Harm Reduction In Practice

In the earlier community education article "What is Harm Reduction," which was printed in the Aug. 31 issue of The Glasgow Courier, the harm reduction model was defined as a practice of strategies that reduce drug-related harm to the individual and community through programs to support well-being and lessen infectious disease transmission. Addiction and drug use are understood through the disease model as substance-use disorders. Evidence shows that harm reduction strategies do not encourage substance use and greatly increase treatment-seeking.

Based on the record-breaking overdose deaths in the United States and the sheer volume of Americans behind bars for non-violent drug charges and other offenses symptomatic of struggling with substance use, it is clear the current approach does not work. The harm reduction model targets issues over punishing symptoms. Symptoms are punished though vagrancy laws that criminalize being poor/unhoused, neglected comorbid serious mental illness, public disturbance laws, and others.

Global governments currently spend 100 billion annually on drug control efforts. Harm Reduction International reports that "just 7.5 percent of that [100 billion] toward harm reduction services would lead to a 94 percent reduction in new HIV infections among people who use drugs and a 93 percent drop in HIV-related deaths by 2030." The United States 2022 drug control budget is $39 billion - five times the projected budget to tackle a major public health concern related to drug use. The earlier article alluded to harm reduction examples and strategies. These are evidence-backed preventative and responsive interventions that are supported with education at clinics and in the community.

Needle exchange programs are aimed at providing safe disposal sites and minimizing needle sharing to prevent the spread of infectious diseases. One in 23 women and one in 36 men who use drugs intravenously will contract HIV at some point during their lifetimes, according to the Harm Reduction Coalition. Harm reduction clinics also provide information on available resources and education on safer injection practices.

Naloxone and methadone are chemicals that bind to the opiate receptors in your brain. Naloxone is most often used in overdose intervention. First responder services like EMS and law enforcement often carry Narcan since they can reasonably assume they could interact with people who are overdosing on opiates. Naloxone only reverses opiate overdoses, so it will not cause harm if given to someone with no opiates in their system.

Methadone and suboxone block opiate cravings and soften withdrawal without getting someone high. There is a tipping point in substance use where using is a means to cope with or avoid miserable withdrawal as much as, or more than, to get high. This replacement therapy targets the barrier of being in the right mind to seek treatment or decide not to reach out to a dealer. When someone's body becomes dependent on a given substance, the brain stops producing endorphins. These are "happy chemicals," but they do more than just feel good. Serotonin and dopamine, for example, are linked to motivation, emotional regulation, and decision making. Some people are concerned that methadone can be resold on the street. Methadone doesn't get you high, so it doesn't have the same street demand of reselling pain pills.

Addiction and drug use is a multifaceted and intersectional topic. Understanding the experience of addiction is crucial to effective programs. Researchers, treatment providers, and loved ones of people who use drugs have been consistently involved in prevention and treatment efforts for decades. So, what's missing? Lived experience of having a substance use disorder gives priceless insight that others can only theorize despite best intentions.

The harm reduction model encourages people who are or have used drugs to be involved with policy and program design to remove the guesswork on what works, what doesn't, filling gaps, and have a vested interest in getting things to work. Even if someone is currently sober, they know how rough addiction is and how others will receive help from improvement. People get sober with help; you can't get sober for someone so the best you can do is your best to support them.

If you'd like to share a story of resilience around behavioral health, including substance use, consider submitting an anonymous entry to Stories from the Strong at valleycarecoalition.com.