Harm Reduction
On February 26, the Sunday New York Times devoted most of its Sunday Opinion section to “One Year Inside A Radical New Approach to America’s Overdose Crisis”. Authored by Jeneen Interlandi, this thoughtful and very thorough article describes the concept of Harm Reduction and utilizes actual programs based in New York City to illustrate its implementation. In the opinion section, the Times Editorial Board also added “America Has Lost The War On Drugs. What Now?”
Harm Reduction focuses on reducing the most harmful effects of drug use, rather than try to eliminate it. We have proven that we cannot eliminate it, so its time to try something else. A few years ago, someone in recovery explained it to me as: “Dead addicts don’t recover”.
Harm Reduction is not a new concept. Decades old data shows that these programs significantly reduce overdose deaths and increase peoples’ participation in treatment. Some studies show that people are five times more likely to enter treatment than those not involved with these programs. An example of an older Harm reduction program is Methadone treatment. Newer models are the use of Narcan and clean needle sites.
The strength of Interlandi’s story comes from the personalization. Although research and data is cited, we are introduced to the workers in the programs and the people with addictive disorders who are struggling to stay alive.
“More Americans are dying of overdoses than at any point in modern history”. Current estimates are 100,000 per year and 40 people per day in New York City.
The Editorial Board notes that there are not enough trained clinicians, in any discipline, to assess and treat substance use disorders. In Massachusetts, there are no graduate level programs that specialize in assessing and treating substance use disorders. I have been working with colleagues within the Massachusetts state university system to develop a Masters level program specializing in substance use and addiction. It has been over five years and we finally launched a pilot last year out of the Bridgewater State University School of Social Work. This post graduate certificate program provides 18 hours of focused training and will hopefully serve as proof of concept for a thorough MSW in this area. Bridgewater is the first graduate school of social work to provide a specialization in Harm Reduction, through a partnership with the RIZE foundation. The organization where I am Clinical Director, Square Medical Group is one of the internship sites for the RIZE scholars and partnered with Bridgewater to develop this program.
The Editorial Board also notes that what many people need, in addition to treatment is housing, mental health care and help with job placement.
The Bureau of Substance Addiction Services in Massachusetts has a proposal to address these problems and is contracting with service providers to provide “Low Threshold Housing”. Based on a proven Harm Reduction model known as “Housing First”, this program provides basic housing for people, without a requirement of abstinence from drug use. The idea is to get a person off the streets, provide them extensive case management services and offer easy transition to treatment services if they want them. The case management services will connect people with primary medical care, dental care, support for legal services, job support and support to attain long term housing. The thinking is that with basic needs met, a person battling addiction may be more inclined to engage in treatment than when they are worried about where to sleep for the night and where to get something to eat.
Square Medical Group has been awarded a contract from the Commonwealth’s Bureau of Substance Addiction Services for a Low Threshold Program. We have a site ready to go in Quincy, Massachusetts that will provide 20 beds for men and an additional 14 beds for women and couples. Unfortunately, the Commonwealth has been unable to get us the funds to move the project further. Apparently, the one government staffer who knew how to shift the money from one account to another so that the funds could be distributed departed when the previous governor left office in January. No one in the current administration seems to know how to complete this process.
Lack of training, stigma and now bureaucratic snafus. The obstacles are persistent. The toll is unconscionable.