In the middle of Moss Park in Toronto stands a white tent. It looks like the kind used by vendors at a festival or for registering for a 5K race. But the sign pasted on the outside of the billowing fabric makes it clear this is not your ordinary tent. The sign reads: Overdose Prevention Site. When the site, the first of its kind in Toronto, opened in August, some doubted anyone would visit. But in its first week, 36 people entered the tent under the watchful eye of nurses and counselors who distribute clean needles and keep a supply of Naloxone on hand in case of overdose. Since then, it has been used by about 20-25 people daily and over a dozen overdoses have been prevented thus far.
This overdose prevention site is the result of passionate lobbying by harm reduction workers who have endeavored to bring awareness to the opioid addiction that is causing damage in both Canada and the United States. Over the past 14 months, over 1,400 people in British Columbia alone have lost their lives due to opioid overdoses. In the United States, opioids were involved in more than 33,000 deaths in 2015.
Although the current site is temporary, it will be joined by three permanent overdose prevention sites this fall, a move that many believe signals a promising new approach to how governments respond to opioid addiction. But while the opioid harm reduction tent is indeed significant, both practically and symbolically, even harm reduction workers do not believe the government’s singular focus on harm reduction is enough. “I think it’s a good start,” says Byron Klingbyte, harm reduction coordinator at AIDS Committee of Windsor. “[But the government] didn’t mention anything about treatment centers and that’s a big hole in addiction services. Something has to be done.”
The Need for Opioid Harm Reduction
The opioid crisis can no longer be denied. As Mary O’Hara writes, “More US citizens die from overdoses than from gun fatalities or car crashes. It is now becoming the leading cause of death for the under 50’s.” Dr. Daniel Ciccarone, a public health researcher and physician, believes opioid addiction is this generation’s AIDS crisis, an epidemic that claimed 51,000 lives in a single year at its peak in the United States. He says:
I talked to a user in West Virginia. Nice guy. Manages to keep his habit and keep his job. He’s 10 years out of high school. He’s 29. He went to his high school reunion. I kid you not—half of his high school class is gone…It was mostly [opioid] pills and heroin.
As with the AIDS crisis, many of the most visible efforts to prevent opioid overdose have relied on harm reduction strategies. In contrast to the abstinence approach, harm reduction strategies are grounded in the understanding that people will continue to use to various extents and are designed to minimize the risks associated with that use. “The extent of use, or use itself, is not the issue,” says the committee on harm reduction at the Center for Addiction and Mental Health, “The primary focus is on people who are already experiencing some harm due to their substance use. The most appropriate interventions, whether macro or micro, are those geared to movement from more to less harm.” Indeed, the ethos of harm reduction is deeply informed by efforts to prevent the transmission of HIV via needle exchange programs and, more recently, the use of pre-exposure prophylaxis (PrEP) medication.
What is Opioid Harm Reduction?
There are a number of opioid harm reduction strategies in place that target risks associated with opioid use in general as well as specific methods of use. These include:
- Overdose Prevention Sites: Overdose prevention sites provide a space in which opioid addicts can use under the supervision of medical professionals who are equipped to reverse overdose. There are currently no such sites in the United States.
- Naloxone Distribution: Naloxone is used to reverse opioid overdose and may be taken as a nasal spray or auto-injector. Police, first aid responders, and other medical professionals have historically been responsible for administering Naloxone, but a growing number of places are now offering free Naloxone kits to the public, allowing for more rapid administration. As some users are reluctant to seek medical help due to fear of arrest, private Naloxone use provides a way of immediately intervening even if a person does not contact medical professionals.
- Needle Exchanges: Needle exchange programs provide clean syringes to users in exchange for their used equipment in order to prevent the sharing or use of contaminated needles. This is designed to reduce the risk of transmitting or contracting HIV and hepatitis C.
- Medication: Methadone and buprenorphine may be used in place of more dangerous opioids to reduce cravings and stave off withdrawal symptoms. Unlike other harm reduction strategies, these may be used as part of a comprehensive addiction treatment plan with the goal of eliminating illicit opioid use and eventually eliminating opioid use altogether.
Ideally, harm reduction programs work to treat each person with respect, dignity, and compassion while administering immediate interventions as well as offering education and referrals to treatment programs.
The Limits of Opioid Harm Reduction
Opioid harm reduction programs fundamentally work from the understanding that not everyone wants, has access to, or is ready for addiction treatment and there are concrete steps they can take to reduce risk in the meantime. However, the current focus on harm reduction efforts should be combined with equal attention to comprehensive addiction treatment in order to truly make strides toward reducing not just overdose deaths, but the rate of addiction. After all, the risks attendant to opioid addiction go beyond overdosing or contracting HIV—addiction affects every aspect of a person’s life and damages them mentally, emotionally, physically, and spiritually. Supervised injection sites and Naloxone may be effective ways of preventing death, but they do not address the roots of addiction, only its possible consequences.
Comprehensive addiction treatment programs, on the other hand, are designed to reduce risk by eliminating the use of harmful drugs altogether. These programs combine evidence-based addiction treatment therapies and techniques in order to identify the impetus for your drug use, including any co-occurring mental health disorder that may be spurring the addiction. Through an individualized curriculum of therapies, individuals are able to identify the barriers standing in the way of healing and remove them with the support of compassionate clinicians and peers. Clients can gain the insight and coping strategies they need to understand triggers, handle cravings, heal relationships, and create a life without drugs.
However, comprehensive addiction treatment programs do often integrate harm reduction medications as a vital aspect of relapse prevention. Buprenorphine, in particular, is often an essential part of the healing process and may be used throughout your time in residential care as well as continuing care, whether in an IOP, sober living environment, or in your everyday life. Unlike in a pure harm reduction model, however, addiction treatment programs use these medications within a holistic treatment plan, typically with a goal of eventual discontinuation.
Harm reduction provides invaluable strategies for keeping opioid users safe, and the proliferation of harm reduction initiatives does indeed indicate an important shift in how addiction is understood. At the same time, it is essential to recognize that opioid use is not inevitable. Addiction is a treatable illness, and comprehensive addiction treatment programs built on a medical model offer the best hope for people seeking lasting freedom from addiction.
Alta Mira offers a comprehensive suite of treatment programs for people struggling with drug and alcohol addiction as well as co-occurring mental health disorders and process addictions. Contact us to learn more about our renowned Bay Area-facilities and how we can help you start on the path to sustainable recovery.
Image Source: Unsplash user Micah H