Harm reduction strategies: Helpful or irresponsible?
Recovery Centers of America
The case for harm reduction strategies
White paper
Date: September 2019
Author: Dr. Deni Carise, Chief Scientific Officer, Recovery Centers of America
Background on harm reduction strategies
With knowledge that not everyone with a substance use disorder will seek and find recovery, harm reduction initiatives in the United States and abroad have aimed to minimize the damage drug and alcohol use can cause. In addition to needle exchange programs, other notable public health initiatives have included a state-funded safe space for alcoholics to continue drinking, a New York City Department of Health pamphlet on heroin injection that minimizes risks of infection, and the availability of safe injection sites. These initiatives remain controversial, as objectors inaccurately argue that they condone or even encourage substance use.
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Position
Although harm reduction is aimed at individuals who want to continue using drugs, Recovery Centers of America believes that such strategies should always provide and promote access to treatment. The organization opposes harm reduction provided in isolation, which can cause further harm to the individual user for a perceived benefit to society (helping to prevent the spread of infectious diseases, providing places for drinking or using drugs to get users off the streets, etc.). There is no good reason to help one to the exclusion of the other. Harm reduction strategies that promote or encourage treatment benefit both the individual and society. And happily, almost all harm reduction efforts include other vital services (medical attention, social services) as well as offers of treatment for the substance use disorder.
Rationale
People suffering the devastating effects of substance use disorders cannot change their lives overnight. Programs that provide them with a sheltered space away from the streets—or a method of using drugs that minimizes the likelihood of infectious disease and overdose—can be a first step in the process. However, substance use can never be safe; therefore, harm reduction in isolation is inadequate and irresponsible. These strategies should be integrated with a variety of services within a continuum of care that helps individuals move from a life of chronic addiction to recovery.
Supporting Facts
Left untreated, injection drug use and alcoholism can cause irreversible physical damage. Heroin abuse is associated with serious health conditions, including fatal overdose, pulmonary complications, and infectious diseases such as HIV/AIDS and Hepatitis. Alcoholism increases a person’s risk of certain cancers, stroke, and liver disease. It can also lead to Wernicke-Korsakoff syndrome, commonly known as “wet brain,” in which a person loses frontal lobe function. The mortality rate for late-stage wet brain is 20 percent.
Harm reduction strategies that include the offer of a continuum of care can remove barriers to treatment. A New England Journal of Medicine study found that clients at Insite, a safe house for injection drug users in Vancouver, also increase their use of detoxification and withdrawal services. Insite is part of a larger organization that also provides residential treatment, opioid replacement therapy, and prevention, among other services.
Resources
“NIDA InfoFacts: Heroin.” National Institute on Drug Abuse. March 2010: http://www.nida.nih.gov/infofacts/heroin.html
Carise, Deni. “Are Wet Houses Causing Wet Brains?” Phoenix House blog, 2011
Carise, Deni. “A Stronger Case for Vancouver’s Drug ‘Safe House.’” Phoenix House blog, 2010: https://www.huffpost.com/entry/a-stronger-case-for-vanco_b_474106.
“NYC Health Department Issues Heroin Booklet.” My Fox New York, 2010: http://www.myfoxny.com/dpp/health/100104-nyc-health-department-issues-heroin-use-booklet. 15 August 2011.
Talking Points
Do harm reduction strategies provide a false sense of comfort about drug use?
Effective harm reduction strategies educate and offer many additional services including education and referral to treatment. Harm reduction is a rung on the ladder, rising up from chronic addiction, to decreased use with fewer health risks, to treatment, to sustained recovery. In its second year of operation, Vancouver’s Insite provided 2,000 referrals to treatment and other services to clients who were initially uninterested in treatment. However, New York City’s controversial heroin pamphlet was a less balanced initiative, offering numerous tips about how to properly inject the drug and far fewer tips regarding how to find treatment.
Why support one harm reduction model over another?
Successful harm reduction programs usually share similar goals—to decrease harm to the public and the user, and to keep options for treatment and recovery visible and available. For instance, clean needle exchange programs provide users with sterile needles in exchange for their used ones and always offer referrals to medical, psychiatric, and substance abuse care. The availability of a “wet house” for alcoholics, on the other hand, does nothing to decrease the continuing brain damage resulting from long-term, ongoing, heavy alcohol use—nor does it lead to engagement in any form of treatment.
Will drug users who participate in harm reduction programs lose hope that they’ll get better?
Harm reduction initiatives (like the “wet house” noted above) that are not accompanied by the offer of support groups or treatment, tend to leave participants feeling even more hopeless. Individuals struggling with substance abuse problems must be reminded that people can and do get sober no matter how long they’ve been using. If this message is not conveyed, the strategy will not give hope; instead, it may cause some to give up.
Counterclaims
Myth: All harm reduction strategies encourage drug use and perpetuate addiction. Research has shown that harm reduction programs like Vancouver’s Insite, which operate as part of a broad continuum of care, have actually motivated more people to seek treatment. Effective standalone programs always offer treatment and support services while also helping prevent some of the consequences of long-term drug use—such as HIV in the case of IV drug users.
Myth: By minimizing the damage drug users cause, harm reduction strategies cut health care and other costs. The costs of harm reduction initiatives that do not offer referrals to treatment may outweigh their potential benefits. For example, healthcare costs of residents of an alcoholic “wet house” were reported to be 53 percent lower in the first six months of participation compared to heavy drinkers on the wait list. However, this figure did not take into account the significant healthcare costs of alcoholics with wet-brain. Without treatment, long-term alcoholics develop serious health conditions that eventually require 24-hour nursing care.
Myth: Some individuals with substance use disorders are beyond help and will never benefit from treatment. Although some may not seem ready or willing to quit using, recovery is always possible. At Recovery Centers of America, we have seen patient’s find lasting sobriety after using for decades. For this reason, a harm reduction strategy should never be an end in and of itself. It is never too late for treatment and recovery.
