A Smart Way to Battle Drug Addiction and Save Lives: Harm Reduction

A mother from suburban Hartford, Conn., had a life-saving drug on hand when she truly needed it. One evening last spring, she found her son, who had recently returned from an addiction treatment pro-gram, unconscious in his bedroom. He had relapsed and overdosed on heroin.

"He was not breathing, and he was gray," says the woman, who requests anonymity to protect her son’s privacy. "That’s when I called 911 and went running around the house trying to find my Narcan. We gave him two injections to get him breathing again before the ambulance got to our house."

Narcan is the trade name for naloxone, a drug that’s been used by emergency medical personnel for decades to reverse accidental drug overdoses from opioids, including heroin, methadone and prescription pain medications like oxycodones. This mother had received her supply through a Connecticut program that trains individuals to administer it in their home. A physician involved in the program says the drug is so safe that if it’s given to a person who’s not overdosing on an opioid, it will have no effect -- so it has no street value.

In June, Rep. Donna F. Edwards (D-Md.) introduced the Drug Overdose Reduction Act in 2009. It would provide cities, states and community-based groups with $27 million in annual grants to prevent and reduce drug overdose deaths. The bill emphasizes naloxone distribution, and calls for tracking overdose deaths and developing a national strategy to address the problem.

"I introduced the [legislation] because overdose is the second leading cause of accidental death in the United States," Edwards said in an e-mail, "and the number of overdose deaths continues to rise." So far her bill has attracted nine co-sponsors.

Increasing the availability of naloxone is an example of what is known as "harm reduction," a public health approach to social ills like substance abuse and sexually transmitted diseases. Harm reduction initiatives include having "designated drivers" for drinkers and needle exchanges for IV drug users.

Robert Heimer, a researcher at the Yale School of Public Health, says it’s important to recognize that harm reduction includes motorists wearing seat belts and bicyclists wearing helmets. Heimer says a harm reduction approach should be used with people from all social strata, not just marginalized groups like drug users. Their pariah status has led to the implemation of policies that have resulted in increased deaths. For example, the failure to fund clean needle programs increases the likelihood that many addicts will re-use needles contaminated with HIV, the virus that causes AIDS.

Heimer worked on a seminal study that began in 1990, when the state of Connecticut allowed a needle exchange pilot program to be created in New Haven. "By the middle of the 1980s, syringe-borne HIV far outstripped sexual transmission in the state," he said. "It was 70 percent of the cases in New Haven."

After a year of providing clean needles in exchange for addicts’ contaminated ones, Heimer and his colleagues estimated the HIV infection rate from dirty needles had fallen by 40 percent. "The program was so successful that the evidence persuaded the state to expand the number of programs and allow limited, over-the-counter sale of syringes -- up to the discretion of the pharmacist," he said.

Fast forward 20 years, and only two states -- Delaware and New Jersey -- still outlaw the sale of syringes without a prescription. Pennsylvania changed its law to allow such sales only last month. (Yet even now, after such success, Heimer says only 30 percent of pharmacists in Connecticut are willing to sell syringes to individuals who would use them to practice their drug habit more safely.)

While selected cities and states were developing life-saving programs like New Haven’s, the federal government -- under every president since the rise of AIDS in the 1980s -- has refused to ask Congress to fund needle exchanges. That may be changing under President Barack Obama.