A Harm Reduction Approach to the Opioid Epidemic

Image courtesy of: EHS Today

The opioid crisis is at an all time high, as opioids continue to threaten the lives of many.

One of the many reasons this is the case is the presence of fentanyl in opioids. Fentanyl, a synthetic painkiller, is fifty to a hundred times stronger than morphine, and when mixed with heroin, will overdose the user significantly more proficiently than its standalone components. In most cases, heroin users will unknowingly consume heroin without knowing it was laced with fentanyl, leading to a sudden episode of overdosing. What if I told you there was a humane approach to preventing incidents like these? That method is called harm reduction.

Fentanyl is the leading cause of overdose deaths. Image courtesy of: The National Institute on Drug Abuse

Currently at the federal level, opiates are still considered illegal and prohibition is the standard. While many would have you believe that the prohibition of opiates is the solution, another glance will reveal that drugs will not and have not magically disappeared despite the presence of anti-drug policies. Just as in the conception of the 18th Amendment during the Prohibition era, simply making a desired substance illegal doesn’t magically make it disappear. Instead, this can easily backfire and create an even greater problem as people will still seek out these substances. Prohibitionist policies of the Roaring ’20s led to the creation of speakeasies; it would be foolish to assume prohibition of opiates would not produce a similar result, like a black market or other “tainted” drugs.

In the same vein, preaching abstinence while teaching sex education has been shown to be less effective than teaching safe sex for our youth, and I believe it would be more effective we should look at drug usage in a similar light.

Opponents of harm reduction generally view drug abuse from a moral/criminal standpoint, and that by setting up facilities like safe-injection sites, we are promoting and enabling drug abuse. However, this line of thought is unhelpful at best, as treating addiction as a crime is the reason why we fail to resolve this issue in the first place. Throwing someone in jail over drug possession really is only a band-aid solution at an attempt to dissuade drug consumption.

If we instead treat drug abuse as a disease, more productive solutions can be produced. After all, addiction chemically alters the abusers’ brain, it only makes sense to employ a disease model in treating it. For instance if a patient had an eating disorder, the patient could be considered to be “abusing” food by over/under eating, much like how a drug abuser abuses substances. Therefore, it would be treated from a medical standpoint using medicine and therapy. We should be doing the same with drug abuse.

In this line of thought, the philosophy of harm reduction is one that works to “reduce” the amount of harm done by abusing drugs. The ultimate goal of harm reduction is to save lives. Under this philosophy, this generally means that harm reduction programs are geared to work with where the user is at, including supervised and controlled drug use. This allows patients to undergo treatment under more flexible programs, as not everyone has the physical or emotional capacity to undergo harsher regimens such as prohibition and its absolute extremism in restricting drug use altogether. In this sense, harm reduction is truly a humane alternative to the opioid crisis.

Harm reduction goes hand in hand with other preventative measures, and by extension, public health policies. Image courtesy of: The Recovery Research Institute

An example of harm reduction is the Supportive Place for Observation and Treatment Clinic (SPOT), found in Boston. Founded by the Boston Health Care for the Homeless Program (BHCHP) as an answer to the numerous deaths of those served by the BHCHP, the SPOT clinic serves as an observational area that doesn’t allow users to inject on-site but is ready to provide medical assistance for those overdosing or at risk of an overdose. It is important to note that the SPOT facility staff do not provide or assist in the consumption of drugs, nor are opiates allowed to be consumed on the premises. However, they monitor outside the premises and are ready to assist if they perceive potential overdose. For you gym rats out there, this is much like “spotting” someone bench pressing or squatting. If anything goes wrong, the spotter is there to help set things right.

This method of observation contrasts from safe injection sites which aren’t sanctioned in the United States. In safe injection sites, staff also do not assist in the consumption of drugs, but drug users are allowed to use drugs on-site, meaning that the staff can ensure that the users don’t overdose during consumption. Safe injection sites also provide sterile equipment, specifically needles, which reduces the transmission of bloodborne diseases that would be spread otherwise. This also grants the facility the opportunity to educate their patients on safe consumption and possibly on steps to becoming drug-free.

Another program that hasn’t shed light in the United States is substitution therapy. Substitution therapy works similarly to a nicotine patch; these facilities aim to provide a less potent version of the drug causing addiction. In this case, the drug is actually administered by the staff. Studies have shown that this reduces financial burdens for users, as illicit drugs are not bought by the user, and it is correlated with a decrease in crimes committed by illicit drug users.

While harm reduction is not the only step we as a society can take to combat the opioid epidemic and drug addiction as a whole, it is certainly a step in the right direction for our nation. Society has given us plenty of precedence to suggest that outright prohibition cannot be the first step taken while looking at a potential problem, from alcohol to teenage sex.

In a similar manner, demonizing drug addiction as something that was a result of a choice will not alleviate the opioid situation, and perhaps may even cause more harm due to backlash of illicit dealings without regulation. Diametrically opposed is harm reduction; it is not a blanket solution that simply prohibits, thus not taking into account the individuality of each person and their situation. It seeks to add regulation and empathy to a drug problem that necessitates it. But most importantly, harm reduction aims to incorporate empathetic help to the opioid epidemic, something that we in healthcare, society, and individually should be seeking more of.