The National Institute on Drug Abuse defines addiction as a “chronic, relapsing brain disease.” There is no suggestion of moral weakness or failure here. Instead, this definition seems to suggest that people who have addictions struggle with a deficiency that’s outside of their control, and that must be treated in order for healing to take place.
Psychologists, social workers, counselors and addiction specialists can provide a number of innovative therapies to help people overcome their brain chemistry deficiencies so they can live a life that’s free of drugs. But even so, many people who have addictions simply don’t want to pursue a life of abstinence. For example, in the 2010 National Survey on Drug Use and Health, of those illicit drug users who didn’t enter treatment, 30.1 percent stated that they simply weren’t ready to stop using drugs. Even if treatment was available, these people didn’t want to take part.
While it’s possible to simply ignore these people and allow them to continue to abuse drugs in a completely unrestricted fashion, the evidence suggests that drug abuse does harm to the community, as well as harming the drug user. A look at prison statistics makes this point quite clear:
Putting drug users in prison means spending money on housing, food and health care, and it means losing tax revenue. Leaving illicit drug users in place with no treatment, however, means dealing with a raft of problems, including:
- Increased crime
- Public health problems, including HIV/AIDS
- Increased need for long-term foster care for children of addicted parents
- Lowered property values in drug-impacted communities
An alternate idea involves harm reduction. The idea here is that people will continue to use illicit drugs to some degree, but the community will step in to provide support that can make that drug use just a little safer and a little less harmful for everyone involved.
Harm Reduction Principles
Harm reduction is generally described as a set of practices that can reduce the impact of specific drug-using behaviors. People who embrace this concept suggest that drug use in some people is just inevitable and unavoidable, and rather than pushing people into an abstinence they won’t immediately or fully accept, it’s wiser to simply buffer the community from the full impact of addiction running wild.
Harm-reduction principles might include developing a needle-exchange program for people who inject their drugs. This would allow people to take in old needles and walk away with a new set they could use in order to take in their illicit drugs. Rather than using one shared needle multiple times, and perhaps injecting blood-borne viruses like HIV in the process, these people could have clean, sharp tools for each time they use drugs.
Some communities are taking this idea yet further, and they’re considering developing “shooting galleries.” One such proposal in England, for example, would allow users of cocaine and heroin to walk into a drug consumption area and access clean needles and disinfecting agents, so they could use their drugs in a sterile manner without being worried about an arrest following their use.
Harm-reduction strategies might also include free access to condoms, so people who use drugs and feel uninhibited as a result wouldn’t be tempted to have unsafe sex and pass diseases back and forth. Instead, they’d have at least some level of protection, and that might keep some types of infections from invading the community.
Some or all of these principles might be in place in communities all around the world, but some organizations focus harm-reduction strategies on medication. For these officials, providing the right kind of drug could mean keeping people from using specific types of drugs to excess, and that might mean allowing people to live with their addictions for just a little bit longer.
Methadone is one of the oldest harm-reduction medications available. This particular drug works on the same receptors used by heroin, providing users of this drug with relief from cravings and symptoms of withdrawal without providing them with an intense high. This drug has been proven remarkably effective in keeping heroin users alive, even while they’re trying to recover from a devastating disease. For example, in one study published in 2001, researchers came to this conclusion:
“Harm-reduction-based methadone treatment, in which the use of illicit drugs is tolerated, is strongly related to decreased mortality from natural causes and from overdoses.”
That’s a remarkable statement, and it demonstrates just how innovative a methadone strategy might be in helping people to recover from the use and abuse of these powerful drugs.
Buprenorphine is similar, in that it also works on the same receptors used by opiates like heroin, but this drug also has a ceiling effect, meaning that people can’t take massive doses of this drug in order to get high. They can take the drug to ameliorate cravings and withdrawal, but it’s not designed for abuse. The makers of this drug sometimes make that abuse-resistance potential yet stronger by adding in naloxone, which kicks in at high doses and keeps users from overdosing.
Medications containing buprenorphine have been proven effective in helping people to stay motivated to enter treatment programs. They’re also considered an ideal form of long-term treatment, as they can be prescribed by a medical doctor, rather than an addiction treatment professional. In some cases, people can even take these medications at home, rather than walking into a clinic or a pharmacy for a daily dose.
But some drug users resist the idea of replacing a drug they love with a prescription medication that only modifies the high they can feel. These users might benefit from access to naltrexone. This medication, whether delivered by shot or via nasal spray, can block an overdose in progress by kicking all active bits of drugs from their receptors. It’s typically given by an emergency responder, like an ambulance driver, but making the drug widely available could allow drug users to treat one another in the case of an overdose, and that might result in the saving of thousands of lives.
These are just a few of the medications available for pharmaceutical control of addictions. Naltrexone and Antabuse are others, and they work in much the same way and bring about the same kinds of benefits.
Public Support for Harm Reduction
In general, people seem receptive to the idea that addictions are chronic conditions that people can and do recover from. In fact, some companies are even moving toward hiring people who are in recovery from addiction, just proving that many people believe in the idea of second chances and long-term healing.
But it’s harder to know how people might feel about the idea of living with, working with, and interacting with people who continue to use drugs in a more safe or controlled manner without ever achieving a long-term sobriety. Even people who work in the industry don’t seem overly enthusiastic about this idea. For example, one study conducted in Canada found that only 61 percent of workers in addiction treatment facilities supported long-term methadone maintenance. Similarly, a study of doctors in Canada found that only 56 percent would be willing to provide long-term replacement therapy for addicts. Studies like this seem to suggest that addicted people might need to work overly hard in order to get the help they might need to really enjoy robust harm reduction, as they might struggle to find providers willing to assist them.
Similarly, many community members seem to resist the idea that an addiction is a brain disease that some people can only manage and never beat. The Clean Slate Addiction Site, for example, has this to say about addiction:
“On the other hand, addiction to drugs and alcohol is not obviously a disease, and to call it such we must either overlook the major gaps in the disease argument, or we must completely redefine the term ‘disease.’”
Opinions like this might lead to out-and-out discrimination of people who participate in harm reduction, as people who hold these opinions might believe that all people could recover if they would just work hard enough.
A Changing View?
Many organizations continue to spread the message that people who take medications for addiction are similar to those who take medications for diabetes or heart disease. If we wouldn’t say a person with diabetes is “addicted” to insulin, then should people with a heroin-based problem be labeled as “addicted” to methadone?
The passage of the Affordable Care Act may help with this shift. As part of this legislation, addiction treatments are considered “essential services,” meaning that they must be provided as part of an insurance package. Four of the medications mentioned above are included as part of those services. This might mean that more people get these medications, and that might translate into broader awareness and acceptance of the importance of replacement medications. But more must be seen in order for the results to be really clear.
In the interim, we continue to push for all people who have addictions to get help for their conditions and come to learn the benefits of a sober life. Our admissions coordinators are available now to help answer your questions about how our treatment programs can help.
”Drugs, Brains, and Behavior: The Science of Addiction.” (n.d.). National Institute on Drug Abuse. Accessed April 25, 2014.
”Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings.” (Sept. 2011). The Substance Abuse and National Health Services Administration. Accessed April 25, 2014.
Dewey, W. (Oct. 2008). “Transition Paper.” Friends of NIDA. Accessed April 25, 2014.
Philby, C. (April 17, 2013). “Shooting Galleries: The Drug Plan That Could Be Too Liberal Even for Brighton.” The Independent. Accessed April 25, 2014.
Langendam, MW; Van Brussel, GH; Coutinho, RA & Van Ameijden, EJ. (May 2001). “The Impact of Harm-Reduction-Based Methadone Treatment on Mortality Among Heroin Users.” American Journal of Public Health. Accessed April 25, 2014.
A. L. Krook, A.L.; Brørs, O.; Dahlberg, J.; Grouff, K.; Magnus, P.; Røysamb, E. & Waal, H. (April 25, 2002). “A Placebo-Controlled Study of High-Dose Buprenorphine in Opiate Dependents Waiting for Medication-Assisted Rehabilitation in Oslo, Norway.” Addiction. Accessed April 25, 2014.
”Understanding Naloxone.” (n.d.). Harm Reduction Coalition. Accessed April 25, 2014.
”Website Encouraged Hiring of Recovering Addicts and Ex-Offenders.” (April 28, 2005). The Partnership at DrugFree.org. Accessed April 25, 2014.
Ogborne, A.C. & Burchmore-Timney, C. (March 1998). “Support for Harm-Reduction Among Staff of Specialized Addiction Treatment Services in Ontario, Canada.” Drug and Alcohol Review. Accessed April 25, 2014.
Dooley, J.; Asbridge, M.; Fraser, J.; Kirkland, S. (June 13, 2012). “Physicians’ Attitudes Towards Office-Based Delivery of Methadone Maintenance Therapy: Results From a Cross-Sectional Survey of Nova Scotia Primary-Care Physicians.” Harm Reduction Journal. Accessed April 25, 2014.
”Addiction is NOT a Brain Disease, It is a Choice.” (n.d.). The Clean Slate Addiction Site. Accessed April 25, 2014.
Vimont, C. (Feb. 26, 2013). “Affordable Care Act to Provide Substance Abuse Treatment to Millions of New Patients.” The Partnership at Drugfree.org. Accessed April 25, 2014.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.