An emerging new model, harm reduction, challenges our current strategies for managing the opioid and substance use epidemic. This approach combines compassion and pragmatism for a realistic approach to a complicated problem.
The American Journal of Public Health in 1995 endorsed the concept of harm reduction, a model that aims to mitigate or reduce the negative effects of substance use, whether legal or illegal, rather than trying to stop it altogether or all at once. These negative effects include not only the spread of blood-borne diseases like HIV and hepatitis C from sharing needles, overdose deaths, homelessness and overcrowded jails, but also, on a larger scale, the chaos, carnage and killings — more than 60,000 in Mexico alone in five years — caused by our war on drugs.
Syringe exchanges and supervised injection sites are just two examples of harm reduction strategies. In fact, in Vancouver, British Columbia, where a supervised injection site opened in 2003, has seen a dramatic decrease in new HIV and hepatitis C infections, and the city’s injection site has seen zero overdose deaths among the more than 3.6 million clients who have used it since 2003. Further, easy access to naloxone, which reverses opioid overdoses, can and does prevent overdose deaths.
Resistance to these common-sense programs persists despite an abundance of evidence supporting their effectiveness. “The evidence is overwhelming that needle-syringe exchange and safe injection facilities work, save lives, are cost-effective, and prevent new infections,” Chris Beyrer, president of the International Aids Society and director of Johns Hopkins Center for Public Health and Human Rights, said in 2015. In addition, syringe exchanges and supervised injection sites are likely the only contact many users will have with referrals to treatment centers and other help. Finally, treatment programs that don’t expel clients who relapse, and provide renewed access to treatment are most effective.
Harm reduction essentially challenges our current medical models that label all illicit substance use as abuse, as well as our moral code that considers substance use as bad and makes it illegal.
At the center of substance use policy failures is our disastrous war on drugs. The oppression of people of color and the poor gives the government a convenient bludgeon of control. And, just as in the U.S. experiment with alcohol prohibition, the results are an exponential growth in violence from organized crime and gang warfare. Since the war on drugs escalated under Presidents Richard Nixon and Ronald Reagan, more than $1 trillion has been spent to stop drug use, and the problem is worse than ever. As long as substance use is a law enforcement issue and people who use drugs are stigmatized as criminals, there can only be bandages but no cure.
The obvious solution is to legalize all drugs and regulate them just like Colorado, Washington and Maine have done with marijuana. However, decriminalizing drug use might be a first step in overcoming a century of bias and misleading information. This will take people who use substances and those with substance use disorder out of the criminal-justice system and make it a health issue.
For the last 18 years, all drugs have been decriminalized in Portugal, and the sky has not fallen yet. None of the fearful projections of a drug-crazed society have materialized. In fact, Portugal has seen a decrease in HIV infections and drug overdoses. Further, drug use among 15- to 24-year-olds has declined, and the level of drug use in Portugal is below the European average.
In addition, crime and incarceration rates have fallen dramatically, freeing funds for treatment. Treatment is the standard in Portugal and vans with clean syringes and methadone make access easy. Legalization in Portugal is likely on the horizon, but until the heavy-handed policies of the U.S. war on drugs are changed, the rest of the world fears the sanctions dramatic changes would bring.
Decriminalizing drugs, and making their use a health issue would free us from a stigma-burdened treatment system, empty our jails and prisons of tens of thousands of inmates, radically reduce crime and incarceration, free money for common-sense strategies for the substance use crisis, and begin to put us on the path to evidence-based strategies that are part of harm reduction.
Arthur Barry Adoff of Veazie is a writer and recent graduate of the University of Maine School of Social Work’s master’s program. Maine Health Equity Alliance’s Keep Calm and Carry Naloxone Campaign invites the public to an observance of International Overdose Awareness Day 5-7 p.m. Friday at Pickering Square in Bangor.
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