Harm Reduction: John Hamilton’s Perspective
Written by: John Hamilton, President and CEO of Liberation Programs, Inc.
Harm Reduction gets a lot of bad press and part of the reason is that people think it is enabling behavior. I’m going to take a step back and talk to you about my thoughts on harm reduction. I believe harm reduction is truly meeting human beings where they are without our agenda. 2022 may not be the year of recovery for you or your loved ones, but the goal of Liberation Programs and my goals are to keep people alive until they can find their recovery.
Harm reduction is not enabling. All that harm reduction enables is for people to stay alive; it's not giving people permission to use, it's giving people hope. I always quote Johann Hari, who wrote Chasing the Scream, a British-Swiss journalist that said the opposite of addiction is not sobriety, the opposite of addiction is connection. Harm reduction is true connection, an innovative connection. It's showing love, it's showing people that we care without our agenda.
Harm reduction is on a full continuum. On one end of the continuum, I think there is more acceptance than ever for Narcan saving lives, so Narcan would be considered a harm reduction “101”. Reducing alcohol use for people that might be moderately involved in substance use disorder with alcohol could also help some people reduce the harmful effects of alcohol use. Reducing drug use is also a strategy, having drug use be safer, reducing their drug use, reducing the amount and the quantity or the times in which they use are all harm reduction strategies.
On the close end of the continuum of more acceptance in society is needle exchange. Syringe exchange programs have been wildly successful around the country for many years but only seven years ago did the Federal Government release the moratorium on being able to pay for syringes through federal funds. Syringes are a public health solution. It reduces HIV and the spread of Hepatitis B, and reduces the mortality of drug use. So that is certainly a harm reduction strategy. You have fentanyl strips for people to test what their drugs are. We at Liberation are involved in all of this; Narcan distribution to all individuals and families, needle and syringe exchange, we give out Fentanyl strips and overdose prevention kits to keep people alive for when they are ready for recovery.
There are more radical approaches. One would be safe injection, which was started by Liz Evans, whom we are honored to have as our Senior Director of Harm Reduction Services. Liz started the first safe injection site in Vancouver, Canada. She was beside herself seeing friends and family lose their lives because of heroin addiction so she created a safe haven, called Insight, to be able to provide a safe place to use and if a person was overdosing they would be able to get help in real time. There were also on-site linkages to services. There were, I think, over 10 years that she ran that program there was not one fatal overdose! So imagine if we opened that in Connecticut we would have maybe saved the 1,300 lives that were lost last year from drug addiction and overdose.
They also did a program in Canada called Naomi, which was a heroin maintenance program for those individuals who wouldn’t be interested in methadone maintenance or any type of other medication in assisting their recovery. They gave them pharmaceutical heroin (Dilaudid) to be able to maintain them on the system and many of those individuals converted into traditional treatment. So those are some of the radical approaches on the harm reduction continuum that I am not so sure we are embracing, although New York has opened up a safe injection site.
My understanding in March is there is legislation to approve the pilot of a harm reduction site in Rhode Island and we are hoping in Connecticut that if we can create harm reduction centers, that we can also create a safe haven for people who still may be in the throes of addiction to keep them alive. Similar to the CCAR recovery houses for those looking for a safe haven in recovery, we want to give people a safe haven for when they may still be using. We want them to feel that they are lovable and that they are worthy and they have value as well, even if they are still using. When you don’t judge people and give them dignity and respect, they start developing a sense of self love because others around them give them some sense of belief in themselves.
I think the recovery coach movement has done a wonderful job asking questions to really engage individuals ready for recovery. There are generally two questions recovery coaches ask, the first is, “how can I help you in your recovery today?” and the follow up is, “what does recovery look like to you?” Furthermore, harm reduction staff, overdose specialists or outreach workers, ask a simpler question, “how can I help you today?” And the follow up question would be “what does help look like to you today?” These specific questions make it possible to meet that person where they are. In therapy they say “if you meet people where they are, they always walk away with a new understanding of love and compassion.” If you walk away with anything else, frustration, anger, resentment, it means that your expectations of where you believe that person should be is not a match for where they are and that will always be your problem.
At Liberation Programs we have our “Peace, Love and Liberation” outreach vans in the community meeting people where they are every day from Bridgeport all the way through to Greenwich and in every community. We try to help people stay alive and for some of them, maybe convert them in real time into treatment. But even if they don’t, we are going to still work with them and keep them alive and be able to let them know they have value.