Now 40, Jennifer S. is a heroin addict from Selden who has used the opiate since she was 13 years old. She’s been clean for years at a time, and she’s been jailed for years at a time. She shoots up three or four times a day and has a husband and a home and a job. Actually, two jobs. She’s an office manager and bookkeeper, and she works for Community Action for Social Justice, the only “harm reduction” and syringe-exchange program on Long Island. Jennifer helps addicts stay alive, people like her who aren’t ready to stop using.
Harm reduction is a big challenge, one made more difficult by a system that focuses most resources on preventing addictions and treating addicts ready to quit. To many, driving resources and compassion toward active addicts feels like enabling. But both the resources and compassion are necessary, because no one’s ready to quit until he or she is ready, and because no one can get better if he or she is dead.
Naloxone, the drug that snaps users out of heroin or painkiller overdoses, plays a big part in harm reduction. Huge strides have been made in Naloxone distribution and training by police departments, municipalities, social services and volunteer groups. Yet overdose deaths continue to skyrocket. In 2015, 3,009 people in New York State died of drug overdoses, and more than three-quarters were attributable to opioids. Tina Wolf, executive director of Community Action for Social Justice, says part of the answer lies in making sure addicts themselves have Naloxone, not just the concerned parents and community members trained in its use. Opioid users are the people who overdose and hang out with others who do. Advocates say that to save lives, government — federal, state and local — should mandate and fund programs that hand Naloxone to addicts when they walk out of a jail, hospital or rehab center. Yet, that’s almost never done.
A peer outreach worker like Jennifer, who didn’t want her last name used, is a great resource, because she can make sure her drug-using acquaintances have Naloxone and know how to use it. And she can work to reduce a variety of other harms for them, too, because opioid addicts face plenty of dangers beyond overdosing.
According to the Centers for Disease Control and Prevention, hepatitis C is the deadliest infectious disease in the United States, killing almost 20,000 people in 2014, with a new wave of infections among those who inject drugs. More than 1.2 million people have HIV, the virus that causes AIDS. These diseases are a plague to people who inject drugs, and the best way to stop the spread is by dispensing free, clean needles and syringes, as well as condoms. With a budget from the state of about $500,000 a year, Community Action for Social Justice isn’t getting to most people who need help.
Wolf and her co-workers also talk to drug users about how to inject safely, and avoid overdoses, infections and vein problems. And when someone is ready for sobriety, they help with that, too. But they also stress the value of helping people maintain their health and dignity even if they are not ready to stop using.
Those who aren’t ready will use drugs, Jennifer says. Addiction is a disease, and taking risks to get high is a symptom. She says she has tried three times in the past year to get a bed in a detoxification clinic, but none have been available. And when she failed to get sober, she used drugs.
Harm reduction is needed after addiction prevention doesn’t work and before recovery takes hold. Experts say we are not spending nearly enough on it, not talking about it enough, not pushing hard enough to make sure active users stay alive and as healthy as possible. If the rising death toll from opioid addiction is to be reversed, if the most possible people are to recover, that has to change.— The editorial board