‘Harm Reduction’ alternative can save lives
I was startled and shocked by the front page headline April 15: “Overdose deaths rising.” Then came the outrage and finally the sadness at the waste of human life and the trauma for those left behind.
The really sad part is that there is an evidence-based alternative available that would protect substance use disordered people (addicts) from the all-pervasive fentanyl. That alternative goes under the name of Harm Reduction in its fully developed form.
Oregon has some aspects of harm reduction in place. Measure 110 was a step in the right direction, but the next steps are crucial to actually saving lives.
Not all people who use drugs are necessarily disordered, but are able to use and to function. Some who use illicit drugs come from the street and some come from the doctor’s office, having been denied adequate pain management. We do have methadone and buprenorphine (Subutex) as viable alternatives that are fentanyl-free and don’t provide a high but do keep withdrawal symptoms at bay. Obviously for various reasons this has not been the complete answer.
What has proven effective for preventing fentanyl are medically supervised injection sites or overdose prevention centers. Here people bring in their own substance which can be tested for fentanyl so the risk is known and the medical help for overdose is there if needed. However, people will get high with this method. And that is where the focus shifts from saving lives to how it looks: optics.
Critics claim that they are suggesting medically sanctioned shooting galleries and “enabling” users. This is where the stigma is operating. It is as though they are saying that if you are going to use to feel good perhaps you should be willing to take the risk to your own life. Essentially, “You’re an addict and we don’t care if you die.” See John Oliver, “Harm Reduction,” March 27, 2022 and “Harm Reduction Expert Reacts To Last Week,” both on YouTube.
The critics are reacting to gut-level beliefs about what is right and what is wrong as opposed to outcome studies, which clearly support the idea. People don’t die using overdose prevention centers, and live long enough to quit another day. If you disagree, please share the evidence that supports your position.
There is one more step we could take to keep users safe from fentanyl. Give them pharmaceutical-grade heroin.
Again, this idea triggers a powerful reaction, but where it is being done, users stay alive and many quit using. Also on Youtube, see Ed Bradley’s report broadcast on “60 Minutes” Dec. 27, 1992, Legal Heroin for Addicts in Liverpool 1990s. That was 30 years ago! Think of the lives that could have been saved if we could have really listened to the evidence presented. I also recommend Maia Szalavitz’s “Undoing Drugs” and “Unbroken Brain,” as well as “Chasing the Scream” by Johann Hari.
Michael Rhoades is a board certified alcohol and drug counselor who moved to Roseburg after losing his home in the Almeda fire.