Harm Reduction and Overdose Prevention

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Harm Reduction and Overdose Prevention

It’s no secret that drug and alcohol abuse is one of the biggest challenges facing the country. Since 2000, more than 700,000 people have died from drug overdose in the U.S. alone. The federal government has allocated more than $35 billion dollars of its annual budget to drug prevention and treatment in an effort to address the problem, and that’s in addition to the cost of law enforcement and courts used in dealing with drug-related crime.

Drug and alcohol addiction also harms the economy. It’s estimated that companies and families experience $442 billion dollars per year in economic impact due to losses in jobs and productivity from drug and alcohol abuse.

However, the full impact of substance use disorders goes beyond economics to the very heart of our society.

For example:

• Roughly 224,000 people are being incarcerated each year for drug-related crimes. This contributes to prison overcrowding and makes criminals out of people struggling with what are essentially mental health issues.

• 80% of all persons currently incarcerated struggle with substance use disorder. More than one-fourth of all arrests in the U.S. are drug-related.

• Between 400,000 and 440,000 children are born with health and behavioral issues due to maternal drug or alcohol use during pregnancy. That’s 11% of all live births in the U.S.

What’s more, the relapse rate after recovery is as high as 60%.

Why Is Substance Use Disorder So Difficult to Treat?

Anyone who has struggled with addiction knows how difficult it is to quit using. Often, it’s less a matter of willpower than it is the physical and psychological dependence on intoxicating substances and the discomfort that comes from withdrawal.

Substance use disorder is indicated when drinking or taking drugs become the main focus of your life. You become preoccupied with taking your medication, counting pills, and watching the clock while waiting for your next dose or drink.

This can progress to the point where you will continue to use the substance despite negative consequences, such as job loss, breakups, and failure to meet obligations.

Substance use causes changes to your brain that make quitting difficult. Your brain literally cannot function properly without your substance of choice because new connections have been created. This mainly affects dopamine production in the pleasure centers of the brain, serotonin levels, and regions of the brain that regulate impulse control.

Left untreated, substance use disorder also leads to physical and mental health problems. These include:
• Heart and liver disease
• Brain damage
• Kidney disease
• Oral health problems, such as breath odor and tooth loss
• Malnutrition

No one starts out wanting to become dependent on drugs or alcohol. It’s a process that often happens before you know it. Once you’re in the throes of addiction, it becomes even harder to find your way out without guidance and support.

In the meantime, it’s important to reduce harm with safer use and prevent overdose deaths. Harm reduction programs seek to achieve both by a variety of means and methods.

What Is Harm Reduction?

The best way to reduce harm and prevent overdose deaths is to take prescriptions only as directed by your doctor and avoid recreational drug and alcohol use. However, that isn’t very realistic considering the scope and complexity surrounding drug use and substance use disorders.

That means that we should do everything in our power to minimize the risks associated with alcohol and drug use while putting an emphasis on education and planning for long-term sobriety.

Harm reduction is also sometimes called “safe drug use.” Although some critics feel that this method of managing substance use disorder only encourages further use, it has been found to be very effective for minimizing the negative impact of use and preventing drug and alcohol-related death until long-term, sustainable recovery is possible.

The strategies deployed through a treatment approach that includes harm reduction are evidence-based and backed by research. They include access to safe supplies like clean needle exchanges that prevent the spread of HIV and hepatitis, access to naloxone to reverse the effects of opioid overdose, and supervised consumption services.

Even the simple act of taking the keys from someone who is intoxicated is a form of harm reduction. The principle point and mission of this movement is to reduce the health, economic, and social impact of substance use.

How Harm Reduction and Overdose Prevention Programs Work

The approach to harm reduction varies depending on the substance of choice and other factors. For example, the imperative with opioid use is to reduce the risk of overdose. This is especially important considering the new, more powerful forms of opiates and how they’re distributed.

Overdose Prevention and Opioid Use

The opioid crisis has been one of the biggest challenges facing our country over the past 20 years, destroying families and ending lives in record numbers. In fact, opioids were indicated in 70% of drug-related deaths in 2019.

Stronger, more addictive forms of opiates, such as fentanyl and carfentanyl, are so cheap that they’re even being added to recreational drugs, multiplying the incidences of accidental overdose and death.

Therefore, harm reduction for opioid use involves:
• Establishing injection sites, which are facilities where users can obtain clean needles, education about safer methods of use, counseling, and medical attention when needed. It’s important to point out that drugs ate not obtained at these facilities, nor are they administered by workers. Programs like this are already in place and showing favorable results in Canada, Australia, and some European countries. Pilot programs are set to launch in select cities in the US.

• Needle exchange programs (NEP) are places in local communities throughout the U.S. where people can obtain clean, sterile needles and dispose of old needles and syringes. This cuts the risk of infection and prevents the spread of HIV and other communicable diseases. Such programs are also known as needle-syringe programs (NSP) or syringe services programs (SSP).

Medically Assisted Treatment (MAT) is an older approach to opioid treatment, but there are newer methods and drugs used to curb opiate use. The best-known medical maintenance drug is methadone, but naloxone and buprenorphine are also effective and have lower risks of abuse.

Such programs reduce the incidences of death by overdose, drug-related crime, and health risks from IV drug use. They also help users remain in rehab and improve recovery outcomes.

Reducing the Impact of Alcohol Abuse

Harm reduction for alcohol use disorder is designed to help reduce the risk of death due to events like drunk driving and alcohol poisoning. It can also help prevent alcohol-related conditions like heart and liver disease.

Some harm reduction programs and services that deal with alcohol abuse include:

Designated driver programs that vary by community and range from paid services to volunteer driving programs funded by non-profits. On certain holidays that are notorious for excessive drinking, some bars, police departments, and taxi companies will provide safe drivers free of charge and without legal consequences.

Harm reduction, abstinence, and moderation support (HAMS) is a peer-to-peer support program that allows those struggling with alcohol use disorders to set goals based on 17 principles and to curb their drinking habits. In a way, it’s similar to 12-step programs but more personalized and strategic.

Managed alcohol programs (MAPs) were created to reach some of those most affected by alcohol abuse and least likely to seek help: the homeless. Similar to MAT for opioid addiction, participants in these facilities are given housing and just enough alcohol to ward off withdrawal, but not enough to cause intoxication. The goals are to reduce involvement with police and emergency services, get people off the streets and into a safe treatment center, and wean them off alcohol.

Harm Reduction and Stimulant Use

Stimulant use is linked to everything from cardiac problems to tooth loss to psychosis. With such familiar names as meth, Adderall, crack, and powder cocaine, stimulants have also become some of the biggest addiction issues next to opioids and alcohol.

Harm reduction for stimulant use is usually done in the form of street outreach. Mobile units go into areas known for high levels of stimulant sales or users and provide clean syringes, refer participants to treatment services, and perform interventions for those who are in the throes of stimulant-enabled episodes. This includes helping those experiencing extreme anxiety, hallucinations, and delusions. Hydration and nutritional support are also offered to offset health problems stemming from stimulant use.

Minimizing the Harm of Recreational Drug Use

Recreational drugs like ecstasy and marijuana are thought to be relatively harmless and non-addictive. However, they’re still prone to misuse and psychological dependence. An overdose of these substances can lead to hallucinations, risky behavior, and memory problems. They can also contain additives that are addictive and dangerous.

Programs dealing with these drugs range from education about safe use to information and pill testing services. Outreach is also conducted in clubs to help users deal with issues like psychosis, anxiety, and delusions. Referrals are given regarding treatment and educational programs about the dangers of recreational drugs.

Common dangers include:
• Risky behavior
• Higher risk of contracting STDs
• Danger of fetal harm during pregnancy
• Increased risk of driving fatalities
• Sleep and appetite disruption

Help Is Available for Substance Use Disorders

When you or someone you care about is struggling with substance use disorder, it’s difficult to know where to turn for help. The good news is that nearly every community in every part of the country has a combination of public and private addiction treatment centers and programs available.

Such options include:
• Public mental health centers
• Private rehabilitation centers
• Public and private outpatient treatment
• Intensive outpatient treatment
• Medical Maintenance
• Inpatient treatment
• Residential care
• Sober living
• Aftercare

Harm reduction can be a component of any of these other treatment options. The point is to prevent substance use before it becomes a problem and/or mitigate the damage caused by substance use disorders through meaningful recovery options and overdose prevention.

What Prevents People From Seeking Treatment?

Denial is very strong when it comes to substance misuse. You might think you’re functioning fine and that your substance use isn’t really hurting you or anyone else. That might even be true, at least in the beginning.

However, even if you’re able to mask your addiction and function, you’ll probably begin to realize that you have a problem long before your use destroys your life. Unfortunately, the nature of addiction makes it so that the behavior will continue even after your life and substance use begins to spiral out of control.

So, what keeps people from getting help? There are a myriad of barriers to overcome, including:

• Not feeling ready to quit; facing life sober is a daunting prospect, especially if there are root causes that are unaddressed
• Thinking that treatment is unaffordable
• Not knowing where to get help
• Fear of change
• Fear of consequences if people in your neighborhood, your family, or on the job learn of your disorder.

While these are very real concerns, none of these factors should become barriers to wellness. There are solutions available for almost every type of addiction and person needing help.

Legal protections are in place to further reduce harm by preventing excessive life disruptions and removing barriers to treatment. For example, problems like homelessness and job loss can hinder. You while you’re getting help to recover. In fact, the Affordable Care Act (ADA) and Family and Medical Leave Act (FMLA) mandate that substance abuse treatment is covered under health insurance policies and that your job will not be in jeopardy while you’re getting treatment.

With attitudes about substance use disorder changing and multiple organizations coming together to address the issues, finding help to overcome addiction is more accessible than ever. Talk to your doctor or call your local mental health services provider for more information about treatment options.

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Reviewed By:

Dr. John Elgin Wilkaitis

Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Children’s Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.

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