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In June 2012, my 20-year-old son, Alex, was released from his first 30-day inpatient drug rehab stint at Father Martin’s Ashley, a treatment facility in Havre de Grace, MD.
I had never heard the term “Harm Reduction.” At the time, my husband and I just listened intently to the counselors who told us that during his stay at their facility, Alex had gained tools to help him stay drug-free and that he would get additional support through attending daily Narcotics Anonymous (NA) sessions and from working the 12-step program. And, since had we arranged for him to go straight to a sober living community in Aspen, Colorado—where he would spend his time working for the Aspen Ski Company and enjoying the great outdoors white water rafting, mountain biking, and skiing—it seemed perfect.
At the time, it seemed so clear that heroin was the enemy, and that lifelong abstinence was an appropriate and achievable goal. We felt confident that Alex was on his way to tackling the addiction monster and living a substance-free life.
But that’s not the way it turned out. Over the next few years, Alex worked hard to stay in recovery, but a relapse sent him to an inpatient program in Minneapolis, and a second relapse to an outpatient program when he returned to Baltimore. Alex’s final relapse came after 2 ½ years in recovery. He was just six days shy of his 28th birthday when he was killed by a toxic fentanyl overdose.
Harm reduction is good public health policy
It seems that in the two years since we lost Alex, harm reduction discussions have been finding their way into the mainstream, no doubt because abstinence-based recovery is clearly not always effective in preventing overdose deaths. Long before the COVID-19 pandemic, the United States faced an epidemic of drug overdoses, topping half a million deaths over the last decade. And COVID-19—both the virus itself and some of the policies implemented in response to it—made the preexisting overdose crisis so much more severe.
Harm reduction recognizes that substance use disorder is a disease and that not everyone is ready to commit to abstinence. It accepts the existence of substance use, and rather than punishing people for using drugs, it focuses on minimizing the harmful consequences of using. A significant aspect of harm reduction is educating people about safer substance use.
Abstinence-based treatment isn’t right for everyone
On the surface, abstinence may seem like the right benchmark. But it’s just not that simple. Abstinence-based programs often have a one-size-fits-all recovery process, as opposed to individualized treatment that meets people where they are to seek recovery without all the shame and stigma attached. One of the biggest criticisms of abstinence treatment is that it frequently has a faith-based component, and not all people are comfortable with that. Opponents also point out that these abstinence programs often kick people out of the treatment facility if abstinence is not maintained. This puts patients out on the street without any support and in grave danger of overdosing. And it completely goes against the understanding that addiction is a disease and relapse is often a part of recovery.
Medically Assisted Treatment for addiction
One harm reduction tool that has become widely accepted now that was never an option in the treatment facilities that Alex attended is Medication-Assisted Treatment (MAT) which includes Suboxone (buprenorphine), naltrexone, and methadone. None of these is a magic bullet, and people who take them can suffer side effects, can misuse them, and can have withdrawals trying to wean off them. But MAT can also help those suffering from addiction hold down a job, raise a family, and lead a more normal life. It can also help prevent them from dying of an overdose.
Reversing overdoses
Another valuable tool is naloxone, commonly referred to as Narcan. This medication helps to reverse an opioid overdose by quickly restoring normal respiration to a person whose breathing has slowed or stopped as a result of overdosing on heroin or prescription pain medication. I know many parents who have lost a child to overdose who always carry this medication with them. I think it’s because we all share the feeling that, although it’s too late to save our child, we might have the opportunity to give another person a second chance—one in which they will perhaps be able to seek recovery and lead a long, productive life.
Addiction shouldn’t be a crime
Today in Maryland you can be arrested and charged with a crime if you are found in possession of certain items that are considered “drug paraphernalia” for your personal use. We need to reverse those laws, and instead adopt public health-centered approaches that treat people with substance use disorders with dignity and compassion. Decriminalizing possession of paraphernalia would also expand access to sterile harm reduction supplies, and put an end to any racial bias in enforcing these arcane laws.
Over the past few years, harm reduction legislation has been introduced in Maryland, and two bills—Senate Bill 420 and House Bill 372—that would decriminalize drug paraphernalia for administration (i.e., supplies used to take drugs and substances)—were working their way through legislation this spring. Unfortunately, SB 420 was recently vetoed by Governor Hogan after passing on both the House and Senate floors. Senator Jill P. Carter, who introduced the bill, is working to overturn that veto.
Safe Use
As drug-related deaths continue to rise dramatically since the onset of COVID-19 , there’s another harm reduction idea that some cities are exploring, and that is the opening of supervised injection sites—where people can go use illicit drugs with trained staff ready to intervene in case of an overdose. Critics say these supervised sites will encourage drug use and crime. Proponents argue that they save lives and can help addicted people reconnect with society and get much-needed health services. Many of these sites are currently operating successfully in other countries with staff to administer naloxone in case of overdose and to provide safe injection advice. They also supply health services information and treatment options for those who are ready to seek treatment.
Before Alex died, it would not have occurred to me to support any of these harm reduction measures. They are contrary to everything I believed about the best treatment options for those suffering from addiction. And I certainly thought my smart, kind, talented, determined son would eventually overcome his “drug problem” and go on to live a long, happy, successful life. But as you now know, that’s not how it turned out.
Isn’t it time we take the fear and shame out of the disease of addiction and provide those who suffer from it compassion, care, guidance, and some harm reduction tools to help prevent more tragic deaths?
Since the loss of her son, Alex, in May 2019, Liz Bement has been working to support harm reduction legislation in Maryland. She lives in the Fell’s Point neighborhood in Baltimore City.
You can learn more about harm reduction here.
If you live in Maryland you may be interested in the Maryland Harm Reduction Network
LITT has free Narcan kits available. Please contact us here to get a free Narcan kit.