What Is Harm Reduction?
When it comes to drug addiction, harm reduction is a nonjudgmental approach that focuses on reducing the dangers that addiction poses to your health and social well-being. It doesn’t necessarily focus on simply stopping the use of the drug itself.
Harm reduction is a broad concept that’s not limited to opioids. For instance, some examples of harm reduction unrelated to opioids include using a nicotine patch to quit smoking and drinking enough water to avoid getting sick when drinking alcohol. In fact, we use harm reduction every day when we wear a helmet riding a bike or wear a seatbelt in the car.
- Naloxone and similar substances. These medications are “opioid receptor antagonists.” They rapidly block the effects of opioids and last up to about 90 minutes. When taken quickly after an overdose, they can save a person’s life. Narcan is the brand name of the nasal-spray form of naloxone. Evzio is the brand name of naloxone’s injectable form.
- Medication-assisted treatment (MAT). This is the use of medications, in combination with counseling, to help people overcome their addiction. MAT for opioid addiction includes the use of methadone, buprenorphine, or naltrexone. These relieve withdrawal symptoms and physical cravings for opioids. The MAT approach has been shown to help people addicted to opioids survive, stick to their treatment, decrease their drug use and any related criminal activity, as well as find and keep jobs.
- Safe injection sites. Also called overdose prevention centers, these are safe, clean, sanctioned spaces where people can inject under the supervision of a trained staffer who is ready to step in if the person overdoses, instead of having people inject drugs in public spaces like restrooms and parks. This improves public safety as well as protecting the lives of people with an addiction.
- Needle exchange programs. These provide things like sterile needles and safe smoking supplies to drug users, who could otherwise find dirty or unsafe equipment elsewhere. These programs help prevent dangerous infections and reduce the spread of disease.
- Sex education, medication and disease prevention, and testing. These reduce the spread of sexually transmitted and bloodborne diseases like HIV and hepatitis, for which drug users are at greater risk.
- Fentanyl testing strips. These detect fentanyl, a dangerous and very strong opioid that is a key driver of the epidemic and is often found laced in drugs that are bought on the street.
- Support programs. This includes things like counseling and motivational interviewing, as well as connecting people with peer support specialists, sponsors, and case managers. This can help reduce the stigma surrounding drug use and connect people with the services they need.
- Good Samaritan laws. Around a quarter of people who inject drugs report being sent to jail. And while incarcerated, 90% don’t get MAT or other treatment. More progressive laws in many states now allow people to call 911 without fear of arrest if they are experiencing an overdose. Laws around syringe services programs aim to protect users from being arrested for possessing or distributing safe needles and other supplies. Other laws that require users to get treatment, instead of prosecuting them, have been shown to reduce the likelihood of future offenses. Experts are pushing for a big cultural shift away from punishing drug users and instead toward offering them the services they need to get better.
Getting Your Life Back
Caleb Blaschke, from Sioux Falls, SD, tried several attempts at sobriety before he found any success in moving forward from opioid addiction. One thing that made a big difference in giving him the boost he needed was Suboxone, the brand name for a drug that combines buprenorphine and naloxone.
Eric asked WebMD not to use his full name for this story, in order to protect his privacy.
Harm Reduction as a ‘Buffer’
MAT is not a cure, but rather a bridge connecting a person to their recovery goals. By mitigating withdrawal symptoms, MAT lessens a person’s feeling of urgency enough to allow them to hear above what Eric calls “the din of physical addiction.”
Similarly, Good Samaritan laws and needle exchange programs, Eric says, can be thought of as reinforcements for someone who is struggling to quit all on their own, something that is often virtually impossible.
“Given that many of those with active substance use disorders have poor social support networks, these types of services provide much-needed ‘buffers’ that can help those who might overdose, i.e., IV drug users,” Eric says. “Establishing a trustworthy relationship through these means of outreach sets the foundation for more lasting recovery options.” These include getting involved with community recovery centers, MAT, and life skills training.
Barriers to Care
A hard thing about MAT programs, Blaschke says, is that they are not always easy to get into.
In the case of naloxone, the drug is so effective at preventing overdose deaths that experts urge families with loved ones struggling with addiction to keep naloxone or other similar drugs on hand.
“I know [naloxone] works because I saw it used on a friend once,” Blaschke says. “Within 10 or 20 seconds, he was fine.” But it can be expensive, and most people addicted to opioids don’t have it at their immediate disposal.
“If you’re addicted, are you going to spend that on drugs, or a [naloxone] kit?” he asks. “I think it’s very rare someone would pick a kit.”
And although many types of insurance cover naloxone, they are not required to by law. The average out-of-pocket cost for the nasal spray form (Narcan) is about $140, while the injectable form (Evzio) is about $4,000. While $140 may not seem like much to some, it is still far beyond the immediate means of many living in the U.S., where only about half of households have a savings account, and 7 million households don’t have a bank account at all. Also, over half a million Americans are homeless, a number which is almost certainly underestimated. This means that the same people who are at the greatest risk for opioid addiction and overdose are also those who are the least able to access care for it.
The two New York centers reported about 60 overdose preventions in just the first 3 weeks. And rather than encouraging drug use, a concern voiced by those who oppose these sites, research shows that opening these sites actually makes people more likely to seek long-term addiction treatment.
Harm Reduction Works
Drug addiction is not simply a matter of willpower. It is a real, chronic disease that requires treatment.
Reducing the stigma around opioid use is an uphill battle, and it continues to prevent the U.S. from implementing the most effective strategies on a large scale. The nation has made some strides in shifting away from a traditional abstinence-only model of drug addiction treatment to more evidence-based methods. But there’s still a long way to go.
Some officials and even care providers have continued to argue that things like MAT and safe injection sites are a “crutch,” enabling people to stay addicted. But the research shows that harm reduction strategies, though each may not work for every person, have the opposite effect overall.
Harm reduction offers tools and services for people with addiction. Beyond that, it has another critical benefit: It helps shield people from the many life complications caused by addiction. This allows them to stay focused and feel supported while they work towards getting better.
“These forms of harm reduction not only save lives,” Eric says, “but also make the lives of those with substance use disorders less stigmatized and strengthen the possibility of lasting recovery.”