Helping addicts survive, not abstain: “harm reduction” receives federal support

GREENSBORO, NC – The thin young man quietly entered the room, awaiting free supplies to help him avoid dying: sterile water and stoves to dissolve illegal drugs; clean syringes; alcohol wipes to prevent infection; and naloxone, a drug that can reverse overdose. A sign on the wall – “We forbid loving drug addicts as they are” – sounded like a hug.

It was the first day that the reception center in a residential neighborhood here opened its doors since the coronavirus forced them to close in the spring of 2020. “I’m so glad you are all open again”, the man, whose first name is Jordan, said a volunteer who handed him a full paper bag as heavy metal music echoed over a speaker in the background. He asked for additional naloxone for friends in his rural county, an hour’s drive away, where he said it had been scarce throughout the pandemic.

Overdose deaths rose nearly 30% in the 12-month period that ended in November, to over 90,000, according to preliminary federal data released this month – suggesting that 2020 has passed. recent records of these deaths. The staggering increase during the pandemic has many contributing factors, including job losses and widespread evictions; reduced access to drug treatment and medical care; and a supply of illegal drugs that became even more dangerous after the country was shut down.

But the forced isolation of those struggling with substance abuse and other mental health issues is perhaps one of the most important. Now, with the country reopening, the Biden administration is backing the controversial approach taken by the center here, known as harm reduction. Instead of helping drug addicts achieve abstinence, the main goal is to reduce their risk of dying or contracting infectious diseases like HIV by giving them sterile materials, tools to check their fentanyl medications, and other deadly substances, or even just a safe space to take a nap. .

Such programs have long come under attack for allowing drug use, but President Biden has made expanding harm reduction efforts one of his drug policy priorities – the first president to do it. The American Rescue Act includes $ 30 million specifically for evidence-based harm reduction services, the first time Congress has allocated funds specifically for this purpose. The funding, while modest, is a victory for the programs, both symbolically and practically, as they often operate on tight budgets.

“This is a huge signal, recognizing that not everyone who uses drugs is ready for treatment,” said Daliah Heller, director of drug use initiatives at Vital Strategies, a global public health organization. “Harm reduction programs say, ‘Okay, you use drugs. How can we help you stay safe, healthy, and alive above all else? “

While some programs like this, run by the North Carolina Survivors Union, have been successful in continuing to provide supplies during the pandemic – handing them out of windows, offering curbside pickup, or even mailing them out – virtually all of them have stopped inviting drug addicts inside. Many clients, like Jordan, have stopped coming, losing a safety net of trust.

Some former regulars in downtown Greensboro have died or are missing. Many have lost their homes or jobs. At the same time, the center has been inundated with new customers and is now struggling to keep enough supplies on hand.

“The amount of struggle that people have right now, unrecognized and unanswered, is really difficult,” said Louise Vincent, Executive Director of the Union of Survivors.

Yet many elected officials and communities continue to resist equipping people with supplies for drug use, including the recent addition of test strips to check for the presence of illicitly manufactured fentanyl, which appears in most overdose deaths. . Some also say that the syringes of harm reduction programs end up littering neighborhoods or that the programs lead to an increase in crime. Researchers dispute both claims.

West Virginia has just passed a law making it much more difficult for syringe service programs to operate, even though it is seeing an increase in HIV cases from intravenous drug use. The North Carolina legislature considered a similar proposal this spring, and elected officials in Scott County, Indiana, whose needle exchange helped curb a major HIV epidemic six years ago, have voted this month to shut it down. Mike Jones, a commissioner there who voted to end the program, said at the time that he feared the needles handed out could contribute to overdose deaths.

“I know people who are alcoholics and I don’t buy them a bottle of whiskey,” he said. “And I know people who want to kill themselves, and I don’t buy them a bullet for their gun.”

Many harm reduction programs are run by people who have used drugs in the past or still sometimes do so, and their own struggles with addiction, mental illness or other health issues also erupted during the period. pandemic. In Baltimore, Boston, New York, Washington and elsewhere, beloved leaders of the movement have themselves died of overdoses, chronic health conditions and other causes over the past year, their deaths leaving behind holes in efforts to continue to provide services.

Ms. Vincent, whose opioid addiction stems from a long struggle with bipolar disorder, briefly returned to illicit drug use this spring. She was eager to avoid withdrawal, she said, after an unsuccessful attempt to switch from methadone to another anti-craving drug, buprenorphine. She later learned that the small amount of fentanyl she was using was mixed with xylazine, an animal tranquilizer that can cause weeping skin ulcers. She landed in the hospital with her hemoglobin so low that she needed a blood transfusion.

At the start of the pandemic, Ms. Vincent said, the price of street drugs skyrocketed. Then the drugs sold like heroin, methamphetamine or cocaine started to be cut with unknown additives. Fentanyl was ubiquitous, including, increasingly, in counterfeit pills sold as prescription pain relievers or anti-anxiety medications. But so were substances like xylazine, which made its appearance in illicit drugs from Philadelphia to Saskatchewan.

“It’s just poison,” said Ms. Vincent, who has resumed her methadone treatment. “The drug supply is unlike anything we’ve seen before. “

On the afternoon of the center reopening, a young woman asked for a reminder on how to inject naloxone and if Ms Vincent could explain what a meth overdose looked like. An older man asked if there was food with clean syringes; a volunteer put him a pastry in the microwave.

In addition to leading the program here, Ms. Vincent promotes harm reduction services across the country as the leader of the National Urban Survivors Union, a larger non-profit organization. In 2016, her 19-year-old daughter died of a heroin overdose while in an inpatient treatment center that did not have naloxone on hand, she said.

Naloxone is now more prevalent, but Vincent would like another lifesaving tool to become mainstream: drug control programs that would let people know exactly what substances are in illicit drugs before they take them. Such programs legally exist in other countries, including Canada, the Netherlands and New Zealand. Another type of harm reduction program used in other countries – where people use illicit drugs under medical supervision for overdoses – remains illegal here after a group seeking to open one in Philadelphia lost until now in court.

“We vswould have a real-time monitoring system instead of waiting for death reports from the coroner, ”said Ms. Vincent. “It would be a game changer, wouldn’t it?”

She discovered xylazine in medication she recently took with a device called a Fourier Transform Infrared Spectrometer, which a donor gave her group this year. It can determine the substances in illicit drug samples within minutes.

Jordan, who is 23, had traveled from Stokes County, near the Virginia border, where the overdose death rate even before the pandemic was almost twice the state average. His cousin, he said, had been hospitalized weeks earlier after overdosing on a “real bad batch” of fentanyl which tests revealed contained traces of heavy metals.

“At least 50 people in my area have been rescued by Narcan from here,” he said, taking several boxes, each containing 10 vials of the injectable form of the antidote. “Even my grandmother knows how to administer it.”

Many harm reduction programs, including this one, help people get drug treatment or even sometimes provide it. But Jordan is among the many addicts who are not interested in this path, at least at the moment. The closest programs are in Greensboro or Winston-Salem, each a good distance from their home. And treatment with anti-craving drugs like buprenorphine or methadone, while proven to save lives, “doesn’t really work for me,” he said.

The county that includes Greensboro, the third largest city in North Carolina, experienced 140 fatal overdoses last year, up from 111 the year before. The figures do not include people who died from infections caused by injection drug use, including the fiancé of a woman who entered the center after dark on the day of the reopening, calling Ms. Vincent: “Where is Louise? “

She met Ms. Vincent when they were both patients in a methadone clinic six years ago, and came regularly to the center to get syringes and naloxone. She and her fiancé had tried to quit using drugs during the pandemic, pissed off by the strange new adulterants appearing in the supply. But her fiancé started having high fevers last December and was admitted to a hospital intensive care unit critically ill with endocarditis, an infection of the heart valves that can result from injecting drugs. He died just before Christmas.

“Do you all have a meeting tonight?” The woman asked Ms Vincent, referring to the support groups the center held several times a week before the pandemic.

“They will restart soon,” Ms. Vincent assured him. “Being connected is much more important than we thought. “

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