Today I was doing some research for the Expectant Mothers Treatment Program (EMTP) when I came across an article about a pilot perinatal addiction clinic called the Perinatal Addiction Treatment Clinic of Hawaii. The more I read about it, the more it sounded like our own EMTP. Just like us, they are based on a harm reduction model, and encompassed perinatal care, transportation, social services, family planning, and addiction medicine, which we also cover in the program. There were a few differences between our treatment programs: their center only accepted pregnant women addicted to methamphetamine (MA) because MA abuse is so prevalent in Hawaii, while we accept pregnant women addicted to any substance. Also, they offer childcare services, which we currently don’t offer, but hope to in the future. Otherwise the structure of each program was pretty much the same-we’re both harm reduction models in slightly different ways.
There are a lot of ways of thinking about the harm reduction strategy. I know some people may read it or hear it and immediately assume it has a negative connotation, that it involves supporting or helping people use illicit drugs. That is not the case. According to Harmreduction.org, the definition of harm reduction is “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”
After reading the rest of the article, I was struck by how much attention the term “harm-reduction” has gotten lately. In the news, cities like Philadelphia already approved safe injection sites in January 2018. After reviewing the harrowing facts about the opioid crisis and reviewing numerous feasibility studies, city officials approved the measure and now face the challenge of how to run them, manage them, and where to build them. “”There are many people who are hesitant to go into treatment, despite their addiction, and we don’t want them to die,” said Dr. Thomas Farley, Philadelphia’s health commissioner and co-chair of the city’s opioid task force. Supervised safe injection sites, he said, save lives by preventing overdose deaths and connecting people with treatment.”
Cities like San Francisco and Seattle have also declared their intention to open safe injection sites, and New York City is right behind them. Mayor Bill DeBlasio recently declared support for the harm reduction plan that has been considered successful in Canada and Europe. According to the New York Times, the plan would be for 4-6 sites to open after a 6-12 month period of outreach to the communities in which they would operate. They would still only operate as a pilot program for the first year. William Neuman of the New York Times outlines the plan for pairing using with treatment: “At the sites, which would be called Overdose Prevention Centers, trained staff would be available to administer medications, such as naloxone, to counteract drug overdoses. Social workers would also be on hand to possibly counsel drug users in the hope that they could be steered into programs intended to help them with their addiction.” New York city is one of the largest cities in the U.S., and saw over 1,000 overdoses last year. I think having social workers, counselors, clinic staff and treatment teams available is absolutely necessary for this exchange to work. We cannot passively sit and watch people engage in illicit drug use. Employees would have to monitor them for overdose and provide information about treatment options. What would be even better is having people on hand to enroll people into treatment programs. The problem is, if they have a “safe place” to use, why bother going to treatment? I’m sure some will see it that way. But I’m hopeful others will be open to trying programs for substance abuse. Many users often wish they had the help to get sober because they don’t think they can do it alone. This is our chance to engage with them.
Also in New York, harm reduction was introduced in yet another formation: a high school recently tried the harm reduction approach while educating kids about drugs. Author Victoria Kim explains, “the curriculum was designed to discourage substance use, but to also acknowledge the possibility that some kids will choose to experiment. Students are taught how to be safe even if they choose to use drugs and alcohol.” Administrators believed the harm reduction approach would work better with young people today, who have access to everything through the internet. In support of their decision they gave this example: “”abstinence-only education may tell young people that they should refrain from using drugs because they could overdose,” explains the Drug Policy Alliance. “Harm reduction drug education explains how to recognize the signs of drug overdose, how to respond and how to get help if they fear that a friend is overdosing.” School officials believe arming kids with knowledge about real circumstances they may face is more logical than simply advising avoidance of drugs altogether. Chances are, with how much of the population uses substances (as of 2016, 28.6 million US citizens aged 12 and older used drugs in the last month, according to drugwarfacts.org), you will at one time or another have an encounter with drugs. It may be passive, like helping someone who takes them or working with people who take them. But for some, it will be active, such as through experimentation. This high school would rather have you know how to stay safe around them or using them than bet on you avoiding them altogether and crossing their fingers.
So it sounds like people are realizing through the opioid crisis that past strategies are no longer effective in keeping people away from drugs, and new ideas and approaches need to be tested. A principal central to harm reduction is “understanding drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.” So how does the Expectant Mothers Treatment Program fit the harm reduction model? We help pregnant women who are drug users safely use Medication Assisted Treatment, which in our case is a drug called Buprenorphine, to wean themselves off of their drug of choice. So, is Buprenorphine a totally safe substitute medication for mom and baby? No, it has potential health consequences for both, which is what makes it harm reduction. In a perfect world pregnant women wouldn’t have to take a drug like Buprenorphine, but if you are addicted, it is safer for mom and baby to take that than the mother continuing to use drugs or going through symptoms of withdrawal while pregnant, which could cause damage to both mom and baby. Harm reduction isn’t ideal by any means. I would call it compromise in a time where drugs have become so prevalent. Users suffer in many ways when they use drugs-they could lose their social support systems, have relationship difficulties or domestic violence, engage in poor nutrition and health habits, be at risk financially, lose their shelter or ability to work, be forced to cope with mental disorders alone, lose self-esteem and self-worth. If that is the choice, between someone going back to that kind of life or using a harm reduction model, I would side with the strategy that can save lives, not endanger them.
1. Implementation and evaluation of a harm-reduction model for clinical care of substance using pregnant women
By Tricia E Wright, Renee Schuetter, Eric Fombonne, Jessica Stephenson and William F Haning III
Harm Reduction Journal, 2012. 9-5.
2. What’s Next For ‘Safe Injection’ Sites In Philadelphia? by Elana Gordon for NPR.com
5. New York High School Tests New Harm Reduction Drug Education Course by Victoria Kim, 4/18/18
6. Harm reduction definition: http://harmreduction.org/about-us/principles-of-harm-reduction/