August 25, 2008

Harm Reduction

Still Dreaming has been blogging about supervised injection sites and ways that we deal with addiction for the past few posts over at her site. She's written a great analysis and raised some very good questions.

Harm reduction is a concept near and dear to me. I was introduced to it by my social work education and I'm sure that if you had told me about it before I started my BSW, I would have been against it. However, I've learned a lot about it over the past year or so and am in full support of it as one of the four pillars of the Four Pillar Drug Strategy.

Recently, I came across an article about a program called NAOMI, which is described on their site as "a clinical trial that tests whether heroin-assisted therapy benefits people suffering from chronic opiate addictions who have not benefited from other treatments".

Some of the operative terms in there are "chronic" and "not benefited from other treatments". The criteria to get into this study was very stringent. You had to have been a continuous opiate addict for more than five years, you had to have attempted methadone maintenance treatment more than once, you had to be over 25 years of age and be a resident of the downtown eastside of Vancouver, Canada's poorest postal code neighborhood. In other words, they wouldn't let just anyone into the program. Only the worst off.

Rather than post the whole article, I will give you the chance to visit the site that offers it and instead, I will post some of the more pertinent bits of information here. You can find the article HERE.

This part points to the why and how of effectiveness of providing heroin to chronic injection drug users:
The research team has heard stories about women who no longer turned to prostitution for drug money, Schneiderman said. Some participants said they had stopped committing crimes in order to buy heroin, and others had found employment.
So there's one benefit. Women who are addicted generally turn to prostitution to feed their habit and survive. Survival sex. By providing heroin, by prescription, this lifestyle would no longer be a necessity. The whole day would not be wasted trying to earn enough to feed the habit. The day could be spent turning a broken life around. This is described here:
"This is the first time that I've gotten up in the morning and the first thing that I didn't think about was where I was going to get my next fix,"' she said. The study provided a reminder that for addicts, that next fix is the focus of their entire day, she said; when that need is removed, they have time to focus on other ones, like employment, housing or relationships.
Here's a little bit about harm reduction in the early 20th century in the USA:
Prescribing heroin to addicts is not a new idea. Several prescribed morphine and heroin clinics ran in the United States from 1919 until 1923, when the government shut them down.
Holy crap, who knew? The leaders in the War On Drugs provided this type of care? Wow.

The whole of harm reduction boils down to this quote by Dr. Martin Schechter:
"I think it's just unrealistic to think that without this study, they would not be using drugs," Schechter said. "So the question then becomes, how and where do you want them using them?"
While the quote can come off a little bit paternalistic, it holds the essence of harm reduction. I don't believe that chronic addicts want to be living the lifestyle that they are living. They are in pain. They are suffering. They sometimes just don't know any other way. By accepting them for who they are and what they do and helping them find this other way through education and guidance, maybe they can find their way out of the muck.

I encourage you to read the article (and even opposing articles!) and make up your own mind.



bluejeansocialwork said...

Thanks, antiSWer, for the background. It's so helpful to those of us who encounter substance abuse only on the fringes of what we do. I also love your inclination toward research and solid stats. Sound research is the basis of all interventions with any integrity.

cb said...

Thanks for that, it's very interesting stuff. On a gut level I tend to work on a very pragmatic/utilitarian level. I think there's no doubt these programmes are ideal for some people there are very far from an 'easy' option. But I think that's pretty much the conclusion you've come to.

Reas Kroicowl said...

"Holy crap, who knew? The leaders in the War On Drugs provided this type of care? Wow."

Yeah, we actually had enlightened government at one point.

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