Harm reduction: apathy or compassion?

By: Chrysta Carroll - Bladen Journal

In a nation caught in the grip of an opioid epidemic, the strategies to combat it are as passion-inciting as they are diverse.

One school of thought behind a wide range of efforts says addiction is a physical problem, a mindset shared by at least two Bladen County pharmacists.

“Addiction is a disease, and I’d like to see us putting more money toward treating the disease rather than throwing addicts in jail,” voiced Dickerson’s Pharmacy owner Bruce Dickerson, citing studies that show the physical link between brain chemistry and addiction.

Fellow pharmacist John Stoll, of Clarkton Drug, agrees.

“We’ve got to get rid of the stigma surrounding addiction,” he commented. “The general public has this perception about people addicted to drugs that they’re bad or strung out, but the bottom line is that it’s a disease like alcoholism or rheumatoid arthritis. If a person has arthritis, you don’t have that type of reaction. One of the big problems is getting away from that stigma.”

Other schools of thought say addiction is a choice, a belief that would seem to be at the root of the penal system. It is also shared by leaders of Carolina Crossroads, like director David Chestnutt.

“We don’t teach people here that addiction is a disease,” he said. “We teach them it’s a sin issue, and they need Jesus.”

While individuals may have different ideas about the root of the problem, even more diversity exists about how to treat it. No methods to treat opioid addiction, however, have aroused more controversy than those treatments that fall under the umbrella of harm reduction.

Loosely defined, harm reduction aims to reduce negative consequences associated with drug use while respecting the rights of people who use drugs. Examples of harm reduction programs include syringe exchanges, methadone clinics, and Narcan distribution.

Patented in 1971, naloxone, sold under the brand name Narcan, is an opioid antagonist, meaning it combats the effects of opioids. Frequently used in the case of overdoses is the intravenous injection, which takes effect within two minutes. If injected into muscle, the drug takes five minutes to work, and it is also available as a nasal spray.

As part of an omnibus bill passed earlier this year, North Carolina made naloxone more readily available to local health agencies, which can now have standing orders.

“This is a big deal,” Dickerson said. “Think about it. In Bladen County, it may take 15 to 20 minutes for first responders to arrive with help. This drug works quickly. As long as your heart is still beating and you’re breathing, it’s immediate help, and it just pops you right out of it.”

The Strengthen Opioid Prevention Act also gives immunity from prosecution to administrators of naloxone acting in good faith, a clause in the law Dickerson called a good thing.

The problem with naloxone, however, is cost. A 2015 International Drug Price Indicator Guide says the price of naloxone in developing countries is between 50 cents and $5.30 per dose. The price in the U.S., on the other hand, is skyrocketing. According to a December 2016 article in the New England Journal of Medicine, in 2014, a package of two auto-injectors in the U.S. ran $690. In two short years, the price had increased more than six-fold, to $4,500.

Critics of the drug say if money is going to be spent on life-saving medication, it should be spent on drugs like insulin, anti-convulsants, or heart medication, since, in large part, the medical conditions affected by the medications are not the result of personal choice.

While naloxone remains an effective method for saving life immediately, other efforts aim long-term. Methadone clinics, like Lumberton Treatment Center, are one such effort and are springing up everywhere.

Commonly utilizing a practice known as replacement therapy, the clinics use methadone to help users end their addiction to opioids. While still an opioid, methadone is a weaker drug than the ones to which users are customarily addicted, and its slow release means it lacks the euphoria, or “rush” commonly associated with stronger drugs like morphine. According to supporters of the treatment, it stifles cravings for opioids.

Critics of methadone clinics, like at least one resident at Carolina Crossroads, say the practice does nothing to get to the root of addiction.

“The worst thing they could do is put a methadone clinic in Bladen County,” said Gavin Kersey, a Clinton resident at Crossroads. “I’ve seen people get up at 4 in the morning to go to Wilmington and get their methadone. You look like a zombie, and you’re still on drugs.”

Kersey added that methadone was as difficult a habit to break as opioids themselves.

When asked why, if methadone is just the exchange of one lifelong dependency for another, the clinics are springing up everywhere, Kersey had a ready response.

“They’re an easy answer for communities wanting to look like they’re really doing something,” the 32-year-old said.

At least as, if not more, controversial are other harm reduction strategies like needle exchange programs. Implemented in large cities like San Fransisco and New York City and endorsed by the North Carolina Harm Reduction Coalition, the program provides clean, sterile needles to drug users in order to cut down on the spread of infectious diseases. The thinking behind it is that society will always have drug users, so efforts should be focused on decreasing the negative impact they have on society, not on penalizing the behavior.

A city in England took the idea one step further, according to a 2013 article in The Independent. Harm reduction proponents there proposed to implement “shooting galleries,” sites where users could come in and use clean needles and actually shoot up on site without fear of arrest.

North Carolina, at the request of the North Carolina Harm Reduction Coalition, took its first step in that direction last year. In July 2016, North Carolina passed H.B. 972, allowing for needle exchange programs in the Tar Heel State. Though the 2017 S.T.O.P. Act prohibits the use of state funds for needle exchange programs, communities are still free to use local money to implement the initiative.

While they may not necessarily agree with harm reduction strategies, the outside-the-box thinking that generated the ideas might be just what the opioid crisis needs.

“There’s a pretty well-proven approach that says you have to approach this ecologically from all different angles,” said Bladen County Health Department Director David Howard. “We can’t just methadone or law enforcement our way out of this problem, but we need to approach it in a number of different ways.”

Chrysta Carroll can be reached by calling 910-862-4163 or emailing ccarroll@bladenjournal.com.


Chrysta Carroll

Bladen Journal