We’ve all been harmed by the consequences of drug addiction and the misguided policies surrounding drug use. People who use drugs suffer. The people who love and care for people who use drugs suffer. Our communities suffer.
We feel helpless in the face of addiction, whether it’s our own or someone else’s. It feels like can’t control it, or stop it, or even get it to slow down as it guts our lives of everything good. We are hurt and we hurt others, again and again. We get angry. We blame. We shut ourselves off from each other in a desperate attempt to find …. what? A place addiction won’t reach? Solace?
But addiction is cruel, and it is relentless.
Addiction is also common. One in four families struggles with addiction. Forty million Americans age 12 and over meet the clinical criteria for addiction involving nicotine, alcohol or other drugs. That’s more Americans than those with heart disease, diabetes or cancer.
An additional 80 million people in this country are “risky substance users,” meaning that while not addicted, they use tobacco, alcohol and other drugs in ways that threaten public health and safety.
We talk about addiction like it’s a superpower we are helpless to stop. Meanwhile, treatment options remain limited and largely punitive. We incarcerate drug users and shun them from society. Despite wonderful advancements in medication-assisted treatment, cognitive behavioral therapies and other recovery options, the favored approach to treatment in the U.S. is based on a spiritual or 12-step model that isn’t effective for many.
We know what we’re doing isn’t working, but we keep doing the same things. When we inevitably suffer, we give up on each other as hopeless. We hand our power over to addiction and say there’s nothing more we can do.
Most people aren’t sure what else to do. All they know is they are hurt from an addiction beats them down, over and over.
We are not powerless. We can make changes that end some of the suffering surrounding addiction. We can change attitudes and enact policies that take away some of addiction’s power to hurt us.
It’s called harm reduction. Harm reduction is about supporting beliefs and actions that aim to end the suffering caused by all the hurt, all the blame, all the shutting off of human connection we do to try to protect ourselves from addiction and its negative consequences.
Harm reduction is not new. It’s not radical. We all follow and support harm reduction policies every day. Many people wouldn’t consider driving down the highway without a seat belt or engaging in unprotected sex. We choose salads as healthier choices at fast food restaurants. We recognize the wisdom in designating sober drivers.
Each of these solutions is chosen specifically for its ability to reduce potential harms that are likely to occur. Applying the harm reduction model to drug use works the same way. It allows us to come up with strategies that counteract or stop bad things from happening as a result of drug use. It prevents more of the senseless and unnecessary hurt that only drives us apart.
Harm Reduction Organizations
There are many harm reduction organizations. A few of the largest and most well-known include:
- Harm Reduction International
- Harm Reduction Coalition
- Drug Policy Alliance
Each defines harm reduction in its own way. Harm Reduction International says, “The harm reduction model supports policies, programs, and practices that aim to reduce the harms associated with the use of psychoactive drugs in people unable or unwilling to stop.”
Harm Reduction Coalition asserts, “Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”
Drug Policy Alliance says, “Harm reduction is a public health philosophy and intervention that seeks to reduce the harms associated with drug use and ineffective drug policies.”
Harm Reduction Isn’t About Ending Drug Use
Many people misunderstand the harm reduction model. Its detractors argue that harm reduction policies enable and even encourage drug users to continue on a perilous downward spiral.
But harm reduction isn’t about ending drug use. It’s about stopping the suffering, whether it’s caused by addiction, bad laws, failed policies, inadequate healthcare, discrimination or any other problem associated with drug use.
Harm reduction policies give people a choice in their health care. They promote compassion without judgment, without condemnation, and without trying to force abstinence. They are based on the belief that there will never, ever be a world without drugs and people who use them.
If we can start here, each of us holding tightly to our agreement on the one basic tenet that we will never eradicate all drug use, we can forge a connection that gives us the strength to change. We can use that strength take back some of the power we’ve given to addiction to hurt us by reducing the harms it causes.
Harm Reduction Policies
Many of today’s legal and healthcare policies fail miserably at addressing the causes and conditions that promote drug use. Harm reduction is about promoting evidence-based strategies for the treatment and prevention of addiction.
The Harm Reduction Coalition (HRC) says, “Harm reduction incorporates a spectrum of strategies from safer use to managed use to abstinence to meet drug users ‘where they’re at,’ addressing conditions of use along with the use itself.”
HRC advocates for harm reduction policies listed on its website including:
- Implementing the Good Samaritan 911 law to exempt overdose victims and callers from criminal prosecution
- Advocating to increase state and federal funding for research into effective treatment options
- Advocating for the use of replacement therapies such as methadone, buprenorphine, and other evidence-based treatment models
- Treatment instead of incarceration
- Increasing access to sterile syringe exchange programs and non-prescription pharmacy sales
- Increased distribution of the overdose reversal medication naloxone
- The safe use of supervised injection facilities
- Ending discrimination against all drug users by reducing stigma and advocating judgment-free, compassionate approaches to care and treatment
Harm Reduction Principles
What follows is a listing of HRC’s central principles of harm reduction. Following each principle, we’ve added a practical explanation of what the principle means to us at Cincinnati Exchange Project:
Accept, for better and/or worse, that licit and illicit drug use is part of our world. Choose to work to minimize its harmful effects rather than simply ignore or condemn them.
As long as there are psychoactive substances on this planet, people will use them to alter reality. We will never completely eliminate drug use in society. What’s more, a whole lot of good people use illegal drugs or misuse prescription drugs.
- In 2015, over 27 million people said they were currently using illegal drugs or misusing prescription drugs.
- At the same time, over 66 million people (a full quarter of the adult and adolescent population) said they binge drank in the previous month.
- Over 2.4 million people in the United States are dependent on prescription painkillers, heroin, or both.
- Drug overdose is now, and has been since 2013, the leading cause of preventable deaths in the U.S.
Many of us, our friends, our family members and our neighbors are among these numbers. We encourage people who wish to stop using drugs. We help them find appropriate treatment and medical care when they are ready for help. But, again, harm reduction is not about forcing abstinence on everyone who uses drugs.
We remain steadfast in our commitment to providing sterile injecting equipment, testing services, healthcare, safe sex education, and access to treatment and social services to every person who comes to us, regardless of their desire or ability to achieve or maintain abstinence from drug use.
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 clearly safer than others.
We know that people are not deterred from drug use simply because they don’t have access to sterile injection equipment. They will re-use and share old syringes instead, which increases the risks of infections and the spread of bloodborne illnesses.
Communities with access to a syringe exchange program have lower rates of HIV and other disease transmissions. According to DrugPolicy.org:
- The Centers for Disease Control found that syringe access programs like ours lowered HIV incidence among people who inject drugs by 80%.
- HIV among people who inject drugs in New York fell by 75% in the decade following the introduction of syringe access.
- Clients of a Seattle syringe access program were five times more likely to enroll in drug treatment than those not in the program.
- Neighborhoods in Baltimore with syringe access experienced an 11 percent decrease in break-ins and burglaries.
The expansion of syringe exchange programs helps prevent the spread of diseases and other harms associated with the lack of sterile injecting equipment and does not result in a corresponding increase in crime rates or other problems.
Establish quality of individual and community life and well-being – not necessarily cessation of all drug use – as the criteria for successful interventions and policies.
This is the most misconstrued and misunderstood principle of harm reduction. Again, complete and total abstinence for every person who uses drugs is not a harm reduction goal.
Society criminalizes addiction and doles out treatment as punishment. Court-ordered treatment programs require total abstinence from people suffering a chronic, progressive illness, and lock them up when they do what every person who has a chronic illness does – which is exhibit symptoms.
People who use drugs deserve basic human rights such as compassion, adequate healthcare, and safety. The fact that someone is unable or unwilling to stop using drugs doesn’t negate these rights.
Detractors say not demanding total abstinence implicitly condones drug use. Some say it goes so far as to encourage people to continue using drugs regardless of the many problems it causes. We don’t encourage drug use. But we don’t demand abstinence, and we refuse to close the door on people who use drugs. Abstinence is only one measure of success among many.
Success should be measured by how many overdoses were prevented and how many people received effective treatment when they sought it. Success is seen in how many HIV and Hep C infections were prevented. Success is measured in smaller victories, too, such as abscesses avoided and used syringes safely removed from the streets.
The number of days a person abstains from drug use is irrelevant. The number of harms we prevent from occurring? That’s the real measure of success.
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.
Stigmatization of drug users is one of the most dangerous harms. It is a huge barrier to treatment. A large part of society has viewed and continues to view drug use as a moral failing. Some people who don’t know differently view those who use drugs as weak individuals who lack the moral fiber that makes other people capable of making “good” choices.
In a recent report, the U.S. Surgeon General said, “Few other medical conditions are surrounded by as much shame and misunderstanding as substance use disorders.”
Drug users are vilified in the media. DrugPolicy.org says, “Although drug use and addiction pervade all categories of race, gender, class and age, sensationalized media coverage of drug use has resulted in a popular but inhuman caricature of the typical drug user or addict.”
Consequently, the United States doesn’t dedicate the time and resources to substance use and addiction treatment that it does to other medical conditions such as diabetes and heart disease, even though those ailments are often also caused by lifestyle choices.
Instead, American society criminalizes addiction. The Justice Department’s Bureau of Justice Statistics states that “drug law violations are the most common type of criminal offense.” These drug-related offenses include criminal drug possession or sales, offenses directly related to drug abuse (stealing money for drugs, etc.), or offenses related to a drug-using lifestyle (associating with other criminals)
Incarcerating drug users does nothing to help and only exacerbates the issues that encourage an addicted lifestyle. Many people who currently use or formerly used drugs are excluded from opportunities for employment, education or positions in society because of criminal records.
We support policies and actions that recognize the futility and inherent harm in the senseless criminalization of addiction.
One such effort we support is called the Law Enforcement Assisted Diversion (LEAD) program in Seattle. It gives police officers the discretion to offer non-violent, low-level drug offenders help in the form of treatment and opportunities for housing and employment rather than incarceration.
For more information on the success of LEAD:
View Frontline’s informative and thorough documentary, Chasing Heroin:
Read the Seattle Times article:
Ensure that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them. Affirm drug 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 which meet their actual conditions of use.
For decades, we’ve used the criminal justice system to try to deal with what is really a public health issue. It’s now more evident than ever before that we need change how we approach getting people into treatment and reducing the harms caused by using the legal system to try to deal with a health issue.
Though we are making real progress with programs such as LEAD, we’ve yet to expand harm reduction policies and programs enough to meet even a fraction of the need for effective treatment that exists.
In 2013, an estimated 22.7 million Americans (8.6 percent) needed treatment for a problem related to drugs or alcohol, but only about 2.5 million people (0.9 percent) received treatment at a specialty facility.
Only about 10 percent of people who need help get any type of addiction treatment. Over 40 percent of people with a substance use disorder also have a mental health condition (such as anxiety or depression). Yet, fewer than half receive any treatment for either.
Medication-assisted treatment and other scientifically proven treatment options need to be expanded and made more readily accessible to the large population of people who need them.
Additionally, people who use drugs have an in-depth, real-life intimacy with the negative, harmful effects caused by addiction and the ineffective policies surrounding it. They can relate to and help others who are where they have been. They can share invaluable experiences, strength, and wisdom when designing solutions for reducing harm. A main component of harm reduction is about empowering people and providing choices in when and how they receive treatment, if and when they are ready.
Recognize that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.
As HRC points out, we must meet drug users “where they are at” to help them take actions to reduce harm. People who use drugs are ordinary people who often need help with housing and job placement.
Often for us, this means helping them access social programs and healthcare to improve their chances of success. Inadequate health care stands in the way of many of those who seek treatment for addiction. Drug Policy Alliance reports that nearly 40% of people who wanted drug or alcohol treatment reported they were unable to obtain it because they had no health coverage and could not afford it.
We also advocate for increasing the use and availability of medication-assisted treatment such as methadone and buprenorphine. These and other medications have demonstrated their effectiveness in helping lead people toward healthier living.
Countless other medications are designed every year to block or negate the harmful effects of unhealthy lifestyle choices and brain chemical imbalances. Diabetes medicine, heart and cholesterol medications, antidepressants and mood stabilizers are accessible to those who need them, but addiction medication is not.
We should greatly expand access to medications that reduce drug cravings, block the effects of drug use, and help those with addiction manage their symptoms. We should also increase access to cognitive behavioral and motivational therapies and other evidence-based treatment options that help people who use drugs live healthier lives.
Do not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.
Not all drug use causes harm. But problem drug use tears apart the lives of everyone around it. Left unchecked, drug addiction causes legal, emotional, and physical damage beyond repair. Jobs, relationships, health, happiness, freedom, a bright future – all are lost if addiction is allowed to run its course unchecked.
Friends and family suffer alongside the addict. Communities crumble. Whole families are wiped out physically, financially and emotionally. Relationships are altered and sometimes destroyed forever. Young lives are needlessly lost.
We agree that sobriety and refraining from drug use are critical elements in healthy, happy lives. Our greatest wish is for all of our clients to build successful lives on a strong foundation of abstinence from illicit drug use. Their success will naturally result in stronger, healthier communities.
We believe that the first step is to work together to reduce the harms caused by drug use. We can educate people about the realities of drug addiction and the ineffective policies in place which cause more harm than good. We can leave behind the stigma of stereotypes and enter a new era where addiction is seen as a human condition, not a moral failing. We can reform policies, laws, and treatment methods and base new options on evidence-based research and results.
Harm Reduction International: https://www.hri.global/what-is-harm-reduction
Harm Reduction Coalition: http://harmreduction.org/about-us/principles-of-harm-reduction/
Surgeon General’s Report on Alcohol, Drugs & Health https://addiction.surgeongeneral.gov/
The Harm Reduction Journal: https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0135-4
National Institute on Drug Abuse: https://www.drugabuse.gov/publications/principles-drug-abuse-treatment-criminal-justice-populations/introduction
Inject Hope: http://injecthope.com/get-educated/
National Institute on Drug Abuse: https://www.drugabuse.gov/publications/drugfacts/nationwide-trends
US News “A Blind Eye to Addiction” https://www.usnews.com/opinion/blogs/policy-dose/2015/06/01/america-is-neglecting-its-addiction-problem