Help drug users survive rather than abstain: “harm reduction” gains federal support

Greensboro, NC — A lean young man quietly entered the room while waiting for free supplies to prevent him from dying. Clean syringe; alcohol wipe to prevent infection; and naloxone, a drug that can undo overdose. The sign on the wall — “We represent that we love drug users like them” — felt like a hug.

It was the first day that a drop-in center in a residential area opened here since the coronavirus was forcibly closed in the spring of 2020. Jordan spoke to a volunteer who handed him a complete paper bag while heavy metal music riffed the speakers in the background. He asked for an additional naloxone for a friend in his rural county an hour away, where he said it was missing through a pandemic.

According to the report, deaths from overdose increased by about 30% in the 12 months ending in November to over 90,000. Preliminary federal data Released this month — suggests that 2020 has surpassed the recent record of such deaths. The tremendous increase during the pandemic is due to many factors, including widespread unemployment and eviction of peasants. Reduced access to addiction treatment and medical care; and the supply of illegal drugs that became even more dangerous after the country was essentially closed.

However, forced quarantine of people suffering from addiction and other mental health problems may be one of the biggest problems. Now, as the country reopens, the Biden administration is throwing support behind the controversial approach taken by the center here, known as harm reduction. Instead of helping drug users achieve abstinence, the main goal is to give them sterile equipment, tools for checking drugs for fentanyl and other deadly substances, or just a safe space to take a nap. Is to reduce the risk of dying or acquiring an infectious disease such as HIV by giving.

Such programs have long been attacked to enable the use of drugs, but President Biden has made it one of him to expand his harm reduction efforts. Drug policy priorities — The first president to do so.American rescue law Includes $ 30 million This is the first time Congress has allocated special funding for that purpose, especially for evidence-based harm reduction services. The funding is modest, but the program often runs on a small budget, so it’s a symbolic and practical victory for the program.

Daliah Heller, director of the drug use initiative of Vital Strategies, a global public health organization, said: “The harm reduction program says,” OK, you’re using drugs. First and foremost, how can you help you stay safe, healthy and alive? “

Some programs like this are run by North Carolina Survivors UnionDuring the pandemic, we were able to continue to provide some supplies — handing them through the window, providing porch pick-up, and even mailing them — virtually everything inside the drug user. I stopped inviting. Many clients like Jordan have stopped coming and lost a reliable safety net.

Some of the former regulars at the Greensboro Center have died or disappeared. Many have lost their homes and jobs. At the same time, the center is flooded with new customers and is currently struggling to keep enough supplies on hand.

Louise Vincent, Executive Director of the Survivors Union, said:

Nevertheless, many elected officials and communities continue to resist providing people with supplies for substance use. This includes the recent addition of test strips to check for the presence of illegally manufactured fentanyl. Others say that the syringes of the harm reduction program get cluttered in the neighborhood, or that the program causes an increase in crime.researcher Disagree with both claims..

West Virginia Passed the law Despite what it sees, it makes the syringe service program much harder to work Rapid increase in HIV cases Driven by intravenous drug use.North Carolina General Assembly weighs heavily Similar suggestions An elected official in Scott County, Indiana, who helped control the outbreak of large-scale HIV six years ago by replacing syringes this spring Vote this month Shut it down. Commissioner Mike Jones, who voted to end the program, said he was concerned that the syringes distributed at the time could contribute to death from overdose.

“I know alcoholics, and I don’t buy them a bottle of whiskey.” He said.. “And I know people who want to kill themselves, and I don’t buy them bullets for their guns.”

Many harm reduction programs are run by people who have used or still use drugs in the past and fight addiction, mental illness, or other health problems during a pandemic. Is also intensifying.To Baltimore, Boston, New York And elsewhere, exercise beloved leaders died last year from overdose, chronic health problems, and other causes, and their death left a hole in their efforts to continue to serve.

Vincent, whose addiction to opioids arose from a long struggle with bipolar disorder, temporarily returned to illicit drug use this spring. She said she was anxious to stop withdrawal symptoms after failing to switch from methadone to another anti-craving drug, buprenorphine. She later learned that the small amount of fentanyl she used was mixed with xylazine. Xylazine is an animal tranquilizer that can cause exuding skin ulcers. She landed at the hospital. Hemoglobin levels were so low that blood transfusions were needed.

Early in the pandemic, Vincent said the price of street drugs soared. Later, drugs sold as heroin, methamphetamine, or cocaine began to be cut with unfamiliar additives. Fentanyl has always been present — more and more contains counterfeit tablets sold as prescription analgesics or anxiolytics. But so did substances like xylazine. Philadelphia To Saskatchewan..

“It’s just a poison,” said Vincent, who returned to methadone treatment. “The supply of medicine is like we have never seen.”

On the afternoon of the center’s reopening, a young woman asked for a review of how to inject naloxone and asked if Vincent could explain what a stimulant overdose would look like. An elderly man asked if there was any food to eat with a clean syringe. Volunteers pasted pastries in the microwave for him.

In addition to running the program here, Vincent said National Union of Urban Survivors, A larger non-profit organization. In 2016, her 19-year-old daughter died of heroin overdose while she was in an inpatient center where naloxone was not at hand.

Naloxone is more prevalent today, but Vincent hopes another life-saving tool will become commonplace. It is a drug testing program that allows you to know exactly which substances are contained in an illegal drug before taking the illegal drug. Such programs are available in Canada, the Netherlands, new Zealand..Another type of harm reduction program used in other countries (using illegal drugs under medical supervision when overdose) is a group trying to open the drug in Philadelphia. Lost in court So far.

“we cInstead of waiting for a coroner’s death report, we need a real-time surveillance system, “Vincent said. “Will it change the game?”

She learned about xylazine in a drug she recently took using a device called a Fourier transform infrared spectrometer. This is what the donor provided to her group this year. Within minutes, you can identify the substances contained in a street drug sample.

23-year-old Jordan traveled from Stokes County near the Virginia border. There, even before the pandemic, overdose mortality was almost twice the state average. He said his cousin had been hospitalized a few weeks ago after overdose of a “really bad batch” of fentanyl, which tests found to contain trace amounts of heavy metals.

“At least 50 people in my area were saved by Narkan from here,” he said, taking several boxes, each containing 10 injectable vials of antidote. “Even my grandmother knows how to manage it.”

Many harm reduction programs, including this one, help connect people with medications and sometimes even offer them. But Jordan counts himself among the many drug users who aren’t interested in the path, at least at this time. The closest programs are in Greensboro or Winston Salem, each with a healthy drive from home. And treatment with anti-craving drugs like buprenorphine and methadone Proven To Save life“It doesn’t really work for me,” he said.

A county that includes Greensboro, the third largest city in North Carolina. Seeed a fatal overdose of 140 people Last year it increased from 111 in the previous year. It does not include those who died of drug injection infections, such as the fiancée of a woman who stepped into the center around dusk on the reopening day and asked Vincent, “Where is Louise?”

She met Vincent six years ago when both were patients at the Methadone Clinic and came to the center regularly for syringes and naloxone. She and her fiancé tried to stop using drugs during the pandemic. And I wasn’t nervous about the strange new adulterants that appeared in the supply. However, her fiance began to develop a high fever last December and was admitted to a severe hospital intensive care unit with endocarditis, a heart valve infection that can be caused by drug injections. He died shortly before Christmas.

“Are you having a meeting tonight?” The woman asked Vincent, referring to a support group that the center held several times a week before the pandemic.

“They will recover soon,” Vincent assured her. “Connecting is much more important than any of us think.”