Harm Reduction

This week, I plan to cover a subject that is very near and dear to my heart, harm reduction. I had intended to write on another subject this week, but last weekend I helped out with a petition drive. The purpose was to get the federal government to treat the opioid crisis as a public health emergency and to provide a safe supply for those struggling with addiction. I should note that it is not only compassion that drives me to support this. There is another, just as important, reason. Quite simply, it’s because such programs work.

I should probably start out with an admission. I, too, struggled with addiction during my younger years. Currently I am 30 years clean. Yes, this does make me biased on the subject, but it also puts me in a unique position to understand the crisis on a deeper level. My training as a nurse also gives me an understanding on how addiction affects the body, as well as the underlying causes of addiction in individuals.

We see them every day. These people racked by addiction. We avoid eye contact, we clutch our belongings a little tighter, and we quicken our pace to get away. They are seen as dirty, criminals, and we believe that they are responsible for whatever fate befalls them. Their very presence drives us to call for more police, more prisons, as well as stricter laws for drug users and harsher penalties for those that continue to use. We want to feel safer. We want them off of our streets and out of our neighborhoods. This is our gut reaction. The problem is, none of these tactics works, and here’s why.

The reason is that no one chooses to be an addict. No one gets up one day and says, “I want to be a junkie”. When looked at in those terms it seems ludicrous, but this is still the belief held by the majority. Even worse, that belief then directs public policy on drug addiction, which is why we are left with a system that so heavily favors punishment. The reality is that drug addition is almost universally linked to diagnosed or undiagnosed mental health issues. As many as 97% of addicts suffer from schizophrenia, depression, bipolar disorder, PTSD, etc. Many of these people have fallen through the cracks of the mental health system. They become what we call self-medicaters.

In other words, people become addicts for two reasons. One, in an attempt to even their moods out so that they can feel somewhat normal. The second is to escape memories that may be to painful and traumatic to deal with.

As a result, our current drug policies result in the brutalization of those that have already been brutalized. Jail time may help them to be sober or clean out of necessity, bit it reinforces the reasons for why they began taking drugs in the first place. The same, unfortunately, can be said for most drug and alcohol treatment programs. Lack of funding means that most programs are forced to focus on detoxing patients and then sending them on their way. There is no time to delve into the reasons they started in the first place. We end up stuck in an endless cycle of treatment and relapse, which does nothing to either help addicts or to ease the concerns of society. In the end, all they accomplish is to make us all feel better as a society.

Now, we are paying the price for our ignorance. When fentanyl first hit the streets, the death tole was appalling. Then, it just got worse. Because fentanyl is readily available and cheap, more and more was showing up on our streets. A study done last year where I live revealed that 80% of the street drugs examined contained fentanyl. Even the local marijuana was tainted. The medical system was quickly overwhelmed. Paramedics were having to administer narcan multiple times a shift. Hospital visits skyrocketed. Many, many more where found too late to save.

Then, we were hit with covid. Borders were locked up tight as a result. One would think that this would have lowered the drug supply, but dealers are not apt to accept a decline in revenues. Instead, they were forced to become more imaginative. The quality of the drug supply plummeted drastically. As new chemicals were added, the death toll began to rise. For instance, many drugs are now testing positive for Levamisole, which is used as a hog dewormer. In addition, we are seeing an upswing in the potency of fentanyl being used, up to and including carfentanyl. Narcan is simply not designed to deal with any of these scenarios.

In July, B.C. paramedics responded to a total of 2,700 calls for overdoses, which is an average of 87 calls per day. May and June saw a total of 351 deaths province wide, more than double the death toll for the same period in 2019. These totals are greater than those for all homicides, motor vehicle accidents, suicides and covid deaths combined.

So, why harm reduction? Lets forget for a minute that programs such as safe injection sites, needle exchanges and a clean supply have been universally shown to reduce deaths and talk of more practical matters (for those that care more about such things). The reality is that they save money. Our current system of punishment costs us more in policing costs, ER visits, prison costs, inappropriate use of first-responders (fire and paramedics), court costs, etc. For instance, a New Zealand study showed that the cost of harm reduction cost 1$ for every 20$ previously spent on enforcement (The Center for Harm Reduction, 2002). Other studies have found that harm reduction has reduced HIV infections by 94%, saving long term medical costs. This is the same for many other infectious diseases, such as hepatitis. It also results in reduced crime rates as addicts are no longer forced into criminal activity to feed their addiction.

In Canada, just taking police, court and incarceration costs into account, drug enforcement costs Canada 2 billion dollars a year. In 2017, there were a total of 90,625 drug arrests, most for simple possession.

Harm reduction also results in more addicts seeking treatment for addiction, due to the fact that such programs enhance access to more programs. This also saves a great deal in long term costs.

Then there are the costs associated with those for whom treatment is not a viable option. In my career as an emergency nurse, I have seen many that are beyond treatment. Prolonged or successive traumas simply leave them unable to cope with sobriety in any way. For many, there is simply no life beyond addiction, nothing meaningful to go back to. It is sad but it is a reality for many. Harm reduction keeps these people safe. It also keeps them out of the hospitals and jails.

Of course, there are those that still feel harm reduction only encourages addiction. The logic goes that if we make it easier for addicts, then somehow everyone will want to try. As the studies show that addiction is related to mental health issues, it is simply ludicrous to assume that harm reduction is in any way associated with greater numbers of drug addicts. If anything, the reverse is true, as more addicts are encouraged to enter treatment. There is, in fact, no evidence that such programs result in more addicts.

Lastly, there is one other group that can be directly impacted by access to a safe supply. That group consists of those who use drugs but can not be classified as addicts. This includes children, who may experiment with drug use, as well as those who use drugs recreationally. By ensuring that these groups have access to drugs that are not laced with fentanyl or other poisons, we greatly reduce the risk of a death sentence being imposed on people for one-time use. A teenager using pot for the first time certainly does not deserve to die, even for those who might believe that others do.

It is far past time that we put aside our prejudices and look at this crisis logically. With sufficient harm reduction policies, we reduce casualties, reduce associated costs and create meaningful connections with those in our society that are most vulnerable. In the end, it’s the only humane and human thing to do.