There was universal agreement among panelists during a Sunday morning session at the National Conference on Addiction Disorders East about the benefits of harm reduction strategies. They prevent overdose deaths and the spread of infectious diseases, and also better position providers to deliver care when patients are ready for treatment.
Exactly which strategies should be implemented—or what even constitutes “harm reduction”—was where views began to diverge.
In some corners of the field, there is a philosophy that medication-assisted treatment itself is a harm reduction strategy. It’s a view that Brandee Izquierdo, MPA, CPRS, RPS, executive director of the SAFE Project at the University of Baltimore, took strong exception to.
“The language is changing,” Izquierdo said. “If we continue to call it abstinence-based vs. MAT, we’re stigmatizing within the behavioral health system. Abstinence-based should be abstinence-based regardless of whether you are using MAT or nothing at all.”
Among more widely recognized forms of harm reduction, the stances of the organizations represented on the panel regarding the use of supervised injection facilities (SIFs) were mixed, although none of the panelists themselves expressed personal strong opposition. Sgt. Sean Genest, supervisor of the fatal overdose unit at the Anne Arundel County, Maryland, police department said guidance from his department’s upper leadership is that the department will not support places that facilitate drug use or violating criminal law. He noted, however, that Anne Arundel County police could have a change of heart as more data becomes available.
Similarly, in the absence of enough compelling research from other countries where supervised injection facilities are used, particularly Canada and Portugal, the Substance Abuse and Mental Health Services Administration favors pursuing other harm reduction strategies first, at least for now, said SAMHSA chief medical officer Neeraj Gandotra, MD.
“As far as the leadership within the organization goes, the position is that we can support syringe exchange programs, but the idea of supervised injection, some people have not come around to that,” Gandotra said. “I can understand that. There is a lot of stigma still attached to addiction and viewing it as a behavioral issue, not a health issue. They do decrease the spread of infectious disease, having a safe place engage in that.
“Personally, I may not have a strong opinion against it, but as far as the Substance Abuse and Mental Health Service Administration, right now, we believe the other forms of harm reduction should be utilized first.”
Izquierdo said first-hand experience in a supervised injection sites can be the most moving way to change attitudes toward the facilities. SIFs are more akin to health clinics than opponents might think from afar, she said.
The panelists concurred that syringe exchanges are also effective at reducing the spread of infectious diseases, but Dean Drosnes, MD, FASAM, associate medical director for Caron Treatment Centers, acknowledged that for cash-strapped communities, funding such programs can be a tough call.
“The data is very clear with the studies that have been done looking at the reduction in the prevalence of HIV and Hepatitis C,” Drosnes said. “Syringe exchanges do decrease the spread of these infectious diseases. That’s the point.
“When arguments come up about whether to continue them, they’re labor intensive, there’s no question about it. There’s a lot of work that goes into it, and resources to treat addiction are always limited. So, where are you going to focus your efforts? Are you going to focus your efforts on cutting down on addiction or are you going to focus your efforts on trying to cut down some of the consequences? But as far as knowing do these syringe exchange programs decrease these devastating infectious diseases, there’s no question that they do.”