Friday April 18th 2014

Harm reduction in opiate and opioid users

Millions of Americans misuse illicit and prescription opiates. Access to opioid pain killers is fairly easy, while availability of prescription pills is high in the U.S. market. But what do people who use opiates risk? And how can harms of opiate or opiate use be minimized?

Here, we examine these questions and offer the most up-to-date harm reduction for addicts taken from the book Harm Reduction: Pragmatic Strategies for Managing High Risk Behaviors. Recently updated, the second edition of the title is an outstanding desk reference for anyone working with addicted populations. Dispelling myths about harm reduction and offering evidence based practices, this book is a MUST HAVE for addiction professionals interested in understanding the realities of harm reduction initiatives and their effects. As always, we welcome your questions at the end.

Harms of opiate and opioid use

Historically, certain use patterns have been a consistent focus of harm reduction interventions. For example, needle exchange programs are perhaps one of the most well-known and controversial harm reduction techniques that address disease that is spread by opiate injection. Additionally, methadone maintenance success aims to reduce heroin or hard opiate use by substituting less potent opioids in a controlled environment.  Further, harm reduction techniques aim to address public health and order problems caused by drug users. However, there are additional harms that you may not have heard of that can come from opiate or opioid use. These include:

  • addiction
  • death
  • drug interactions
  • increased emergency department visits
  • overdose
  • progression to more potent opiate use, especially heroin
  • public order problems (crime, theft, public intoxication, etc.)
  • transmission of blood borne diseases (HIV, hepatitis B, hepatitis C)

Top 10 opiate harm reduction approaches

Opiate harm reduction techniques aim to reduce or eliminate illicit opiate and opioid use. Although this goal is the basis for abstinence based programs, it is must less frequently realized during psychosocial drug interventions that target only abstinence. In fact, sometimes just keeping people “medically maintained” keeps them in treatment, reducing illicit drug activity and associated harms. Some of the most recent approaches to reducing opiate and opioid harm include:

  1. Drug substitution (opiate substitution therapies for less potent or less harmful substance; ie. LAAM, methadone)
  2. Drug consumption rooms
  3. Health care provider interviews including drug screening, drug testing, and drug contracts
  4. Ibogaine treatment for opiate cravings and depression
  5. Increasing access to to addiction treatment services
  6. Informational campaigns for prescription drug interactions and disposal
  7. Needle exchange programs
  8. Prescribing inject-able heroin (diamorphine) or oral heroin (diacetylmorphine)
  9. Prescription drug labeling and warnings
  10. Supervised drug injection sites

Harm reduction opiate questions

The practice of harm reduction continues to undergo research and evolution. As tools are available to drug treatment providers to help target opiate use and abuse, we as a society set the stage for harm reduction. So what needs to be in place for harm reduction techniques to work for opiate addicted individuals?

And what outcomes do we really want?

Your feedback, comments, opinions and questions about harm reduction for opiate and opioid use are welcomed below.

Reference sources: Harm Reduction: Pragmatic Strategies for Managing High Risk Behaviors (2012) pp. 170-200.

Photo credit: Todd Huffman

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5 Responses to “Harm reduction in opiate and opioid users
phatpooch
11:25 pm March 30th, 2012

Methadone heroin interviews

http://www.youtube.com/watch?v=Wb7mAvgPz_4

4:51 am March 31st, 2012

Thanks for sharing that link, phatpooch. The interviews with methadone and heroin users were for me an eye opener, and I could really see the difference that methadone can make for people. I know that many people criticize methadone maintenance, but I think that the first two women interviewed are doing much better than the last woman.

phatpooch
4:42 pm March 31st, 2012

Thanks. You can check out my other vids i made. One I created with three of my friends we all were hard core addicts here in Vancouver. I am doing the interview

Luke
11:33 pm April 1st, 2012

Although I agree methadone is safer to use than heroin and can be extremely helpful for individuals who are trying to fight their drug addiction, I remain very torn about it’s use. Even though it is not as powerful of heroin, it is often much more difficult to withdrawal from because it has such a long half-life. While heroin users may face withdrawals for about a week, methadone withdrawal tends to last for about a month because it stays in your body for so long. I have even heard of withdrawals lasting beyond six weeks. With methadone withdrawals last so long, people tend to trade one highly addictive substance for another. However, I agree most individuals are able to function better in society on methadone, and it is given by a professional who limits the use so it is definitely safer. I just would like to see some type of program implemented that helped individuals get clean from methadone after a few months of use in order to help them get completely clean. In the end, I wonder if those who become addicted to methadone wish they were able to go through a substance abuse program from the beginning so they did not have to go through a month of withdrawal to quit.

3:29 am April 2nd, 2012

Hi Luke. Thanks for sharing your opinion about methadone. There has been research which shows that 6 months is about the minimum amount of time that people should take methadone, But as doctor prescriptions are based on individual doctor decisions as well as patient outcomes,methadone maintenance programs CAN last for years for some people.

Have you heard of any programs that also have detox / withdrawal from methadone as part of clinical services?

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