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:
- drug interactions
- increased emergency department visits
- 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:
- Drug substitution (opiate substitution therapies for less potent or less harmful substance; ie. LAAM, methadone)
- Drug consumption rooms
- Health care provider interviews including drug screening, drug testing, and drug contracts
- Ibogaine treatment for opiate cravings and depression
- Increasing access to to addiction treatment services
- Informational campaigns for prescription drug interactions and disposal
- Needle exchange programs
- Prescribing inject-able heroin (diamorphine) or oral heroin (diacetylmorphine)
- Prescription drug labeling and warnings
- 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