By Katie Hyslop with Devan Schwartz, Contributing Writers
Hundreds of doctors, politicians, researchers and frontline workers will get together with drug users and ex-users in Austin, Texas, this month to openly talk about drug use. But instead of reaffirming their commitment to the decades-long war on drugs, the eighth National Harm Reduction Conference will feature discussions on opening needle exchanges, legalizing and regulating the drug trade, and overdose prevention methods.
“What we do in (the United States) is make drugs as unsafe as they possibly can be, and we do that through laws, which means that, if you get busted with drugs, you go to prison for a long time. And that’s designed as a deterrent to make people stop using drugs, which obviously it isn’t,” said Allan Clear, executive director of the Harm Reduction Coalition, which runs the national conference. “We do things like take syringes out of circulation, which has caused epidemics of hepatitis and HIV. So harm reduction is a way of trying to make drug use safer for people who use drugs, without demanding that they stop using drugs.”
Harm reduction can include a range of services from needle exchanges and condom distribution to safe consumption sites and access to addiction services such as methadone and buprenorphine treatments and detox facilities.
Supported by the United Nations and over 93 countries worldwide, harm reduction remains controversial. More than half of the 158 countries where drug use has been reported say they support harm reduction, and 82 countries have needle exchanges, but only 73 provide opiate substitution therapies such methadone, and only eight countries have safe drug consumption facilities. There are only two safe consumption facilities in North America, both in Vancouver, British Columbia, Canada.
Progress in Portland: In the late 1980s Portland, Oregon became one of the first U.S. cities to establish Syringe Exchange Programs, or SEPs. The city was dealing with rampant drug abuse that continued through the 1990s, and reached 250 reported heroin-related deaths in 1999.
Portland now offers three fixed sites for syringe exchange, along with the mobile Multnomah County Exchange Van. A drug paraphernalia law remains on the books in Oregon, though the possession of needles and syringes is exempted.
Outside In provides a majority of local needle exchanges. The organization offer one-for-one exchanges of up to 30 syringes along with HIV and hepatitis C counseling. Kelly Anderson of Outside In observes a clear need for their services in the community, their needle exchange clients alone having doubled in recent years. Nevertheless, she says that their funding “has not increased in over five years.”
Despite the relative availability of services, drug-related deaths themselves have returned to alarming levels in Portland — the state’s main site for overdoses. Oregon’s Alcohol & Drug Policy Commission delivered a report to Governor Ted Kulongoski identifying 229 overdose deaths in Oregon is 2008. The Associated Press reports that in 2009, 127 Oregonians’ lives were claimed by heroin alone.
Dr. Rachel Solotaroff is the medical director at Central City Concern, one of Portland’s oldest service providers. She acknowledges the city’s heroin problems but then expands the purview onto the ubiquity of prescription opiates. Oxycotin, suboxone, and methadone — the latter two prescribed as anti-addictives — can lead to their own addictions, black market street distribution, and even deaths.
“Not many of the prescription opiates on the streets come from people breaking into pharmacies,” Dr. Solotaroff says. “That’s the onus on us as prescribers. Not having sufficient regulation around prescription opiates is a huge contributor to drug-related death in Oregon.”
Solotaroff also identifies structural strains on providers. “With the unemployment and rising uninsurance in the country as well as in the state we just can’t see everybody. We just couldn’t keep our doors open. One issue is the rising uninsurance rate and the other is the increasing complexity of the individuals.”
Often cited social determinants of health include poverty, homelessness, addiction, social isolation, criminal history, and a lack of employment.
But Solotaroff doesn’t believe the issue is strictly a monetary one. “We need the flexibility to give better care to our patients. We need to support them in so many ways. We need to have supportive housing for individuals. And we need to have supportive housing for people still in their addiction. That’s often the first step to getting them out of their addiction. It’s something that may not take a lot of money, just an act of will and understanding and compassion.”
Central City Concern’s own Community Engagement Program (CEP) utilizes aspects of such a multidisciplinary approach. They attempt to address issues of drug addiction simultaneously with issues of chronic homelessness. “Housing is the really critical thing,” says Sara Goforth, Director of Addictions and Chemical Dependencies and Mental Health Services. Continue reading