Making America great again with harm reduction

I recently discovered a fact about the United States of America that should be a source of embarrassment for all Americans. What I found out is this: There is not a single safe injection site anywhere in the entire country. Safe injection sites save the lives of people addicted to opioids, such as heroin and fentanyl. These sites exist in countries around the world, and they are working every day to keep citizens of those countries alive and safe. In the addiction treatment community, we know that these facilities are proven to work, and we accept them as an essential component of harm reduction.

During the last several years, I have committed my medical practice more and more to the treatment of opioid addiction. I have learned a great deal about the subject and changed my opinion on some aspects of addiction treatment. There was a time when I believed that abstinence-based treatment was the only path to success and that we needed to focus on the people who were committed to staying clean. Those people who could not get clean through abstinence-based rehab and support groups were unfortunate victims of the disease of addiction. I realize now that I was wrong to think that way. There are many paths to recovery, and, by being open-minded, we can save many more lives of people who deserve to live and have a chance to overcome their addiction.

Harm reduction in addiction treatment means to keep people who are still in active addiction safe and alive. We have learned that using scare tactics and threats to get them to stop using drugs does not work. Addiction is a powerful force that persists through such weak efforts. In many cases, the best thing we can do is to provide tools to protect people who cannot stop using drugs until they are finally ready to accept our help.

What can we do to improve harm reduction in America? We can make naloxone injections and nasal sprays more available to all citizens. Increasing naloxone availability means making it over-the-counter and less expensive. It also means that we need an educational campaign to teach people about this opioid overdose reversal rescue drug and how it works. As a society, we now accept that hand-sanitizer works, and we all carry it and use it every day. If we can see naloxone nasal spray in the same way, we will be more prepared to reverse deadly overdoses.

Another thing we can do is to understand that addiction is not a moral failing, and it is something that can be treated and overcome. And, we can learn about better ways to support our love-ones who suffer in active addiction. Tough love does not work, and it is killing people. Waiting it out for a child or spouse to “hit bottom” is more likely to lead to tragedy. There are better ways to provide support.

Needle exchange programs and safe injection sites save lives. Another embarrassing fact is that needle exchange sites, while they do exist in the U.S., are rare. For example, I was aware of the IDEA Exchange program that is about 30 miles from my office. Some of my patients have been there before they got clean through medication-assisted treatment. What I did not know is that IDEA Exchange is currently the only needle exchange site in the entire state of Florida. How is this possible?

Why do we not have safe injection sites in the U.S.? There has been an ongoing legal battle in which a non-profit organization in Philadelphia wants to open the first such facility in our country, and the federal government is fighting to keep it from opening. Government lawyers reason that it will promote illegal drug use. Safe injection sites do not provide or sell drugs to users. They provide an environment where the drug user can be protected, preventing overdose death and the spread of infectious disease.

Why do lawmakers fight against life-saving harm reduction measures?  I think it is because they have not had the experience of watching someone addicted to opioids recover with medical treatment. Seeing their progression from hopelessness and despair to being happy and productive can change your views about addiction. These are real people with families and dreams to live fulfilling lives. They are no different from anyone else, and they deserve our help to recover.

As doctors, we can do our part in either providing addiction treatment services or by being aware of such services in our communities. And, we can educate our patients on the importance of harm reduction, by spreading the word about the importance of naloxone, needle exchanges, and safe injection programs. By promoting harm reduction, we will help to spread the word and save more lives from the opioid epidemic.

Please listen to the related podcast: Keeping Drug Users Safe With Supervised Consumption.

Mark Leeds is a family physician, can be reached at his self-titled site,, and podcasts at The Rehab. He can also be reached on Twitter @leedsosteopath.

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