When Republicans are talking openly about this country’s problem with heroin, as both Jeb Bush and Donald Trump did last night after the NH primary, you know we’re getting somewhere. But their logic was absurd, for different reasons. Jeb spoke personally about the addiction problems in his own family, before sharing an anecdote about a craft beer entrepreneur who is unable to succeed because of red tape in Washington. Schizophrenic, no? Trump I won’t even spend any time on, except to say No, Mexico is not to blame for America’s drug problem. In fact, a compelling argument has been made that over-prescribing doctors have contributed to the problem.
But that’s neither here nor there. I want to introduce some talking points to all of you so that you can share them on Facebook or around the dinner table or whatever, because a national conversation is actually happening and it must include data that challenges our assumptions about what addiction is and how it should be handled.
- There is a magical medication called Naloxone (commonly known as Narcan) that has a 99+% success rate at reversing opiate overdose. For a long time, it has been illegal to carry Narcan (and in some states it still is) on the premise that giving heroin users an OD antidote would be ENABLING their drug use. The only thing it enables them to do is live! Naloxone must be available in pharmacies w/o a prescription.
2. Detox can increase the risk of overdose. The regular heroin user has a natural tolerance for the drug. Detox eliminates this tolerance. If they renew their use at their former levels, they are at an increased risk of overdose (Denning, 2004). The counter argument to this may be that detox isn’t the problem, but that people who use drugs after detox are the problem. I disagree, for two reasons (1) Many individuals never really wanted to be abstinent in the first place, but were coerced/pressured/shamed into recovery; (2) Even individuals who DO want to quit for good may go through detox dozens of times. Let’s quit freaking out about how people need to stop doing heroin, and instead take simple precautions to reduce the harm of their use (stop overdoses).
3. Relapse prevention and overdose prevention are not necessarily the same thing. Of course, the safest way to prevent an overdose is to not take a drug. However, if we’re pragmatic, we’ll recognize that people are going to take drugs for a variety of reasons. Once we accept that fact we can start talking about tangible ways to prevent overdose. There are a variety of techniques:
a) inform people about their loss of tolerance after detox
b) encourage people to use in the company of other people and have Naloxone on hand
c) “taste” a shot before injecting
d) increase knowledge, not fear, of drugs
e) decrease stigma around drug use
Overdose prevention should come before relapse prevention, because recovery is impossible once someone is dead. If you know someone who has a problematic relation to heroin, don’t shame them. Learn how to administer Naloxone and tell them you would rather save their life than have them die in private. Recovery is a long, non-linear process.
If you want to learn more, here are some helpful resources:
Denning, Patt, Little, J., Glickman, A. (2004). Over the influence: the harm reduction guide for managing drugs and alcohol. New York, NY: The Guilford Press.