Should health care providers help people to use addictive substances more safely?
The so-called overdose-death crisis and COVID-19 in the United States is a serious matter of concern in healthcare administration. The current risk is that the huge efforts invested in controlling the pandemic could detract attention from the increasing addictive substances crisis.
Historical presidential administrations have focused on this crisis in their health policies, some emphasizing the need for an abstinence-based policy to prevent it, others preferring “harm reduction” strategies (a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use) and still others favoring strong campaigns to eradicate drug trafficking. A difficult task is to find the balance between an effective prevention campaign, combating drug distribution, and an efficient “harm reduction” policy. A review of past strategies is needed given the steady rise in the overdose crisis.
In this respect, an article published in the American journal New England Journal of Medicine (May 13, 2021), entitled “Bringing Harm Reduction into Health Policy — Combating the Overdose Crisis”, addresses this issue, reviewing the harm-reduction policies in the last presidential administrations.
“Help to use addictive substances more safely is an important missing piece of federal health policy”
The authors say that presidential administrations have historically “helped thwart the implementation of harm-reduction interventions for illicit substance use, despite the fact that harm reduction is an important and frequently used tool in medicine and public health”. Consequently, “[i]n the face of increasing drug-related morbidity and mortality, [they] believe that harm reduction is an important missing piece of federal health policy” (read HERE).
“Helping people use addictive substances more safely are important skills for well-rounded clinicians.”
The article then goes on to say that “national survey data suggest that most Americans have used or currently use substances, including alcohol, nicotine, stimulants, cannabis, or other psychoactive drugs (read HERE). People use substances for various reasons: to avoid withdrawal, to ease anxiety, to cope with trauma or boredom, to sleep, or to get through their jobs. Talking with patients about the harms associated with substance use, while probing and acknowledging the perceived benefits, and helping people use substances more safely are important skills for well-rounded clinicians”.
The authors describe programs widely used in modern international harm-reduction practices, including “(…) syringe-services programs; community overdose-education and naloxone-distribution programs [Naloxone is a medication called an “opioid antagonist” used to counter the effects of opioid overdose], which train people who use drugs and members of the general public to recognize and respond to opioid overdoses; programs that provide sterile pipes or other equipment for substance use; drug-checking technology to help people determine the composition of substances they are using; sobering centers, where intoxicated people can be safely monitored; and overdose-prevention centers or supervised-consumption spaces for people to use drugs and receive rapid treatment in the event of an overdose, along with other services.”
Accordingly, they believe that “[t]he evidence base for harm-reduction approaches is strong, especially for syringe-services programs and community overdose-education and naloxone-distribution programs. Other interventions could be implemented and evaluated using standard research methods”.
Our suggestion is to further humanize the philosophy and policy of “harm reduction”
The aforementioned article concludes that approaches by previous administrations centered on reducing supply or demand “haven’t led to reductions in substance use or demand or associated harms, including overdose deaths”, and suggest that if the Biden administration were to consider “[e]mbracing and implementing harm reduction principles for substance use in medical practice and health policy [it] could promote justice and compassion.” In the particular topic, “promoting compassion” from bioethics based on the dignity of the person, the content of the article focuses on “harm reduction” exclusively on preventive and medical issues. In our opinion “harm reduction principles” without a health policy, that includes a systematic personal approach to the addicted persons would not promote justice and compassion.
Bioethical assessment about helping use of addictive substances more safely
Our Observatory agrees with the aforementioned article on this particular approach to tackling the drug crisis, but it is not that simple. Without a strong campaign to eradicate drug trafficking (read HERE what it is being done in this respect) accompanied by federal prevention campaigns and cultural interventions aimed at parents and young people showing the devastating personal and social effects of the different addictions, it will be impossible to halt the growing crisis. If these elements are not combined and properly weighted based on multidisciplinary scientific study, any strategy would once again be inefficient. This is a difficult issue because it involves the cultural values of the population. Prevention campaigns should be implemented with the help of non-governmental institutions, universities, colleges, nonprofit organizations, religious institutions, etc. working together with clear common objectives.
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