harm Reduction
Harm reduction is a controversial topic because the “meet people where they’re at,” philosophy strays from traditional interventions and abstinence-based recovery model that many addiction prevention programs advise. There is similar controversy regarding harm reduction for sexually transmitted diseases, which also traditionally believes that abstinence from sexual activity is the only 100% effective way to stop unwanted pregnancies and spread of diseases. Much of this comes down to the stigma surrounding drug use, as drugs such as heroin, crack and cocaine, though prominently used, are still illegal in the United States. Others believe that the prevalence of strategies such as safe injection sites, syringe exchange programs and Naloxone training are enabling people to continue using drugs with fewer consequences rather than getting them to stop. Advocates for harm reduction would point to the fact that these programs and facilities frequently save the lives of people with Substance Use Disorders, providing more opportunities for them to connect to resources and seek treatment.