What Is Harm Reduction for Opioid Addiction?
The U.S. is in the midst of a severe substance use epidemic. More than 100,000 Americans died of a drug overdose from May 2020 to April 2021, almost 29% more from the year before. More than 250 people in the U.S. die this way, on average, every day.
If you or a loved one is in recovery from opioid addiction, you may have benefited from something called harm reduction. And if you’re not yet there, it could save your life.
What Is Harm Reduction?
When it comes to drug addiction, harm reduction is a nonjudgmental approach that focuses on reducing the dangers that addiction poses to your health and social well-being. It doesn’t necessarily focus on simply stopping the use of the drug itself.
Harm reduction is a broad concept that’s not limited to opioids. For instance, some examples of harm reduction unrelated to opioids include using a nicotine patch to quit smoking and drinking enough water to avoid getting sick when drinking alcohol. In fact, we use harm reduction every day when we wear a helmet riding a bike or wear a seatbelt in the car.
Harm reduction helps keep people who use drugs alive, stay otherwise healthy, and gives them the tools and protections they need to overcome their addiction. This approach has been proven to prevent death, injury, disease, and overdose, and also to prevent substance use disorders altogether.
Harm reduction includes:
- Naloxone and similar substances. These medications are “opioid receptor antagonists.” They rapidly block the effects of opioids and last up to about 90 minutes. When taken quickly after an overdose, they can save a person’s life. Narcan is the brand name of the nasal-spray form of naloxone. Evzio is the brand name of naloxone’s injectable form.
- Medication-assisted treatment (MAT). This is the use of medications, in combination with counseling, to help people overcome their addiction. MAT for opioid addiction includes the use of methadone, buprenorphine, or naltrexone. These relieve withdrawal symptoms and physical cravings for opioids. The MAT approach has been shown to help people addicted to opioids survive, stick to their treatment, decrease their drug use and any related criminal activity, as well as find and keep jobs.
- Safe injection sites. Also called overdose prevention centers, these are safe, clean, sanctioned spaces where people can inject under the supervision of a trained staffer who is ready to step in if the person overdoses, instead of having people inject drugs in public spaces like restrooms and parks. This improves public safety as well as protecting the lives of people with an addiction.
- Needle exchange programs. These provide things like sterile needles and safe smoking supplies to drug users, who could otherwise find dirty or unsafe equipment elsewhere. These programs help prevent dangerous infections and reduce the spread of disease.
- Sex education, medication and disease prevention, and testing. These reduce the spread of sexually transmitted and bloodborne diseases like HIV and hepatitis, for which drug users are at greater risk.
- Fentanyl testing strips. These detect fentanyl, a dangerous and very strong opioid that is a key driver of the epidemic and is often found laced in drugs that are bought on the street.
- Support programs. This includes things like counseling and motivational interviewing, as well as connecting people with peer support specialists, sponsors, and case managers. This can help reduce the stigma surrounding drug use and connect people with the services they need.
- Good Samaritan laws. Around a quarter of people who inject drugs report being sent to jail. And while incarcerated, 90% don’t get MAT or other treatment. More progressive laws in many states now allow people to call 911 without fear of arrest if they are experiencing an overdose. Laws around syringe services programs aim to protect users from being arrested for possessing or distributing safe needles and other supplies. Other laws that require users to get treatment, instead of prosecuting them, have been shown to reduce the likelihood of future offenses. Experts are pushing for a big cultural shift away from punishing drug users and instead toward offering them the services they need to get better.
Getting Your Life Back
Caleb Blaschke, from Sioux Falls, SD, tried several attempts at sobriety before he found any success in moving forward from opioid addiction. One thing that made a big difference in giving him the boost he needed was Suboxone, the brand name for a drug that combines buprenorphine and naloxone.
“I don’t want to say that MAT was a lifesaver, because I did a lot of the work, but it was really helpful in my day-to-day life,” he says. “When you get sober, you still have all those triggers that led you to use. Having something to stabilize you and mitigate those triggers allows you to go through your day normally.” Blaschke also says Suboxone helped lessen his depression and level out his negative emotions. “Those were very strong emotions I was dealing with.”
After about 2 years on Suboxone, Blaschke was able to completely go off the medication in December 2021. This transition can be difficult. Some people need to take low doses of these medications for their entire lives. Stopping can cause some withdrawal symptoms, and it can be a time when users are vulnerable to relapse, especially if they try to stop too soon.
Blaschke, with the help of his doctor, had built up an arsenal of other serotonin-boosting activities to help him stay clean. “I feel like once you get off a substance, you have this massive void,” he says. “Harm reduction helps fill that. For me, hiking and being outdoors also helped. I think more people should look for whatever hobby that will help fill the time or void that used to center around drugs.”
Eric R., from Boca Raton, FL, says that during his recovery from opioids, Suboxone was a lifeline that “broke the physical spell” of addiction. “Until a person can control their symptoms of withdrawal, they remain in the thrall of the painkillers being used,” he says. “With medication-assisted treatment, the body is appeased, and an individual can begin to effectively hear about a life free from bondage to drugs.”
Eric asked WebMD not to use his full name for this story, in order to protect his privacy.
Harm Reduction as a ‘Buffer’
MAT is not a cure, but rather a bridge connecting a person to their recovery goals. By mitigating withdrawal symptoms, MAT lessens a person’s feeling of urgency enough to allow them to hear above what Eric calls “the din of physical addiction.”
Similarly, Good Samaritan laws and needle exchange programs, Eric says, can be thought of as reinforcements for someone who is struggling to quit all on their own, something that is often virtually impossible.
“Given that many of those with active substance use disorders have poor social support networks, these types of services provide much-needed ‘buffers’ that can help those who might overdose, i.e., IV drug users,” Eric says. “Establishing a trustworthy relationship through these means of outreach sets the foundation for more lasting recovery options.” These include getting involved with community recovery centers, MAT, and life skills training.
Barriers to Care
A hard thing about MAT programs, Blaschke says, is that they are not always easy to get into.
“I was very fortunate to get into a MAT program. I wish they were more accessible,” he says. “The MAT center I went to was very adamant that you needed a full-time job and insurance through work to participate. But chances are, if you’re addicted, you don’t have those two things.”
In the case of naloxone, the drug is so effective at preventing overdose deaths that experts urge families with loved ones struggling with addiction to keep naloxone or other similar drugs on hand.
“I know [naloxone] works because I saw it used on a friend once,” Blaschke says. “Within 10 or 20 seconds, he was fine.” But it can be expensive, and most people addicted to opioids don’t have it at their immediate disposal.
“If you’re addicted, are you going to spend that on drugs, or a [naloxone] kit?” he asks. “I think it’s very rare someone would pick a kit.”
And although many types of insurance cover naloxone, they are not required to by law. The average out-of-pocket cost for the nasal spray form (Narcan) is about $140, while the injectable form (Evzio) is about $4,000. While $140 may not seem like much to some, it is still far beyond the immediate means of many living in the U.S., where only about half of households have a savings account, and 7 million households don’t have a bank account at all. Also, over half a million Americans are homeless, a number which is almost certainly underestimated. This means that the same people who are at the greatest risk for opioid addiction and overdose are also those who are the least able to access care for it.
Safe injection sites are also not yet widespread in the U.S., largely due to political pushback. “While I sincerely hope that safe injection sites become a part of the harm reduction ‘repertoire’ as a country in the near future, I have yet to encounter any on a personal level,” Eric says.
There are over 100 sites worldwide in more than a dozen countries. The first opened in Switzerland in 1986. But the U.S. only recently began the practice, with the first two official sites opened in New York City at the end of 2021.
Yet these sites are saving lives. A site in Vancouver, Canada, which opened in 2003, has reported an average of six overdose preventions per day. A study in The Lancet found that overdose deaths in that same site’s surrounding area dropped by 35% after it opened, compared with just a 9% reduction in the rest of the city during that time.
The two New York centers reported about 60 overdose preventions in just the first 3 weeks. And rather than encouraging drug use, a concern voiced by those who oppose these sites, research shows that opening these sites actually makes people more likely to seek long-term addiction treatment.
Harm Reduction Works
Drug addiction is not simply a matter of willpower. It is a real, chronic disease that requires treatment.
Reducing the stigma around opioid use is an uphill battle, and it continues to prevent the U.S. from implementing the most effective strategies on a large scale. The nation has made some strides in shifting away from a traditional abstinence-only model of drug addiction treatment to more evidence-based methods. But there’s still a long way to go.
Some officials and even care providers have continued to argue that things like MAT and safe injection sites are a “crutch,” enabling people to stay addicted. But the research shows that harm reduction strategies, though each may not work for every person, have the opposite effect overall.
Harm reduction offers tools and services for people with addiction. Beyond that, it has another critical benefit: It helps shield people from the many life complications caused by addiction. This allows them to stay focused and feel supported while they work towards getting better.
“These forms of harm reduction not only save lives,” Eric says, “but also make the lives of those with substance use disorders less stigmatized and strengthen the possibility of lasting recovery.”