Harm reduction in substance use treatment
Opioid use and abuse
There is a current public health crisis regarding the opioid epidemic in the US which has been caused by aggressive prescription practices, opioid misuse, and illicit opioid overdose related deaths (Clark & Schumacher, 2017). Harm reduction has been identified as an evidence-based best practice to support opioid abuse, aiming to to mitigate the negative consequences of substance use by offering alternatives to support a client’s long-term goals (Taylor et al, 2021). The Substance Abuse and Mental Health Administration (SAMHSA), a government entity under the United States Health and Human Services Department, identifies harm reduction as a comprehensive approach to serving individuals suffering from opioid abuse. They report that harm reduction ‘decreases overdose fatalities, acute life-threatening infections related to unsterile drug injection, and chronic disease such as HIV/HCV’ (SAMHSA, 2023). The question stands: if research shows that harm reduction can support this public health crisis, why isn’t every treatment facility following these guidelines?
Harm reduction strategies
SAMHSA has created the SAMHSA Harm Reduction Grant Program which offers funding for treatment facilities to increase community harm reduction strategies through outreach and other resources. Facilities which have been awarded these grants include PA, CO, FL, LA, CA, MO, DE, TX, OK, ME, and MI. One harm reduction technique can include cutting down on the amount of the substance a client is using (Sharifimonfared, Hammersley, 2020). Other harm reduction strategies include supporting clients in using clean needles for injection, access to Naltrexone (which works to stop overdoses), and access to resources for lowering risky behaviours (Carrico et al, 2014). Harm reduction is a person-centred approach which focuses on what the client can do within their personal realm to minimise behaviours which put them at risk (D’Ambrozio, Cosgrove, Lilly & McCarthy, 2022).
Rules and regulations
Although harm reduction techniques are considered to be best practice, it has only been relatively recently that treatment centres have been able to put them into practice when treating clients. There are two regulating bodies that clinics often follow in terms of treatment practices: the Joint Commissions is a US non-profit which provides accreditation for healthcare facilities; and the New York State Office of Alcoholism and Substance Abuse Services (OASAS) which has recently added harm reduction strategies as an important part of their approved treatment protocols.
Prior to New York State OASAS approving harm reduction techniques as part of their approved treatment protocols, substance abuse treatment facilities which follow New York State OASAS and Joint Commission regulations and guidelines were not able to utilise these harm reduction, lifesaving clinical techniques.
Harm reduction in practice
Meg Duncan is the senior clinician at a substance treatment facility which follows OASAS and Joint Commission regulations and guidelines. She has been an addictions counsellor for 18 years and has worked in multiple levels of treatment. She is a New York State Certified Alcoholism and Substance Abuse Counselor Advanced level (CASAC) and has excellent rapport with all her clients. Recently, Duncan has expressed the excitement she felt when OASAS included harm reduction techniques to be approved for use by facilities. This excitement is because it will allow her and her team to use more evidence-based best practices to help save lives.
The reality is that many of our substance abuse treatment facilities are required to follow the regulations and guidelines put forth by each individual state. It is important that we advocate for our states to approve harm reduction techniques to be used by professional addiction counsellors for the sake of clients’ long-term health and treatment goals.
ReferencesClark, D J, Schumacher, M A, (2017), America’s opioid epidemic: Supply and demand considerations. Anesthesia and Analgesia, 125(5), 1667–1674. doi.org/10.1213/ANE.0000000000002388
Carrico, A W, et al (2014) Community-based harm reduction substance abuse treatment with methamphetamine-using men who have sex with men. Journal of Urban Health, 91(3), 555–567. doi.org/10.1007/s11524-014-9870-y
D’Ambrozio, G, et al, (2022). Harm reduction, humanistic psychology, and the CRPD. The Journal of Humanistic Psychology, 2216782211362–. doi.org/10.1177/00221678221136240
SAMHSA, (2023). Harm reduction. Retrieved from Harm Reduction | SAMHSA 3/17/2023.
Sharifimonfared, G, Hammersley, R, (2020) Harm reduction and quitting techniques used by heavy MDMA (ecstasy) users. Addiction Research & Theory, 28(3), 222–230. doi.org/10.1080/16066359.2019.1622684
Taylor, J L, et al (2021). Integrating harm reduction into outpatient Opioid Use Disorder treatment settings: Harm reduction in outpatient addiction treatment. Journal of General Internal Medicine : JGIM, 36(12), 3810–3819. doi.org/10.1007/s11606-021-06904-4
Cailyn Green, Ph.D., CASAC-M and Megan Duncan, AS, CASAC-Advanced
SUNY Empire State University