Harm reduction is essential to recovery.
Every month, I sit in on a call with county providers here in Portland, Oregon. I’m a program manager for an agency that provides peer support and recovery mentorship for people struggling with mental health conditions and substance use disorders. On these calls, part of what we do is talk about the numbers. Numbers of people we reached out to, numbers of people getting out of jail and the numbers of folks who have overdosed in that county. The last time we met when we started to talk about the overdose numbers we all knew they were higher. A lot higher. Worse still, I knew that if we were experiencing this in Oregon then the rest of the country was probably in the same place. New numbers support this fear but I also know that there are things we can do today to help slow down the recent overdose explosion.
Brought on by the lethal combination of dwindling treatment options due to COVID-19, economic distress and global anxiety and depression, this new overdose epidemic is one those of us in the field saw coming. It’s felt like an inevitable perfect storm for months and industry-wide, we’ve been bracing for it. Recently, I have seen lots of people personally and professionally relapse. One weekend alone, brought news of three people I know who had all relapsed. According to a piece in the Wall Street Journal, “In a survey of U.S. adults released by the Centers for Disease Control and Prevention, 13% of respondents in June said they had started or increased substance use to deal with stress or emotions related to Covid-19.” The same article reports massive jumps county-by-county across the US in overdoses. In Los Angeles alone, the overdoses jumped up 48% during the first month and a half of the pandemic compared to last year. Last year’s staggering 72,000 drug deaths are expected to be even higher this year. “Suspected overdoses rose almost 18% after stay-at-home orders were implemented across the country in mid-March, compared with the early 2020 period before the pandemic struck, according to data from the Overdose Detection Mapping Application Program, which collects real-time overdose numbers nationally,” the WSJ reported.
Social distancing and closed resources have only added fuel to the fire when people seeking treatment or trying to stop needed help the most. Earlier this month, I watched someone I love try to get into treatment, only to be met with hoops to jump through, wait lists to get on and general uncertainty. Luckily, a series of unheard of treatment miracles lined up and they wound up going to residential treatment but it literally took magic and not reliance on dependable and plentiful treatment options. Lest we forget that COVID testing. Proof of a negative COVID status is required to get into treatment and that also slows down the process. The odds of anyone pushing through the excruciating process just to get into treatment these days are slim to none. A harrowing, recent New York Times article looked at the spike in opioid deaths since the pandemic. It points to grief, isolation and hopelessness as additional causes in of relapse, overdose and death.
As a person who works in the field who also supervises others doing this work, what I can tell you is we need solutions right now. Sure, a magical supply of lower barrier treatment beds would definitely help as would legislation written to help people suffering from substance use disorders, instead of punishing them. But those things take time, time we don’t have. The biggest thing we can do today in hospital rooms, on the streets and online is practice harm reduction. Harm reduction, in my mind, is the only thing to possibly slow down these deaths. Encouraging people to smoke instead of shooting up, helping find clean needles and needle exchanges, reminding friends and loved ones to not use alone and always carrying Naloxone are proven to help cut down on overdoses. It doesn’t end with opioids/heroin/opiates either. Harm reduction strategies can be practiced with meth, alcohol, benzos and beyond.
The big misconception about harm reduction is that it’s telling people that they should go ahead and recklessly use drugs. In fact, it’s the opposite. Harm reduction says your life is of value, whether you use or not. We want to help keep you alive and healthy. This is more than an idea. It’s a movement to help save lives. It’s a philosophy of compassion. The basics, according to The Harm Reduction Coalition, are, “safer use, managed use, abstinence, and meeting people who use drugs ‘where they’re at’.” Most appealingly, harm reduction is a low to no cost idea to help out in a crisis today. Too many times to count, my coworkers and I were forced to have quick conversations with people in the hospital who admitted they didn’t want to stop using. Having practiced abstinence in my own life, I had to get over my prejudices and remember these were humans who deserved dignity instead of my judgment. Once I did that I was able to see that these lives, these humans deserved care like everyone else. The conversation can then shift to productive questions like do have clean water to clean their needles? Do they know where to get syringes? Do they have access to Fentanyl testing strips? While a little awkward in theory, these conversations were usually incredibly powerful and they let the person know I cared about them. But you don’t have to work in a hospital to practice harm reduction and you’ve probably done it already if you’ve ever told a friend not to drink and drive or asked someone from a place of love if they’ve taken the right number of pills.
Harm reduction is a protective measure that isn’t much different from wearing a mask: it can save lives, it can protect communities and if ignored, it can make an epidemic even worse.