Harm Reduction (and why we should sell heroin otc at cvs)

If you haven't been a substance user or close to someone that is, you might believe a lot of the fearmongering and misinformation that seems to come from official sources. We've all seen those news stories where cops are hospitalized after coming into contact with fentanyl, (and the ones where it turns out it wasn't fentanyl in the first place), or the ones talking about "fent laced weed". We've all seen these buzz words like "zombie drug" or "epidemic" or "the war on drugs". We've all seen stories from people in recovery from substance use disorders and their family members talking about the trauma of it all. It can be really, really hard and scary to try and learn the truth about drugs and substance use when there are so many voices talking about nothing but the dangers, the deaths, the overdoses, and trying to make it a moral us-vs-them issues. Where do you even start when the media and government is filled with nothing but misinformation and fearmongering?

It's easy to try and moralize substance use, especially when it's so heavily criminalized in the US. Something being moral and something being legal have long been said to be the same thing— at least by people who are not a part of a minority group— but this idea couldn't be farther from true. There are countless things that used to be legal (and some that are still legal) that we know are abhorrent, immoral, and unethical. Black people being enslaved for generations, hospitals denying care to queer people dying of aids, war, and genocide are all things that used to be or are still legal but are not moral. As a jew, I don't take this example lightly, but even the Holocaust was legal while it was happening.

The truth is though, that substance use and substance use disorders are not a moral issue. Some of the kindest people I've ever met have been people with substance use disorders or even just recreational users. I've seen people who use "hard"drugs volunteer at food banks, their local shelters, harm reduction centers, and crisis centers. I've seen people with substance use disorders push hard for legal change and mutual aid networks. The whole harm reduction movement, started by and for substance users, is an example of this push for things to get better. I've also seen people who are sober who are horrible people. Drugs are not really the factor that decides who is or isn't a good person.

People use drugs for a lot of reasons, but most of those reasons are based in adverse life experiences, trauma, and some form of oppression. Racism and classism, and other socioeconomic factors, play a huge role in substance use. Genetics too, of course, but I would say that socioeconomic factors have just as much to do with family history as genetics do. Almost every drug user I've ever met has been self medicating something in some way.

People who use stimulants may be self medicating ADHD or some other type of nuerodivergence. Some people have to work 3 or 4 jobs as single parents to try and make ends meet for their family, and those jobs are so tiring that they physically can't get through it without stimulants. Some people are self medicating sleeping disorders with stimulants because they can't afford to go to a doctor or were discriminated against when they did go to the doctor.

People who use opioids or downers may be self medicating chronic pain because they can't see a doctor or (because of the so called war on drugs) a doctor wouldn't give them adequate treatment. They could be self medicating anxiety disorders. They could be trying to cope with the trauma of being unhoused.

I could go on like this for every type of drugs for hours because the reasons for substance use and substance use disorders are endless.

I haven't talked about it yet on this blog but I have been substance user and addict for many years. I am a chronic pain patient and someone with unmedicated and untreated mental illness. There are a lot of times that I've tried to get help from doctors, but more often than not I leave my appointments being gaslit and ignored or labelled "drug seeking". (Something that deserves its own post because of the depth of the topic.) I've never gone into these appointments without a real physical or mental issue just to get the doctor to write me a prescription, but I've left labelled as an addict without any medical care dozens of times. I have an illness called Ehlers Danlos Syndrome, a complex genetic disability affecting multiple organs and causing severe chronic pain. My chronic pain is sometimes so unbearable that I can't leave my bed or make myself something to eat. This illness also took over 3 years for my doctor to diagnose despite having it since birth, and the average diagnosis time for it is around 8 years. What am I supposed to rely on for pain management when doctors outright dismiss me, or for the years it takes to get diagnosed in the first place?

This touches base just a little bit about why I am a drug user, but really it goes deeper than this. Sometimes I use because the weight of being in poverty is more than I can bear, like when something breaks and I know that I may never be able to fix or replace it again. Sometimes I use so that I can go grocery shopping without breaking down in a full hyperventilation panic attack in the walmart. Sometimes I use because my physical pain is so bad that suicide seems like the only thing that might provide me some relief. It's a complicated and very personal issue, not only for me but for every single substance user there is.

Unfortunately my story is not uncommon and the war on drugs, and heavy restrictions on doctors prescribing opioids to patients, has created far more people with substance use disorders than its helped. I've even had an elderly family member close to me express the sentiment that they would use illegal street drugs to manage their disabilities if given the chance because their doctor dismisses their very real issues. If a 70 year old religious disabled person is considering turning to heroin because the medical system has failed them so badly, then it truly is a system that is failing us all.

There are a few things that we all have to learn before we can even start tackling the issues that come with substance use disorders.

1) All addicts and people with substance use disorders are human.

We absolutely must be humanized. The media portrays people with substance use disorders as violent criminals, as some kind of evil other. That homeless man using drugs on the street is not some unspeakable other, he is someone's brother, and someone's son, he is someone's friend, he might be someone's dad, but more than any of that, he is someone. And he is someone going through things that, frankly, fucking suck to go through. Seeing him as someone and trying to have compassion for the rough time he's probably going through in his life is the first step to stop moralizing substance use disorders. When you learn that substance use disorders are completely morally neutral, you can start to work on positive changes that actually help people.

2) Substance use disorders and recreational substance use is not a moral issue, it is a complex social issue with set causes.

That's it, really. I know I've been driving this point home hard throughout the entire post, but this is really where most people get stuck when talking about harm reduction and substance use. It is a social issue, and one that we already know how to improve (hint- its not imprisonment or abstinence only based programs and education like AA or NA.)

So that brings me to the actual point of the post— harm reduction. If you aren't involved in the harm reduction community and aren't sure what it really is, I'll give you a run down. Its basically exactly what it sounds like. Harm reduction is things that we can all do to reduce the harm that someone experiences. You're gonna hear this most often in the context of substance use, and that is the primary focus of the harm reduction movement, but it absolutely applies to other things as well. I've even seen some harm reduction education about self harm and eating disorders.

Harm reduction encompasses everything from more "mild" stuff like needle exchange programs that give people clean needles to more "extreme" stuff like safe supply which sells people exact dosages of illegal drugs that aren't laced or cut with anything else. Every aspect of harm reduction works together to ensure that people with substance use disorders are met exactly where they are right now and given options to be safer and healthier without forcing them into treatment. I hate to use the terms "mild" and "extreme" to describe these things when I really mean "socially acceptable/legal" and "socially unacceptable/illegal" because all of the different aspects of harm reduction are equally important, but that is how these things are viewed unfortunately. Many people who agree with needle exchange programs think things like safe supply are ridiculously extreme out-there things. And the belief that I hold is even more extreme than safe supply.

I'm not going to explain every aspect of harm reduction, but here are few things that are done as harm reduction:

• carrying narcan or nalaxone (a nasal spray or injection that reverses opioid overdoses)

• distributing narcan or nalaxone,educating about it, and pushing for it to be widely legally available and low cost

• needle exchange programs (giving people clean sterile needles and syringes to prevent infection, especially infection from sharing needles with others)

• safe use kits (these are kits that include things like bandaids, clean cookers, clean straws, safe tourniquets, alcohol prep pads, and information on how to use drugs safely)

• giving out fentanyl test strips (to reduce accidental overdoses from people who thought they were taking another substance)

• safe supply (giving people access to precise dosages of drugs without the risk of extremely strong batches or the drugs being laced or cross cut with other substances, this is actually done in some places in Canada)

• the Never Use Alone Hotline https://neverusealone.com/ (this is a us based hotline number that you can call if you're about to use an illegal substance by yourself, you tell them what substance, how much, and your location, and they stay on the line with you for a few minutes after you use it to make sure that you are still responsive and haven't overdosed, they DO NOT call the police and only call for EMS if you become unresponsive, they are peer run and DO NOT try to force you into any treatments)

• sitting with friends or family members while they use so that ems can be called in case of an emergency

• safe injection sites (these are legal sites where trained nurses and volunteers monitor someone while they use their substances, making sure that its done safely in a clean environment)

• Medication Assisted Treatment (this includes things like methadone and even sometimes being prescribed recreational doses of medications as a form of safe supply)

The aspect of harm reduction that I really want to talk about today though is safe supply. I don't know if there are any safe supply sites currently in the US (and if there are please let me know), but I do know that they have started popping up in a few other countries like Canada. While I've never had access to safe supply myself, I've heard from other substance users that it is life changing and I don't doubt that for a second.

Safe supply lessens a lot of the risks associated with using illegal substances. While it does not make drug use completely free of risks— nothing could make it completely free of risks — it does make it safer overall. One of the biggest risks of using illegal drugs is that you can never really be sure what you're taking when you buy something from someone else. (Unless you test it with multiple reagents, which most of us don't have the time, privacy, or money to realistically do.)

Now, this idea that dealers are intentionally lacing everything with fentanyl for one reason or another (Ive heard that they're doing it to increase profits and that they're doing it to ensure that everyone gets addicted and keeps buying from them) is not really true. In some cases it can be, but in general people who sell illegal substances don't really want to kill off their clients by lacing things, and most people who sell these substances are also people with substance use disorders themselves. That doesn't mean you shouldn't be testing your drugs or that the dangers of fentanyl in other things is being overstated! It's true that fentanyl is being found in more and more of the street supply, sometimes even in uppers and party drugs, but that's because the street supply is complicated. It changes as laws get stricter and more relaxed, it changes based on whats available, it changes based on a lot of different things. But fentanyl is not a scary boogeyman, and sellers are not clasping their hands together and laughing like a super villain while they pour fentanyl into cocaine.

Having safe supply clinics and places would be a great place to start if we wanted to reduce the amount of people taking substances they aren't aware they're even taking, but like other harm reduction programs, they would only benefit the people who happen to live close enough to the programs, or in a place where they're legal to begin with. As someone who lives in a small, rural town, in a conservative state, I know its places like where I live that need these programs the most, but they will never be funded here. We barely have enough funding to have a public library and there are only two methadone clinics in my entire state with no other harm reduction options that I could find. And I think, truthfully, that safe supply clinics could only get us so far.

Even with all the funding we could throw at it, I don't think it would be realistic for there to be a safe supply clinic in every city in the US, and that means that there will always be people who are left to fend for themselves with a dangerous and unregulated street supply. Safe supply clinics also don't really address the issue of people with substance use disorders that end up committing other crimes just to be able to afford their substances. And that is not their fault, let me be clear about that. Withdrawal on it own can be deadly, and withdrawal on top of other dangerous situations like being unhoused is even worse. If you've ever been that sick, you know that sometimes you will do anything to end it. It's a societal problem.

So what do I think we should do that would solve both the access issues to safe supply clinics and make it so that no one with a substance use disorder would ever have to worry about how they could afford their next dose (and therefore not force them into withdrawals repeatedly or into illegal situations)? Well, a few things.

Firstly I think all drugs, yes all of them, have to be decriminalized. This is the very minimum. We have decades of research now and studies from countries that have actually done this showing that this alone could reduce so much harm. When there isn't the fear of prison and a horrendous social stigma attached to drugs, when people aren't facing the threat of losing everything, more people actually reach out for support and help with substance use disorders. And far more people are able to recover in a way that works for them, when and if they're ever ready, when recovery isn't a one size fits all abstinence only program. Many people do not want to be sober and don't consider that their recovery goal, and any system which makes someone choose between abstinence or prison discourages people from recovering.

Ideally though, they would be legalized and then federally funded. This is where I know I'm going to lose some people. Keep in mind this is not a widely recognized idea in the harm reduction community and is more like my own personal idea and ramblings past this point. Everything above here is good and strongly scientifically supported harm reduction information, but this below is just my own opinion.

The best thing we could do for harm reduction would be to make all illegal substances federally legal, federally regulated, and then available in all pharmacies without a prescription and free to anyone with a substance use disorder that can't afford them. If people with substance use disorders could go in the cvs, or walgreens, or walmart pharmacies, buy their drug of choice over the counter, measured by pharmacy techs and free of any contaminants or other substances, and then be given information on how to use it safely, the risks associated with substance use would decrease dramatically. But how would we make it free to everyone who can't afford it? A government funded program (funded by the taxes of everyone else buying substances in pharmacies) like medicaid or food stamps that pays low income people a certain amount each month or covers all of their purchases.

So yeah, I think meth and heroin (and everything else) should be sold over the counter everywhere.

Here are a few sites that I would really recommend if you're looking to learn more about or get involved in harm reduction.

• https://harmreduction.org/

• https://nida.nih.gov/research-topics/harm-reduction

• https://neverusealone.com/

Remember that the war on drugs is a war on people.