Today there was a HUGE announcement regarding recovery in this country. New York City's Mayor, Bill de Blasio, announced that NYC has opened two overdose prevention centers (OPCs) in upper Manhattan. You can read more about it here.
I call this a HUGE announcement because these upper Manhattan OPCs are the first of their kind in the United States. OPCs are known by various names in various places: supervised consumption sites, safe injection sites, etc. Yes, you are reading that correctly. They are places where users of substances can use knowing that medical attention is available if need be. Their opening in the U.S. provides an opening to the discussion of harm reduction.
The National Harm Reduction Coalition defines harm reduction as:
. . . a set of practical strategies and ideas aimed at reducing negative
consequences associated with drug use. Harm Reduction is also a
movement for social justice built on a belief in, and respect for, the rights
of people who use drugs. (harmreduction.org)
In today's parlance "there's a lot to unpack there," even though it's only a couple of sentences. In this post, I'll cover the first bit -- "reducing negative consequences associated with drug use." Generally, when people think of recovery they think of abstinence, and abstinence is certainly a part of many, if not most, recoveries, but reducing negative consequences associated with drug use does not necessarily require abstinence.
If you or someone you care about were an IV drug user, wouldn't you consider using clean needles a reduction in the potential harm associated with use? Add to that using in a controlled environment where Naloxone, the medication used to counter the effects (e.g. death) of opioid overdose, is readily available to be administered by trained professionals and your or your loved one's use becomes exponentially more safe. Now add assistance in finding treatment and/or social services to assist in recovery, which the OPCs also provide, and you have a major stepping stone towards living your best life while living with substance use disorder.
In a recent conversation with someone regarding harm reduction, they pointed out that access to recovery resources made the concept of OPCs more palatable, but a safe place to use wouldn't be what that person would want for their loved one. Unfortunately, I knew people who lost their lives to overdose, and I know people who have lost loved ones to overdose (in this era when EVERYTHING seems to be laced with fentanyl, overdose is WAY too common).
If the guy on the tightrope in the picture at the top of this post were your friend or loved one, you'd probably be frightened by the fact that he walks on tightropes strung between buildings, and reasonably so! But you'd feel much better if that person used a safety net, especially if it came with the added bonus of someone to help steer them towards counselors that might help them to find a safer hobby. That's what these NYC OPCs represent for people using substances.
Some may see OPCs as enabling use, and I do understand that point of view. I can also promise you that the people I've lost and the ones who have lost loved ones to overdose all wish the user were using in a safe, controlled environment that had someone there to save them. Stigma would tell us that they were degenerates not worth society's time. I can tell you that they were PEOPLE -- people with jobs, degrees, families . . . real, normal, American lives, except they had a disease.
One friend was working on his Ph.D. His substance of choice was prescription stimulants (Adderall, Ritalin, etc.). I knew he was using again, and we had discussed it (this was before I became a coach and a large part of my motivation for becoming one).
He told me he functioned better with the drugs than without, and his real problem and biggest risk was that he was buying on the street. Whether or not he truly functioned better with the pills is certainly open to debate. What is not, is that within a couple of weeks of telling me that, he was dead, a result of pills laced with fentanyl he bought on the street.
Would it have been better for him to have had permission to purchase pills legally or at least take the pills he bought on the street at a supervised site where he could receive treatment if the pills turned out to be laced? Maybe if it came along with mandatory counseling (mandated counseling is a debate within harm reduction)? I'd argue yes. Odds are, he'd still be alive. That's harm reduction.
Clean needle programs were the first toe in the waters of harm reduction for this country and many others. Of course, true to our Puritan roots, the United States' first clean needle program launched two years later (1988) than the world's first modern safe injection site launched in Bern, Switzerland (1986). As of December 2020, approximately 120 safe injection sites were operating in 11 countries including Canada, Australia, Switzerland, Germany, the Netherlands, Spain, Luxembourg, Denmark, and Norway.
Have there been hiccups? Certainly. Some locations have attracted dealers. Some locations have reported increases in discarded needles in the area. That said, just seven locations in Alberta, Canada had a 100% success rate in reviving over 4,300 overdoses on-site in their first 22 months of being open. That is over 4,300 lives saved!
The first step to living your best life while living with substance use disorder is, well, living. While not a perfect solution by any means, OPCs such as those that have just opened in NYC do save lives. That is proven fact. You can't get better if you lose your battle with SUD. Yes, SUD causes damage -- damage to relationships and careers. People with SUD sometimes end up incarcerated. But unless you lose that ultimate battle, there is always an opportunity for life with SUD to get better.
Because of stigma, there will always be disputes regarding operations such as OPCs, just as there have been regarding operations like methadone clinics in the past. "Not in my neighborhood." But when we look past the stigma and realize that people with substance use disorder are our friends, neighbors, colleagues, employees, and loved ones, hopefully, we can open our minds to solutions to SUD beyond criminalization. One big step in that process is accepting the concept of operations such as OPCs.
Author's note: to some, this post may go into a political realm to which I have not ventured to date, and if that's how some view it, so be it. One of the responsibilities that comes with being a certified addiction recovery coach is to advocate for people with SUD. So, yes, here I am advocating for more OPCs and similar operations in America.
"After exhaustive study, we know the right path forward to protect the most vulnerable people in our city," de Blasio said in a release. "And we will not hesitate to take it. Overdose Prevention Centers are a safe and effective way to address the opioid crisis. I'm proud to show cities in this country that after decades of failure, a smarter approach is possible."
On this, Mayor de Blasio and I agree. Considering that in the United States we recently surpassed over 100,000 overdose deaths in a 12-month period for the first time ever, it is clear that changes in how we view, deal with, and treat people with SUD are needed, and OPCs and similar operations are a key step forward towards enacting such changes.
- Chappy
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