Harm reduction the first step in addressing opioid crisis

Soon Philadelphia's Mayoral Opioid Task Force will issue its report on combating the region's epidemic. What can we expect?

If Philadelphia is like other U.S. cities that have convened official bodies to adopt a public-health approach to this crisis, the likely response will be a mixture of law enforcement, prevention, treatment, and harm reduction. The Swiss call this approach "Four Pillars" and have had much success since introducing it more than two decades ago.

However, where Philadelphia's report will differ from Ithaca, N.Y., and Seattle is the recommendation to open one or more supervised injection facilities (SIF). This shouldn't be surprising. Philadelphia has actually assumed a belligerent stance against addicts of late. There seems to be a fear on the part of elected and appointed public officials of straying from the well-worn path of enforcement.

It is an understandable fear. Some elements of the Kensington community are so opposed to services for addicts that uniformed city police officers were called upon to maintain a visible presence outside a task force listening session held at Prevention Point Philadelphia in January. Readers' comments to the March 8 Inquirer article on the consideration of SIFs were appalling in their callousness. They reflected a deep misunderstanding of the broader public health approach we call harm reduction, as well as the enormity of the opposition to the programming these facilities would provide.

Misinformation has been a big enemy of harm reduction from the earliest U.S. implementation of syringe exchange in the late 1980s to fight a similarly destructive epidemic, HIV/AIDS. Some worried that giving people clean needles would increase drug use. Numerous studies have shown it doesn't. Nor did syringe exchange foster the climate of lawlessness that many claimed would drag down surrounding neighborhoods (Harm-reduction programs are frequently forced to relocate as the struggling neighborhoods they're in improve). Others argued that syringe exchanges were a waste of money - the annual savings from preventing just 75 new HIV and 17 hepatitis C infections equals Prevention Point Philadelphia's total yearly budget.

Harm reduction's other enemy is publicly condoned hatred and disdain of drug users. Some of the disdain is understandable: Few of us enjoy displays of public intoxication as we go about our sober lives. The detritus of addiction-used needles, people sleeping in cardboard boxes, and the occasional dead body challenge our sense of humanity and public order. Deep feelings are triggered: of revulsion, of despair, of fear.

My answer to this disdain is simple: There but for the grace of God go I.

No one wakes up one morning saying to themselves, "I think I'll try some heroin, and see how living in the gutter feels." The path to addiction plays out over time and is filled with bad luck, as well as impulsive decisions. These decisions, which appear irresponsible to the casual observer who knows little of the addictive process or the back stories of strung-out users, make complete sense to the person struggling to stave off dope sickness. If you don't believe me, go to the Conrail tracks before the city fences them off and talk to the people down there. If that feels too scary, listen to drug users' hard luck stories at your local 12-step meeting.

The heroin users down at the tracks are neither zombies nor aliens: they are your brothers, sisters, children, and parents. You too may find yourself in similar circumstances one day. In fact, as I read the comments to newspaper articles on "the gulch," I wonder about the cruelties of fate, how the death of a child or some similar tragedy, can lead to a cascading set of circumstances that ends at El Campamiento, as it had for a veteran I met down there recently.

It's worth noting, as New York Times columnist David Brooks recently did, that more Americans died of drug overdoses in the past three years than died in Vietnam in 12 years of war. Many will be appalled at the comparison. But forget the blame and shame game for a minute and just think of the toll on communities and families across the nation. Then add in the lives lost to drug-related violence, disease, and incarceration.

It's time to say enough is enough, forge a new path, and come together as a people, if not to make America great again, then at least to make it a livable place.

Paul Cherashore, formerly of the New York City-based Harm Reduction Coalition, is a member of the Philadelphia Overdose Prevention Initiative. phillyodprevention@gmail.com