24 May Harm Reduction: Keeping Them Alive for the Miracle

This guest blog entry is by Kenneth Anerson, the founder and CEO of The HAMS Harm Reduction Network and the author of How to Change Your Drinking: a Harm Reduction Guide to Alcohol.

Please note that the opinions presented in the article are that of the author and not necessarily the opinions of RHN. RHN chooses to publish articles and share individual sites to evoke discussion and show all options, ideas and beliefs.

Some people seem to think that harm reduction is simply “enabling” people to use drugs or alcohol. Nothing could be farther from the truth. Harm Reduction enables people to recover from addictions. It does this by enabling people to survive their drug use and helping them to keep their resources intact. The research shows that the more resources people have intact, the better their chances of beating an addiction (Peele, 1992).

The research also shows that the majority of people eventually overcome addictions. The NIAAA (2009) tells us that three fourths of people will overcome alcoholism within 20 years of its onset. The NIAAA also tells us that abstinence and AA are not the only way to beat an addiction, Seventy-five percent of alcoholics recover on their own without rehab or AA. Over half of those who recover from alcoholism do so by cutting back instead of abstaining totally.

Some of the harm reduction resources which can help people survive their addictions until they recover include the following:

SAFE INJECTION FACILITIES

Insite, located in Vancouver, British Columbia, is North America’s only safe injection facility. Insite has been rigorously scientifically studied by many researchers and a summary of the results has been published by the BC Centre for Excellence in HIV/AIDS (2009). We have learned the following:

Insite does not lead to an increase in illicit drug use or relapse. Insite leads to a decrease in the number of publically discarded syringes. Moreover, drug users who use Insite to inject drugs are 70% less likely to share syringes than drug users who do not use the facility.

Insite prevents death from overdose. A study which reviewed overdoses at Insite found that there were 336 overdoses in an 18 month period. Because of the medical response at Insite not one of these overdoses was fatal. This is a good thing because dead addicts don’t recover.

Drug users who used Insite were more likely than other drug users to enter detoxification or a drug treatment program. Individuals who used Insite at least weekly were 1.7 times more likely to enroll in a detox
program than those who visited the center less frequently. Contact with Insite’s addictions counselor also significantly increased a person’s chances of enrolling in detox.

SYRINGE EXCHANGE

In Australia syringe exchange has been widely available with government sanction and funding since the mid 1980s which has helped make it easy to do in-depth study of the effects of syringe exchange in Australia. The Australian National Council on Drugs (2006) tells us that by the year 2000 Australian syringe exchange programs had prevented an estimated 25,000 HIV infections and 21,000 hepatitis C infections and saved between $2.4 and $7.7 billion. They go on to state, “Needle exchange programs do not increase drug use and they get injecting drug users into treatment earlier. Indeed nearly all drug users stop using drugs at some point, particularly when treatment is readily available, and needle exchange programs have ensured that when people reach this point they are not also burdened with being HIV positive. This has immeasurable benefits for the families and loved ones of drug users.”

The World Health Organization also endorses the effectiveness of needle exchange programs (WHO, 2004), so it is a shame that needle exchange programs in the US must rely only on volunteers and private funding to get things done. So many more lives could be saved if the US would adapt a national syringe exchange program like that of Australia.

MAINTENANCE THERAPY – METHADONE – BUPRENORPHINE – HEROIN

Methadone is used as a replacement therapy for heroin and other opiates. Methadone is taken orally instead of injected and one dose lasts a full day. Methadone is generally distributed at methadone clinics in the US. Methadone relieves the craving for heroin or other opiates, but methadone does not interfere with ordinary activities such as driving a car or operating machinery.

According to the Office of National Drug Control Policy (ONDCP 2000), Methadone Maintenance Therapy has a significant effect in reducing the spread of HIV/AIDS infection, hepatitis
B and C, tuberculosis, and sexually transmitted diseases. Methadone Maintenance Therapy decreases heroin use by 69% and decreases criminal activity by 52%. Methadone Maintenance Therapy costs about $13 per day. Incarceration costs about $62 per day (U.S. Bureau of Justice Statistics).

Buprenorphine is another replacement therapy drug which has all the positive effects of methadone (SAMHSA). Buprenorphine in the form of Suboxone has far less potential for abuse than methadone or opiates like heroin and can be prescribed for take home which is far more convenient for clients than having to come to a methadone clinic every day for their dose. This is because Suboxone consists of a combination of the partial opioid agonist buprenorphine and the opioid antagonist naloxone. Suboxone is intended to be taken sublingually, in other words under the tongue. Since naloxone cannot easily pass the mucous membrane layer under the tongue the client gets only the effect of the buprenorphine which eliminates opiate cravings. If the client attempts to crush and inject the Suboxone then the naloxone will have its full effect and precipitate opiate withdrawal. Hence, Suboxone is safe from being abused by injection. Moreover, since buprenorphine is a partial agonist rather than a full agonist there is a plateau effect–once the opiate cravings are at bay, increasing the dose of Suboxone does not increase its effect.

Heroin Maintenance Therapy has been used with great positive effect in Switzerland and elsewhere to treat addicts who have not been successful with other forms of replacement therapy such as Methadone Maintenance (Fischer, et al 2007). Heroin Maintenance has proved effective in reducing illicit heroin use, risky injection behaviors, and crime among injecting drug users. Perhaps surprisingly, Heroin Maintenance often leads to stable abstinence or Methadone Maintenance for users who were previously unsuccessful with abstinence or methadone.

HARM REDUCTION SELF-HELP MANUALS AND SUPPORT GROUPS

The Harm Reduction Therapy Center (HRTC) in California offers a harm reduction self-help manual called Over the Influence (Denning et al 2004) with a primary focus on harm reduction for drug users. The HAMS Harm
Reduction Network offers a harm reduction self-help manual called How to Change Your Drinking (Anderson 2010) with a primary focus on harm reduction for people who drink alcohol. Both of these manuals rely heavily on evidence-based, behavioral change exercises to help drug or alcohol users make positive changes in their using habits. HRTC has long offered live user support groups in California and HAMS offers live harm reduction support groups for drinkers in New York City as well as online support groups worldwide. Many harm reduction agencies in other parts of the US also offer harm reduction based support groups. For people who are unable or unwilling to abstain completely these resources can be lifesavers.

REFERENCES:

Anderson K. (2010). How To Change Your Drinking: A Harm Reduction Guide To Alcohol. The HAMS Harm Reduction Network, New York.

Australian National Council on Drugs (2006, 13th November), Australia commemorates 20 years of needle syringe programs.
http://www.ancd.org.au/news-and-announcements-2006/australia-commemorates-20-years-of-needle-syringe-programs.html

BC Centre for Excellence in HIV/AIDS (2009). Evaluation of Vancouver’s Pilot Medically Supervised Safer Injection Facility Insite.
http://uhri.cfenet.ubc.ca/images/Documents/insite_report-eng.pdf

Denning P, Little J, Glickman A. (2004). Over The Influence: The Harm Reduction Guide For Managing Drugs And Alcohol. Guilford Press, New York.

Fischer B, Oviedo-Joekes E, Blanken P, Haasen C, Rehm J, Schechter MT, Strang J, van den Brink W. (2007). Heroin-assisted treatment (HAT) a decade later: a brief update on science and politics. J Urban Health. 84(4):552-62.
http://www.ncbi.nlm.nih.gov/pubmed/17562183
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219559/pdf/11524_2007_Article_9198.pdf

NIAAA. “Alcoholism Isn’t What It Used To Be.” NIAAA Spectrum. Volume 1, Issue 1, September 2009. http://www.spectrum.niaaa.nih.gov/media/pdf/NIAAA_Spectrum_Sept_09_tagged.pdf

ONDCP (2000). Methadone Fact Sheet.
http://www.whitehousedrugpolicy.gov/publications/factsht/methadone/index.html
Retrieved April 27, 2011.

Peele, S. (1992). Truth About Addiction and Recovery. Fireside.

SAMHSA. About Buprenorphine Therapy.
http://buprenorphine.samhsa.gov/about.html
Retrieved April 27, 2011.

U.S. Bureau of Justice Statistics. “Expenditures/Employment”
http://bjs.ojp.usdoj.gov/index.cfm?ty=tp&tid=16
Retrieved April 27, 2011.

World Health Organization (2004), Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users
http://www.who.int/hiv/pub/prev_care/effectivenesssterileneedle.pdf