Harm Reduction

Overview

Law enforcement officers often find the bodies of drug users who overdosed before they were able to quit. Officers know that many drug users relapse because, after drug treatment, they still struggle with mental and physical health problems, homelessness, and unemployment. When drug users relapse, they usually lose access to the services that they need to stabilize their lives and successfully quit drugs. As a result, many officers support harm reduction programs, which help drug users survive their addictions and stabilize their lives, rather than demanding that they quit before offering help.


One of the most frustrating things about working in the criminal justice system is seeing the same people cycle in and out of the system day after day. Many are struggling with drug addiction, yet those of us called upon to handle their cases do not have tools to deal with their root issues. To break their addiction, they need support with mental and physical health problems, homelessness, and unemployment, but our only tools are arrest and incarceration, which often make these problems worse.

Given the dramatic increase in heroin use among young adults, harm reduction is particularly urgent in the United States.1 Heroin overdose deaths have risen almost 250 percent from 2010 to 2014, reaching 29 overdoses per day in 2014.2 Many users inject heroin with shared needles and in unsterilized environments, resulting in HIV, Hepatitis C, and bacterial infections.3 But quitting is notoriously difficult – withdrawal can cause vomiting, tremors, diarrhea, muscle spasms, and bone aches for up to a week, while deep depression can last for years and drive some to suicide. Standard treatment programs that provide counseling and psychological support need to be expanded, but they are not enough. Harm reduction initiatives allow people addicted to drugs to stabilize their lives and gain control over their recovery.
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Solutions

Harm reduction initiatives supported by the Law Enforcement Action Partnership's speakers include:

In almost 100 locations across Europe, Canada, and Australia, drug users bring their own drugs into SCSs and consume the drugs in the presence of medical staff. In more than two decades of SCS operation, no client has ever died of overdose or contracted HIV or Hepatitis C due to needle-sharing in these facilities.4 Bringing people who use drugs out of hiding also builds their trust in medical professionals and allows providers of other services to reach them; studies show that SCS users are more likely to enter treatment.5

LEAD empowers police officers to divert individuals struggling with drug addiction and other issues into intensive support programs instead of jailing them. LEAD case managers coordinate addiction and mental health treatment, health care, shelter, food, housing, and job training. Evaluations of the LEAD program in King County, WA have found that LEAD reduced recidivism, felony crime, homelessness, and unemployment.6

Doctors can prescribe heroin users methadone or Suboxone, replacement opioids that take away their cravings without getting them “high.” While traditional heroin treatment has a 5 to 15 percent long-term success rate,7 MAT program success rates exceed 50 percent.8 MAT brings positive benefits even when drug-dependent individuals do not quit heroin entirely – because they often still reduce their use of the drug, lowering the incidence of criminal activity and medical emergencies. Every $1 spent on MAT programs saves society between $4 and $10, and MAT reduces recidivism when offered to drug-dependent individuals behind bars.9 However, most drug court programs, jails, and prisons refuse to allow MAT.

HAT clinics are facilities in which medical staff assist those who have repeatedly failed treatment with administering pharmaceutical-grade heroin. Since these users no longer need $100 a day to buy their heroin from dealers, they stop stealing, selling their bodies, and dealing drugs, which reduces both crime and heroin use.10 And because the drug is tested for purity and potency and administered in safe conditions, HAT patients do not suffer overdoses or contract new HIV, Hepatitis C, or tissue infections. Once they have the opportunity to rebuild their lives, most stop using heroin—the average patient quits entirely within three years.

SEPs provide drug users with clean syringes and medical advice to reduce the transmission of HIV and Hepatitis C. While SEPs have been proven effective, critics argue that they “enable drug use.” In fact, studies show that SEPs do not encourage drug use, and that by earning the trust of drug users, SEPs become intervention points where drug users seek social services, including drug treatment.11

If you are in need of a needle exchange in your area, click here

The drug naloxone (brand name: Narcan) reverses the impact of opioids on the brain, so it can be used to stop an overdose but cannot be used to get high.12 While it is important for police and other first responders to carry naloxone, the majority of users who overdose are saved by family and friends. Providing naloxone to users and their families has been shown to reduce the overdose death rate by up to 50 percent.13 It is vital that while we provide naloxone to law enforcement and other first responders, we also provide it to these literal first responders.

When drug users work up the courage to seek treatment, they usually face week- or month-long waiting lists. Most relapse before they can be admitted. By greatly increasing public funding for treatment beds, cities can cut down these waiting lists, with the ultimate goal of no wait time at all—Treatment on Demand.

For sources, and with any other questions, please contact OurIssues@LawEnforcementAction.org

Supervised Injection Facilities:
A Closer Look

Take a tour of Vancouver's Insite, the first legal supervised injection facility in North America, with the Law Enforcement Action Partnership's executive director, Major Neill Franklin (Ret.).

Watch as a retired sheriff - our own Sheriff David Lanoie (Ret.); an addiction doctor; and a former drug user all make the case for bringing a supervised injection facility to Boston in this 2016 panel discussion at the Boston University School of Medicine.

Brought to you by Detox Local

  1. Centers for Disease Control and Prevention. "Today’s Heroin Epidemic." Centers for Disease Control and Prevention website. 7 Jul. 2015. Accessed 12 Jan. 2017 at https://www.cdc.gov/vitalsigns/heroin/.
  2. National Institute on Drug Abuse. “Overdose Death Rates.” National Institute on Drug Abuse website. Jan. 2017. Accessed 12 Jan. 2017 at https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.
  3. National Institute on Drug Abuse. “Why does heroin use create special risk for contracting HIV/AIDS and hepatitis B and C?” National Institute on Drug Abuse website, Nov. 2014. Accessed 12 Jan. 2017 at https://www.drugabuse.gov/publications/research-reports/heroin/why-are-heroin-users-special-risk-contracting-hivaids-hepatitis-b-c.
  4. Beletsky, L., Davis, C. S., Anderson, E., & Burris, S. “The law (and politics) of safe injection facilities in the United States.” American Journal of Public Health 98(2) 2008: 231–237.
  5. Kora DeBeck, Thomas Kerr, Lorna Bird, Ruth Zhang, David Marsh, Mark Tyndall, Julio Montaner, and Evan Wood. “Injection drug use cessation and use of North America's first medically supervised safer injecting facility.” Drug and Alcohol Dependence, 2010.
  6. Law Enforcement Assisted Diversion."LEAD Evaluation." Law Enforcement Assisted Diversion website. Accessed 12 Jan. 2017 at http://leadkingcounty.org/lead-evaluation/.
  7. Cherkis, Jason. "Dying To Be Free: There’s A Treatment For Heroin Addiction That Actually Works. Why Aren’t We Using It?" Huffington Post, Jan. 2015. Accessed 12 Jan. 2017 at http://projects.huffingtonpost.com/dying-to-be-free-heroin-treatment.
  8. California Society of Addiction Medicine. "Methadone Treatment Issues." California Society of Addiction Medicine website, 2011. Accessed 12 Jan. 2017 at http://www.csam-asam.org/methadone-treatment-issues.

    Eric Sarlin. “Long-Term Follow-Up of Medication-Assisted Treatment for Addiction to Pain Relievers Yields ‘Cause for Optimism.’” National Institute on Drug Abuse website, 30 Nov. 2015. Accessed 12 Jan. 2017 at https://www.drugabuse.gov/news-events/nida-notes/2015/11/long-term-follow-up-medication-assisted-treatment-addiction-to-pain-relievers-yields-cause-optimism.

  9. CHPDM. “Review of Cost-Benefit and Cost-Effectiveness Literature for Methadone or Buprenorphine as a Treatment for Opiate Addiction.” Center for Health Program Development and Management at the University of Maryland, Baltimore County. August 29, 2007. Accessed January 13, 2017 at http://www.hilltopinstitute.org/publications/Cost_benefit_Opiate_Addiction_August_29_2007.pdf.
  10. Joanne Csete. “From the Mountaintops: What the World Can Learn from Drug Policy Change in Switzerland.” Open Society Foundations Lessons for Drug Policy Series, New York, 2010. Accessed January 13, 2017, at https://www.opensocietyfoundations.org/sites/default/files/from-the-mountaintops-english-20110524_0.pdf.
  11. amfAR. “Public Safety, Law Enforcement, and Syringe Exchange.” amfAR Fact Sheet, March 2013. Accessed January 13, 2017 at http://www.amfar.org/uploadedFiles/_amfarorg/Articles/On_The_Hill/2013/fact%20sheet%20Syringe%20Exchange%20031413.pdf.
  12. Harm Reduction Coalition. “Understanding Naloxone.” Harm Reduction Coalition website. Accessed January 13, 2017 at http://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/understanding-naloxone/.
  13. Maia Szalavitz. “Wider Use of Antidote Could Lower Overdose Deaths by Nearly 50%.” TIME Magazine, February 5, 2013. Accessed January 13, 2017 at http://healthland.time.com/2013/02/05/wider-use-of-antidote-could-lower-overdose-deaths-from-by-nearly-50/.