How many of you know someone who has an addiction? These days a better question would be does anyone not know someone who has an addiction. Addiction has swept our nation; for one reason or another the addiction is all consuming and has caused them to choose that thing over every other logical and obvious choice. Imagine craving something so viscerally you would do the very thing you would never do to get a hold of it. Really think about that, you would do the thing you would never do, addiction grips people. I am a nurse, I deal with these people daily.
Addicts are not just one thing, which is something many of us forget. For many, the goal is sobriety. They do not actually want to live within the throes of addiction. As providers we should support this, hold these people accountable, and provide compassionate care. We should provide a safe detox, support through cravings, challenges and assist to a state of remission, so they can try to get some semblance of their life back. What providers are actually doing is allowing sobriety to evolve into its current pathetic shell known as harm reduction.
Harm reduction is the utilization of techniques or products to reduce risk within the harmful behavior. Sure, some of you all reading this will roll your eyes and say “get off your high horse lady, seat belts, helmets, and nicotine gum all brilliant, proven methods of harm reduction.” The difference between harm reduction in other realms of life and addiction (in this case I am not including tobacco addiction) is those methods make a real and actual difference. The seat belt when used correctly actually saves lives by the millions, helmets — same, and nicotine gum at its 2 mg strength is basically benign and does far more good than harm for someone who previously smoked two packs per day for 40 years.
Harm reduction in addiction is just not saving people in the same way, all it does is hold them at bay. Harm reduction in addiction can be needle exchange programs, opioid maintenance therapies (suboxone/methadone), the widespread dispersal of Narcan. These are resources useful for an active addict but not for someone striving for recovery.
Recovery is many things; a study ‘”What is Recovery” (2016) showed 47 different points that recovered and recovering people would describe as recovery. An important storyline throughout the list supports that recovery should not be a trade off from a “harder drug” to something “less harmful.” I have many alcoholic patients tell me, “I have been clean and sober for 15 years! ” “Congratulations,” I say. “Well, I smoke a lot of weed, but that doesn’t count.” It counts.
Replacing one substance for another, does nothing for the person except to perpetuate their addictive behavior. Many providers, in addition to this harm reduction malarkey, are no longer testing for cannabis when running a drug screen because, “Well what are we going to do, it’s just weed…” said by an actual provider I used to work with on a substance abuse unit.
When did we get so lackadaisical about a mind-altering substance? No one will argue that alcohol gets you drunk, changes your impulse control and probably will affect your liver, and that heroin nods you out, slows down your breathing and you could easily OD. Why are we so ignorant on the potential impact of marijuana? Or about opioid maintenance therapies? Regarding the weed, the novelty of legality and perception of “in” will wear off in time. The opioid maintenance therapy is more of a challenge. Let’s be clear about opioid maintenance drugs, if taken during pregnancy, they still cause your baby to withdraw, they are effective and used as pain medication in appropriate patients, they are controlled and do have similar side effects to opioids.
What are we doing? Why are we pouring all this money into harm reduction? Let’s do more research on how to help people who want to recover, who want their life back. We need to stop worrying about how to lighten the blow of this terrible epidemic and become more responsible in practice. When treating addiction the message should be that becoming free and clear of substance is the path to health and wellness. Recovery is so many things but certainly it is not easy. The utilization of harm reduction is the path of least resistance and in this case it is poor practice and an injustice to our patients.
Ashlee Costa, MSNS, RN, is a resident of Greenfield.