Harm Reduction: A Personal Journey

Rev. Alexander E. Sharp Harm Reduction

Many wage war against harm reduction, opposing clean needle exchanges, Naloxone, and other life-saving drugs. Some religious leaders, especially Evangelicals and Catholics, oppose harm reduction because they find all drug use to be immoral.

CNDP believes harm reduction to be profoundly moral and to reflect the deepest values of our religious faith. We advocate  a health not punishment response to drug use.

To understand harm reduction through first-hand experience, we approached Laura Fry, who directs patient and family services for Live4Lali, a Northern Illinois non-profit that works with individuals and families struggling with substance abuse.

In the following interview, CNDP Executive Director Rev. Alexander Sharp asked Laura to describe how she learned about harm reduction, what it is, and how she applies it in her work.

Al: What is harm reduction?

Laura: We all practice harm reduction every day. In my training sessions, when I ask, “Who practices harm reduction?” at first no hands go up. Then I ask, “Okay, who put a seat-belt on when they got in their car to come here?” Everybody’s hand goes up. We didn’t always have airbags or fluoride in our water. Harm reduction has evolved over the years. It’s anything we can learn or do that might prevent harm to people.

Al: So how does it apply to drug use, and how did you discover it?

Laura: My son was an IV heroin user. Seven years ago, when he was actively using, I would sack his room and throw out or break everything that I found, every pipe, every syringe. I even found his Naloxone [which revives people who have overdosed]. I had no idea what it was.

When I first heard about harm reduction, I didn’t know how I felt about giving drugs to drug users. But I learned that in places like San Francisco, where harm reduction was practiced, deaths dropped because of needle exchanges.

People who are addicted are going to use drugs. If someone with a substance use disorder finds a needle in a puddle, there is a good chance they will use it and even share it with others. When I was an emergency room nurse, a lot of IV drug users came in with abscesses because of reusing needles, sharing needles, not knowing how to inject properly. Those injuries could have been prevented.

Al: Drugs harm people. Why not simply say to drug users, “Look, you’ve got to stop. We’ve got 12-Step meetings that insist that you stop if you’re going to be part of those meetings.” What’s wrong with that?

Laura: Unfortunately, stopping doesn’t tend to stick with a chronic relapsing brain disease. That’s like saying to a person with diabetes, “you should try to produce enough insulin today.” It’s not possible.

People who don’t understand this reality wonder, “Why are you going in and out of rehab? Why are you going in and out of jail?” They think about drug use as an individual flaw. We have to look at the systems that are supporting this population and identify whether they are appropriately serving people in need. The emphasis on abstinence can set people up to fail.

Al: But isn’t abstinence the only way to recovery for some people?

Laura: Absolutely. But what data shows us is that treatment and recovery need to be individualized. A person who has three kids and a full-time job just cannot spend thirty days in an inpatient facility. For that person an evening outpatient program, treatment by an addiction specialist, and medication can be incredibly supportive.

There are definitely some people who need an inpatient program or who can only exist by total abstinence and going to four or five meetings a week. I respect that if that’s what works for you. But people are pretty complex and there are other areas that need to be addressed and other types of recovery programs available. Some people I know with opioid use disorder now use cannabis, medically or recreationally. If it helps you and you’re leading a productive life, and you’re alive, that’s a no-brainer.

Al: What you do for Live4Lali?

Laura: My title is director of patient and family services.  I oversee all  programming, whether in the community or in-house. We have multiple peer-to-peer recovery groups like SMART Recovery, a 25-year-old nonprofit organization that provides real life day-to-day tools for how to work your recovery. It uses cognitive behavior therapy and rational emotive behavior techniques.

Al: Are participants expected to go to meetings sometimes for the rest of their life, as often is the case with 12-Steps?

Laura: No. You graduate from SMART. One of the things that I say is, “I am not going to be sitting in this room 35 years from now with all of you all. People have come to me and said, ‘You know, I think I’ve gotten everything I can get out of this, and I want to discuss that with you.’”

Al: Can someone who’s going through the program continue to use drugs?

Laura: SMART Recovery encourages abstinence, but we make no judgment on that. Some people continue to use. We encourage any positive change. If I see someone who was an IV heroin user and now they’re smoking pot, that is a positive step. We encourage any positive change. It all comes down to: How are your behaviors? Are you an active member of society? Are you working? Are you functioning in your family? Do people like you again? Are you being responsible? Do you like yourself?

Al: What is medically-assisted treatment? Is that part of what you teach?

Laura: Well, I call it medication assisted recovery. We should think of it this way: if the pancreas doesn’t produce insulin, replacement insulin is needed. Medication-assisted recovery helps people who use opioids, alcohol, and tobacco in much the same way. People can be on these medications the rest of their lives. I have a dear friend whose son has been on methadone for nine years now. He’s a lawyer, he has two children, he’s married. Who cares? We don’t question this type of approach for any other chronic illness.

Al: Can you imagine a safe consumption facility? [SCFs are facilities that permit drug users to self-administer under medical supervision. Treatment capacity is available on site, but is not required. Over 60 such facilities exist in Europe and Australia. Only one exists in North America, none in the U.S.]

Laura: Oh, yes I can, but I don’t know if people are ready. People still believe that safe consumption sites are going to encourage people to use drugs.

Al: How do you answer that?

Laura: I’d like to take them to the trunk of my car and say, “I drive around with syringes all day. I’ve never been tempted to be an IV drug user.” Do you know what harm reduction enables? It enables health. Last summer when we started our mobile needle exchange, people were very hesitant to use the program but eventually could see that there’s no judgment, there’s no expectation. There is love. After a while, they said, “Talk to me about treatment.”

Obviously, the national response to addiction hasn’t been working. When I started out, 99 people were dying a day. Now it’s 192. So why not try love and compassion, especially when we know it works?

Al: What about treatment? I understand that in the U.S. we have treatment available for only one out of 10 who need it. You and I have talked about Portugal, where treatment is available for everyone. Would that be part of an answer?

Laura: Of course more treatment capacity would help. But not if it is just an intensive inpatient program that only teaches you one approach. Different levels of care are appropriate for different individuals, based on a validated diagnostic tool. Many treatment programs aren’t working with people on how to find a job or how to dress for an interview. Real life stuff. 

Housing is a great example. If we cannot find sustainable, supportive recovery housing for individuals leaving residential treatment, how does that bolster their resilience and motivation to stay with their recovery plan? What happens now is, people are often secluded for 30 days, which is necessary to break that cycle of use, but then they’re out and there’s no follow-up or connection. It’s really risky to rely on that model, especially without addressing harm reduction.

Al: It seems to me there are two parts to the war on drugs. We can support the use of the force of the state to try to cut down trafficking. Then there is the war against users. Where did the idea come from that we ought to be arresting people for using drugs?

Laura: Using punitive sanctions has been an American ideology that has proven to be ineffective. This is in essence controlling people’s behaviors through policy.  It comes from the myth that bad people use drugs. But we’re actively working to change that, and we’re seeing success.

Live4Lali has developed diversion programming and now we have a lot of law enforcement that want to help people. They’re starting programs where people can come into the police department with their drugs and their paraphernalia, drop it on the counter, and say, “I need help.” I’ve brought people into the police department five or six times. What we’ve seen is compassion. It just blows my mind. People in uniform hugging drug users and holding their hands and saying, “We’re going to help you.”

Al: Has all of your experience with drug use —in your personal life and your clinical work— given you any insight into how people change?

Laura: I lead meetings where I pass around a hand mirror and say, “I want each one of you to look in this mirror and tell yourself you love yourself and why. One thing about you … I don’t care what it is. You have nice eyelashes. I don’t care what it is.” I did this a couple of weeks ago, and I had people moved to tears. People say, “I never thought about myself like that.”

Al: How do they do that? It’s kind of hard to do.

Laura: Practice, practice. You’ve got to change those self-perceptions. I say, “I’m 58 years old. Don’t start this as late as I did. Start your path of discovery now, and learn to love yourself. If you don’t have it inside first, you can have the best job, all the money in the world, it won’t help.”

Al: Is love from other people part of this?

Laura: Absolutely. That’s one of the most important things about recovery.  And, then, turning around, giving back. Volunteer at a dog shelter, Meals on Wheels. Get out of your own head, help someone who might be a little less fortunate than you.

Al: You saw your son struggling with addiction. What do you say to parents who are experiencing the same things you did?

Laura: The first question I ask them: “What are you doing for yourself?” Then, I teach them first person language. Instead of saying, “You are going to kill yourself! How could you do this to me?” try saying “I am really afraid that something bad is going to happen, and that makes me feel anxious. I feel like I haven’t done my job right. I feel like I am not supporting you in the way I should.” The people who are stuck in this brain disease have more shame than we could ever give them. They don’t need us, as parents to say “You’re destroying our family.” You don’t think they know that? Compulsion in their brain is driving them to keep doing it.

I just see families out there, so many friends, who have lost their loved ones, who say now, “I wish I had known about harm reduction. If I had known about methadone, I know that it would’ve worked for my son.”