Wednesday, March 16, 2005

Harm Reduction: What's Not to Like?

FACT: a condition (call it medical, behavioral, hedonistic, self-inflicted, metabolic – whatever you like) exists that involves tens or hundreds of thousands or millions of people in their respective countries sticking dirty needles in their bodies several times a day, risking getting and spreading fatal illnesses (AIDS, hepatitis, among others), risking direct death from an overdose, and doing all this is a legal climate of zero tolerance that demands a variety of laws be broken in the process. All this at enormous expense in human suffering and in financial terms for the users, their families and for every person in the community at large.

FACT: nowhere in the world, despite the application of every conceivable form of prevention and treatment measure – including the most Draconian means of intimidation (long-term incarceration, hanging, beheading, torture) has proven effective in preventing or stopping this condition.

FACT: a variety of means have been demonstrated conclusively, in disparate countries of the world, under dramatically different social, political, economic and drug-using circumstances, to lessen the "harm" associated with this condition – to lessen it in a quantifiable manner by lowering spread of disease, risk of overdose, associated crime and death.

FACT: the various methods demonstrated repeatedly and consistently to reduce harm are remarkably easy to provide – no prohibitive production costs, technological sophistication, extensive training of particularly gifted workers, no elaborate training of the population at risk. Teaching safer-injection techniques and how to use a condom can be accomplished almost instantaneously with people who are illiterate and have never had a day of school attendance , - and with the intellectual elite who despite all their degrees are simply incapable of learning how to use a "Blackberry" – or even a DVD/VCR. I refer to provision and use of sterile needles and syringes, teaching mechanisms of transmission of diseases associated with drug use and/or commercial (or non-commercial) sexual activity, provision of effective treatment that is known to be acceptable to providers and recipients alike (most notably, "substitution treatment" with methadone and, more recently, buprenorphine), provision of treatment of concomitant illnesses such as tuberculosis, HIV-AIDS, hepatitis, etc. Perhaps most basically, I speak of the reduction in morbidity and mortality – i.e., the reduction of harm - that is possible with no more than a compassionate, respectful acknowledgement of the humanity of drug users.

FACT: not a single one of these varied interventions that we know reduce the harms associated with illicit drug use has itself been demonstrated to cause harm – except in truly exceptional instances that exist with every treatment of every medical condition (e.g., babies inadvertently take or are given excessive amount of aspirin and die; patients have allergic reactions to penicillin and die; people use (purposefully to seek a desired effect, or by accident) medications that are prescribed for others, with potentially serious – even fatal – outcome; physicians through inexperience or ignorance prescribe the wrong medication in the wrong dosage to the wrong person. And yet, these exceptional incidents notwithstanding, there is no logical reason for rejecting "harm reduction" measures on the basis of adverse, unintended consequences – some of which are enumerated above. Certainly, neither logic nor experience supports the fear of some that they will "encourage" non-users to use, that they will lessen the motivation of current users to seek assistance in quitting, that they will in some hitherto unknown way undermine the fundamental morality and inherent goodness that some attribute to all of God’s (as yet, non-drug-using) children.

SO WHAT’S THE PROBLEM? Why do people fight with such fervor to deny services known to save lives? Why are they so ideologically threatened that they (i.e., to be specific, the most powerful governments on the face of the earth) bully and blackmail their own citizens and those of other nations to forbid even the use of the words, "harm reduction"?
I am sure there are answers – there are always answers! I confess, however, with true humility, that I do not know what they are. Enlightenment will be welcome.


At 3:27 PM, Anonymous Anonymous said...


Because facts have had very little to do with US drug policy for more than a century....


Because it is in the interests of a vast and profitable network of interlocking industries and power bases to maintain the status quo....


Because even those within this community who ARE in possession of the facts and who DO have the moral impetus to change things are generally not able to speak out freely due to the need to continue to earn a living...

At 11:57 PM, Anonymous Anonymous said...

In theory, the general question "why deny services known to save lives? Why are they so ideologically threatened that they bully and blackmail their own citizens and those of other nations to forbid even the use of the words, "harm reduction" is valid." Yet in the reality of any opiate/methedon dependent's daily life, this is not the true question. The true question is "How can I train my mind and body to be free of such substances...and why bother?" Further, how can a society guide the multitudes into a different frame of mind, ie "positive perspectives"?

There is much good to be said for "harm reduction" policy, however, let's not forget the title of this category is "Opiate Addiction". The question is on addiction/compulsion, yet no answer or question of this nature is addressed here. Only maintenance is addressed here.

Subsequently, the comments of p.vdk are valid, and it is near impossible for a profitable enterprise to stop being profitable for the betterment of mankind. This is a problem. How wonderful to be assured a good profit throughoput the LIFETIME of a maintained paitent.

We must regain sight of the individual. For the most part, the individuals that are "maintained" are existing. They are not living. They are not "free" and have, as of yet, no choice but to be administered upon. We humans are wonderful, thinking animals with much good intent, yet we are still animals. And as such, we have the strong ("free") administering over the addicted...society has an unspoken, unfair, animalistic response, perhaps. So again, the true question is "How can an individual train their mind and body to be free of addiction?" Maintenance and "harm reduction" should be only a stepping-stone.

At 11:41 AM, Blogger Me said...

Yesterday morning I had the misfortune of being awake at 3AM. Consequently I watched a fascinating news report on CBS about this "addiction specialist" at Johns Hopkins who had made a startling breakthrough. He discovered that the tiredness you feel in the morning before your first cup of coffee is not really tiredness but a withdrawal syndrome. Brilliant! Now they have a program to taper people off of caffeine compete with little diaries and behavioral support. Wait until Starbucks finds out how much money they're gonna be out once they don't have all those captive maintenance patients. As far as caffeine addiction being a medical priority, well if you could see me I'm standing here with my mouth hanging open.

At 9:40 PM, Blogger RGNewman, MD said...

"Life-time patients" - anonymous seems to suggest that maintenance treatment of addiction is driven by the prospect of "patients for life" (i.e., paying customers for life). But this is a reality applicable to all chronic medical ailments - diabetes, hypertension, arthritis, etc etc etc. In fact, there is - sadly - far less "competition" for the chemical dependent patient since so few physicians are willing to treat her/him. The reality is that maintenance appeals to patients and providers alike becuase it's known to lessen morbidity and mortality. So we're back to the original question: why does the medical community and the general society damn a medical treatment that is indeed known to reduce suffering, illness, criminality, social dysfunction and death? And in addition, how can one be against measures of any kind that reduce harm associated with drug use? RN

At 9:20 AM, Blogger Mark Beresky said...

"Common sense, personal experience and prejudice are the customary resources called upon by those finding fault with methadone maintenance treatment. The controversy is due, in part, to the apparent contradiction in the concept of treating addicts with what is erroneously regarded as an "addictive drug." While methadone can treat addiction, and chronic use can create physical dependence, methadone "addiction" does not, in realistic terms, exist. When patients relapse, they do so with short acting opiates, such as heroin or morphine and oxycontin but not with methadone. Because of methadone's slow onset and long duration (days) of action, it is rarely sought out by addicts or non-addicts in search of a drug "high." By the time someone seeks out methadone, he or she has already suffered the brain disease, which underlies true opioid addiction. Fortunately, 30 years of relentless, uninformed attacks on methadone maintenance have resulted in its becoming the most thoroughly scrutinized and researched substance abuse modality in history.

Some who have experienced "recovery" from abstinence-based "treatment" or fellowship are unable to comprehend just how lucky they are; they do not realize that most opioid addicts will not be so fortunate. Addiction is a disease like any other. Addicts with a less severe form of the illness may not need medicine, like the diabetics whose disease responds to losing weight, and who do not need medication. The safest and most effective treatment for most opiate addicts, however, involves support and structure along with a medication which will eliminate craving and protect them from overdose.

While this is may be obvious to most, it is threatening to the world-view of some, such as "recovering" abstinence-worshipers or others, whose brand of "religion" compels persecution or shunning of methadone maintenance patients. No amount of scientific study or medical expertise will convince such people of the therapeutic value of MMT; once they assign a negative moral value to the treatment, they have no further need to listen to the results of scientific research. Facts are never an answer to religious belief."


By Dr. Marc Shinderman, National Medical Director, CAP Quality Care (

Apologies to Dr. Shinderman for posting this excerpt but it provides the best explaination I've read to date on why this life-saving treatment regimen is so widely demonized.

Mark Beresky
Opiate Dependence Resource Center

At 6:23 PM, Anonymous Anonymous said...

Caffeine Addiction - Caffeine Effects and Withdrawal part II

Caffeine addiction shows up when a person cannot stop consuming caffeine in high amounts, causing his/her body to demand the substance and react negatively if that no caffeine is intake. Caffeine may not be addictive in the traditional sense, but the body builds up a tolerance over time; some people find it very hard to function well without at least one cup of strong coffee or tea in the morning. The stimulating effects of caffeine are caused by a central nervous reaction, the heart rate increases, blood vessels expand and the brain receives more oxygen. These caffeine effects can last for up to 8 hours, and once they go off then the body feels extremely lazy and slow as a side effect.

Caffeine addiction can even cause death, mainly because the abuse of any stimulant can cause high blood pressure or and heart problems, so if you abuse of it chances are you put yourself at the highest risk of a heart attack.

You need to be careful with caffeine withdrawal because it affects your overall health and therefore, you need to control your consumption of caffeinated products to prevent your body reactions to caffeine withdrawals. If you need more information about caffeine effects and caffeine addiction symptoms or prevention, please investigate a little further on this topics.

You can find more info at:

At 3:31 PM, Anonymous Ibogaine Detoxed said...

Harm Reduction is the way to go! Prohibition makes a personal problem a huge social problem as it pushes up the profitability of the drugs creating gangs, prostitution and crime!


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