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Wed, Jul. 18th, 2012, 12:04 am
Harm Reduction: Climb on Jade's SoapBox


Harm Reduction: A method of working with addicts that minimizes the harmful aspects of drug use.

The idea of harm reduction is simple. If people are kept alive and as healthy as possible while using, they are more likely to recover. Other benefits include leading productive lives while still using and lowering the spread of infectious disease even among non-users (particularly HIV and HEP C).

It buys addicts time in which to decide to quit, time they don't have if they are dead. It lowers infection rates among needle users (because reusing needles again and again tears up your skin, opening the way for abscesses and other nasty wounds). The healthier a person is and the better they feel about themselves, the more likely they are to quit. I was fond friends with a guy who had AIDS and cancer. With the combination of two fatal illnesses, he just gave up, stopped taking any meds or participating in treatment, and slowly killed himself through drug use. Some harm reduction strategies, like methadone treatment, reduce the need for illegal drugs which can also lower the crime rate. (There's a whole chapter in this book devoted to methadone treatments, which I will not be covering because I don't feel qualified to do so.) Not to mention, harm reduction is a beautiful way to reach those who aren't ready to quit. It can help them deal with other aspects of their lives and if they do decide to quit, they know how to access services which can help.

Harm reduction is controversial for a number of reasons. Despite all evidence to the contrary, some people persist in believing that if you help addicts at all (such as providing clean needles), it encourages drug use. To that I reply, "if I hand you a clean needle, are you going to go shoot dope?" Of course not. It's the heroin that makes people want to use heroin, not the needle. In fact, in places where needle exchanges are easily available or needles don't require a prescription, IV drug use actually tends to drop.

Another reason harm reduction is controversial is it directly contradicts some of the abstinence-only program philosophies. Many abstinence programs, such as 12-step, believe that drug users have to hit "rock bottom" before they will become enlightened and quit.

"However, as William White, who works with poor women who have traditionally not been well-served by drug treatment, put it in an interview with Bill Moyers, "I had outreach workers saying, "You don't understand, my clients don't hit bottom, they live on the bottom. Bottom is not new for them." [....] If we wait for them to hit bottom they will die. The issue is not an absence of pain in their lives. They've got more pain than most of us can even comprehend. The issue is an absence of hope." -- Recovery Options: The Complete Guide

Harm reduction is various things. I volunteer at a needle exchange and sex worker advocacy; needle exchanges are what your local bureaucracy is referring to when they talk about harm-reduction programs. We also distribute condoms. We teach folks how to safely inject drugs and how to clean needles (although we prefer they get new needles from us). We perform HIV testing. We have a maintenance group that helps teach people life skills, things that are important to have both before and during recovery. We have a 24-hour hotline. And, of course, we provide referrals all over the place, from mental health to government assistance, to drug-treatment programs. We know the clinics where they can be seen for medical checkups that won't discriminate against them for being homeless, addicted, or (as is the case throughout much of the under-served DC community) transgender. Mostly, though, we listen, and we fight for a community because those individuals are more interested in survival than worrying about things like getting the basic human dignity they deserve.

Just as the idea of residential treatment scares addicts but may be reassuring to loved ones, the idea of harm reduction is terrifying to family and friends but much easier to accept by those with a drug problem. But if you think about it logically, most people would rather have slightly impaired, living friends, than dead ones. Just because abstinence may be the best idea from the viewpoint of a loved one, doesn't mean that harm reduction isn't also a good goal, especially in someone resistant to the idea of abstinence -- change is not all or nothing.

Because harm reduction focuses on reducing problems associated with drug use, success or failure is measured differently than with abstinence programs. Just about every study shows that HIV rates in any area will fall when IV drug users have easy access to clean needles. There is no evidence supporting the idea that access to needles increases drug use. Absolutely none. Generally, states with needle exchanges tend to have lower rates of users than states which ban them. Research shows that folks who come to needle exchanges regularly tend to cut down on their drug use over time, and they don't stay addicted any longer than folks who don't visit needle exchanges. People stop using when they are tired of drugs, not when they don't have access to clean needles.

Some Harm Reduction Strategies
  • Don't mix your downs. Many overdoses are really combinations of downers. Heroin and alcohol, or heroin and benzodiazepines. Alcohol mixed with almost any other downer is a bad idea, and tends to cause unconsciousness rather than a high, anyway.
  • Treat overdoses right away. Most heroin overdoses are not fatal if treated quickly. Call 911 immediately and tell them your friend is unconscious and you can't wake them. That way, just the ambulance with show up (without the police) and you can tell them you suspect an overdose. If you are still worried about police showing up, you can flush your drugs after you call. However, if there is anything left of the drug taken by the OD'd person, put a small amount of it in their clothes or on their person, so that emergency personnel can identify the drug and provide adequate treatment. Don't try waking them in a cold shower, it will only give them hypothermia on top of an overdose. The only safe overdose treatment is Narcan (naloxone) which is available to carry by prescription in certain places. So far, it is not yet legal for most needle exchanges to carry it. We are still working on that in DC. If we could pass out Narcan, we could save a bunch of lives.
  • Try to switch to less harmful drugs or ways of using drugs. Injecting drugs is the most dangerous way to use, smoking and sniffing are much safer. Marijuana use and/or moderate alcohol use is safer than cocaine or heroin, if you can manage to switch drugs entirely.
  • Use clean needles. If you don't have access to clean needles, than clean them before you use them. This includes ones bought off the streets. Sellers are known to repackage needles so they look new for better saleability. Don't share needles, cookers, or stems if you can help it. Shared cookers are one of the overlooked ways that HEP C travels between IV drug users.
  • Make sure you have a safe, well-lighted place to inject. This is a primary harm reduction tip for IV drug users. The injection will go smoother and safer if you can see and don't feel you will be interrupted. If the area is dirty, lay down clean newspaper or rip open a pad of paper to place supplies on. Use clean water. Tap water is cleaner than water from a drain. If all you have is a toilet, use water from the tank and not the bowl. Rotate your injection sites. I have on at least one occasion played 'lookout' so that someone would have time to safely inject their drugs, but it's best if you are just in a safe place in general. Have a 'shooting buddy' if you know another user you can trust, someone to look out for you if you OD, or someone experienced (like a medical professional) who can show you how to safely inject. Yes, there are plenty of medical professionals who go on to use IV drugs.
  • If you think you have been exposed to HIV, get help right away. There is evidence that drugs given directly after exposure can prevent you from getting HIV.
  • Learn to recognize cues that lead to heavy drug use. Avoid these triggers. Knowing this will also help you later if you decide to quit.
  • Take care of yourself. Try to eat right, get some exercise, and take a vitamin supplement. Medical care is available even if you have no income, so get regular checkups and go to the doctor when you are sick.


I guess that's really what I want to say. Take care of yourself. Having a problem with drugs or alcohol does not make you a less worthwhile person; it just means you have a much bigger problem to deal with than some other folks who aren't addicted. So long as you are alive, it is not too late to try and get better, and it's okay to get better slowly in your own time and on your own terms. Peace.

For more information about the place I volunteer, or if you live in DC and think we can help you, visit Hips.org. We are chronically underfunded and always in need of donations. The website is also a little wonky from time to time, again, because we are chronically underfunded and in need of donations (and not web developers).

The information above was learned from the book Recovery Options: The Complete Guide by Joseph Volpicelli and Maia Szalavitz, personal history, and my time volunteering with HIPS. For more in-depth information (including the chapter on methadone treatments), I recommend picking up a copy. There is also a Kindle version of Recovery Options available for instant download. As a gentle reminder, I am not a doctor or substance abuse counselor of any kind.

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