Harm Reduction

If there is one thing that sticks in the collective conservative craw (and I assure you there are many and various such indigestibles on their menu; one imagines a fussy two-year-old scowling stubbornly, arms folded, as the plane loaded with liberal ideas circles fruitlessly outside the hangar), it's the phrase harm reduction. Absurd, you say. How could someone be opposed to the reduction of harm? Harm is bad, right? Stands to reason that its reduction would be, ipso facto, good and therefore immune to the rigid demarcations of partisan politics, but it depends entirely upon whose harm we are reducing, what form that harm takes, and the means necessary to achieve it.

For those unfamiliar with the aforementioned loaded phrase, harm reduction in this context refers to the practice of providing drug-dependent individuals with the means and opportunity to safely administer their drugs without shame or fear of legal reprisal - new, sterile needles and the concomitant accessories, testing and treatment for bloodborne pathogens, and a body of dedicated professionals whose mission it is to not only curtail the spread of HCV, HIV, and the malignant fungi that so freely fructifies in syringes and spoons, but to spreading the radical notion that drug-dependent people are not criminals or intrinsically worthless drains on society but human beings deserving of care and treatment. The hidebound reactionaries adhering to their soft-focus vision of a bygone America that never really existed in the first place need only hear the phrase “syringe exchange”, though, to get their dander up before the chorus of outraged beeping and squeaking begins. “Needles to addicts?”, they gasp with shocked incredulity, covering the ears of their children and spouses. “Why, we might as well start handing out printing presses to counterfeiters or pistols to bank robbers.” I could expound at length on the speciousness of this argument but I’ll presume it’s unnecessary. A better analogy might be giving condoms to rapists, but let’s let the right-to-life sleeping dog lie. 

News flash: the drug war is over. Drugs won. They have not only established a beachhead but occupied every inch of habitable territory and the sooner our focus shifts from punishment and scorn to acceptance and treatment, the better: for the addicts themselves, for the myriad family and loved ones affected, for the judicial and correctional systems, and for the country and the world as a whole.

Addiction divides, separates, and isolates, and every person so affected brought back into the fold represents a win that reverberates long past and far beyond the binary switch from user to non-user; the rewards are exponential, as those who get clean and stay clean undergo a rebirth that taps latent reserves of ambition, drive, and responsibility. They accomplish things they might never have without being fired in the crucible of addiction. They help others to get clean by working in the treatment field, through leadership in 12-step groups, and by being an example of the possibility of redemption. It is rare to find a formerly addicted individual hiding his light beneath a bushel; they are driven to spread the word that all things are possible, once the self-imposed barriers are broken through. Getting clean is analogous to being released from prison after a long stretch; in either case, you will rarely see a person more excited about simply being alive than anyone but a ten-week-old puppy or Jimmy Fallon.

Were addiction a stand-alone problem without precursor or progenitor, its treatment might be as simple and straightforward as those for depression, anxiety, and other mood disorders, but the sad fact is that if you scratch an addict, you will likely find an unstable, dysfunctional home and substance-addicted parent(s) in his personal history, characterized by abuse, neglect, or trauma, sometimes all three, with subsequent diagnoses of learning disability, PTSD, borderline personality disorder, reactive attachment disorder, acute stress disorder, and sundry other by-products of formative years spent not learning to be human amid the security of a loving family, but suffered through and focused only on survival. Understanding this helps people to grasp the idea that addiction is more a symptom than a disease; it is, more often that not, a desperate attempt to quiet inner turmoil and allay crippling fears. It is a reasonable response to unreasonable stress and the whole person must be treated.

Happy, fulfilled people don’t tend to abuse substances because they already have what the addict is trying desperately to replicate with those substances. Given this proposition, it follows that helping drug-dependent people to be happy, confident, and fulfilled adults with the necessary tools to successfully navigate the world would render their erstwhile obsession toothless, but how do you overcome years of conditioned response and habits grooved so deeply in the brain that the mere idea of being without the numbing balm of their drug of choice induces panic and terror? 

Easy. Well—not easy, but simple. Wins. Addicts—we, if I’m being perfectly honest—are unused to winning and much more comfortable with loss and failure. It’s what we deserve because we’re all quite aware of what worthless pieces of crap we are. It must be true because the government says it’s so and puts us away in their prisons, away from the good people. 

Enter harm reduction. The first small win is simply being part of a social interaction in which the fact of addiction is right out there in the open but addressed without judgement, criticism, advice, or anything but warmth and courtesy. Harm reduction says Your choice to use drugs is yours and we do not question it, but ask only that you accept, free of charge, these tools to allow you to do it safely and to be prepared in the event of overdose. We will test you, also free of charge, for the diseases most commonly transmitted through unsafe needle practices and should you prove to be afflicted will arrange for your treatment, and if not provide you with information on how to remain disease-free. Go forth and sin as much as you want to-we’re here to help. 

And if the model is functioning as intended, a seed is planted as either consciously or otherwise the thought Hm. Someone cares about my health and welfare, and with all this clean stuff I can do my dope like a gentleman (or lady), with concern for the health of myself and others. 

And the head, perhaps, is held a little higher, the generally negative outlook slightly mitigated. Slightly is fine. Any infinitesimally incremental trend upward counts toward the ultimate goal of helping them to become the sort of person who doesn’t need drugs anymore. The fundamental difference between harm reduction and current treatment models is that the latter all begin with abstention; Stop using and the rewards will come, they say, as if all we needed was a stop sign reminding us to apply the brakes. Gee, why didn’t I think of that? Harm reduction says Let’s get some of this other garbage out of the way first and maybe then the possibility of quitting won’t seem quite so unattainable. 

MCAVHN - Mendocino County Aids & Viral Hepatitis Network, now doing business as MCAPN, MCAVHN Care and Prevention Network - is not only the public face of harm reduction in the county, it is the whole kit, kaboodle, shootin’ match, and ball of wax, all 10 full-time employees and scant handful of volunteers and community-service layabouts. This group of extraordinarily dedicated professionals is unstinting in their efforts to not only ameliorate the negative effects of intravenous drug use in the county but to tirelessly seek the necessary funding in support of that mission, grant after grant and donation after donation. The plus side of our unique place in the multifarious alphabet soup of agencies engaged with drug-war casualties is that being unaffiliated with any municipal, county, or state agency, we are free to cut through a lot of the bewilderingly Byzantine bureaucratic bullshit most of the others are stymied by, and actually get things done. While Agency A is carrying on a protracted battle with Agency B regarding the medication of a shared client, for instance, one party insisting that his current DSM-V designation does not support a claim for a particular medication and the other alleging a more current diagnosis, involving shrinks, shysters, and a phalanx of lesser functionaries to put it all on paper and clog the mails with red tape, we just go to the drugstore and fill the prescription.

Interagency cooperation is crucial to this mission, as most clients are served by at least two and often several agencies, bodies that occasionally find themselves antagonistically positioned toward one another. The non-profits must justify their grants with quantifiable results and documented effort, the for-profits are living up to their name (though in some instances the distinction between the two is not so clear as you might expect), and the bureaucracies are there to hamper, confuse, and obfuscate. MCAVHN stands alone in its commitment to its mission, willingness to make sacrifices, and the ability, acquired gradually over 33 years, to find ways to help when there are none.

(Next: Pt. II, A Rogue Fungus)

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