Tuesday, February 4, 2014

To Honor Hoffman, Focus on Prevention, not the Drug War Harm Reduction
Leo Beletsky                                                                     
Assistant Professor of Law and Health Sciences, Northeastern University

   911 Good Samaritan Laws, Drug Overdose, Philip Seymour Hoffman, Politics News As devastating details about Philip Seymour Hoffman's apparent heroin overdose are beginning to emerge, we are already hearing speculation about police efforts to identify the drug source. If and when the suppliers are found, authorities will likely use the full extent of the law to prosecute them on drug, and even homicide charges. Instead, the focus should be on preventing others from following Hoffman's fate.

To be sure, efforts to identify dealers (or friends or acquaintances) who supply deadly drugs to overdose victims are important. Just last week, officials in New York State and elsewhere in the Northeast linked the current spate of heroin overdose deaths to a deadly batch cut with fentanyl -- the powerful synthetic opioid. Concerted detective work to locate and destroy such lethal batches may ultimately save lives. But, despite enormous efforts by federal, state, and local law enforcement, spikes in overdoses involving fentanyl-laced heroin have popped up all over the U.S. since the 1990s. In the long run, it has proven impossible to control the supply and purity of heroin and other illicit drugs.

In the meantime, public health officials have used several straight-forward messages to avert overdose fatalities. These include: not using drugs alone, testing new batches for potency, buying drugs from a trusted source, and knowing exactly what to do in the event that overdose does occur. Although such "harm reduction" tips have stirred up controversy in some corners, public health researchers have successfully argued that this common-sense approach is the best tool we have to address risk among drug users. Especially when working on high-visibility cases, law enforcement officials can do a lot to increase awareness about these life-saving measures.

Conversely, high-profile prosecutions of people tied to drug overdoses can be counter-productive. Such strategies have been a mainstay of drug law enforcement for decades and appear to be gaining momentum, especially in regions hard-hit by overdose like Oregon and Wisconsin (where their number doubled between 2012 and 2013). Taken directly from a "war on drugs" playbook, these efforts have certainly put numerous drug dealers behind bars. In many jurisdictions, however, it is enough to have simply shared a small amount of your drugs with the deceased to be prosecuted for homicide, and there are certainly instances of such charges. 

Research suggests that fear of criminal prosecution is the single most important reason why people who witness overdoses do not seek timely emergency medical help. This is particularly true of events that involve heroin: out of all witnessed overdoses, bystanders report calling 9-1-1 less than half the time. Such delays are especially tragic because appropriate emergency response can quickly and effectively reverse most overdoses with the administration of oxygen and -- in the case of overdoses involving heroin or other opioids -- the antidote naloxone. In other words, the fear of legal repercussions likely costs thousands of Americans' their lives each year. What fuels these deadly fears? High-profile prosecutions tied to overdose events, especially like the one currently dominating the news cycle.

In order to encourage overdose witnesses to seek emergency assistance, 17 states including New York have now passed "911 Good Samaritan laws," shielding overdose witnesses and victims from drug-related charges when help is summoned. These laws hold promise, but their impact is limited by several factors. First, they only apply to a limited set of drug possession violations, typically involving small-scale drug possession (state laws also have no bearing on criminal liability under federal law). Secondly, the vast majority of drug users, the general public, and even many police officers may not be aware of such laws. Finally, aggressive and mounting application of criminal prosecutions following overdose events totally thwart any positive public health impact of Good Samaritan legislation and other efforts to encourage overdose witnesses to come forward.

Widespread adoption and aggressive enforcement of punitive drug laws in this country has done little to reduce drug abuse. Acknowledging this, last Thursday the Senate Judiciary Committee passed the Smart Sentencing Act -- a bill to reduce or remove a number of mandatory minimums for non-violent drug offenses. In its current version, however, this bill does not address provisions used to impose 20-year mandatory minimums for supplying controlled substances that result in death or injury. Even if this specific provision is eliminated on the federal level, this will not affect state laws, nor will this necessarily impact prosecutorial decisions to target people who supply drugs to overdose victims -- sometimes bona fide drug dealers, sometimes friends or partners of the deceased. We need to abandon this approach, focusing instead on raising awareness about risk-reduction, widening the scope of Good Samaritan Legislation and finding other ways to save lives rather than fill our prisons.
Harm Reduction

What is Harm Reduction?

North Carolina Harm Reduction Coalition
This section is copied from Human Rights Watch’s article: ”We Know What to Do, Harm Reduction and Human Rights in North Carolina,” with permission by Human Rights Watch. Harm reduction is a way of preventing disease and promoting health that “meets people where they are” rather than making judgments about where they should be in terms of their personal health and lifestyle. Accepting that not everyone is ready or able to stop risky or illegal behavior, harm reduction focuses on promoting scientifically proven ways of mitigating health risks associated with drug use and other high risk behaviors, including condom distribution, access to sterile syringes, medications for opioid dependence such as methadone and buprenorphine, and overdose prevention.

Emphasizing public health and human rights, harm reduction programs provide essential health information and services while respecting individual dignity and autonomy. For drug users, harm reduction recognizes that many drug users are either unable or unwilling to stop, do not need treatment, or are not ready for treatment at a given time. Harm reduction programs focus on limiting the risks and harms associated with unsafe drug use, which is linked to serious adverse health consequences, including HIV transmission, viral hepatitis, and death from overdose.

Harm reduction programs have been shown to lower HIV risk and hepatitis transmission, prevent overdose, and provide a gateway to drug treat- ment programs for drug users by offering information and assistance in a non-judgmental manner. Harm reduction also protects law enforcement officers from needlestick injuries—accidental pricks to the skin from handling hypodermic needles. By providing safe disposal of injection equipment, harm reduction programs reduce the number of contaminated syringes circulating in a community.

Important principles of harm reduction programs include:

  • A non-judgmental approach that treats every person with dignity, compassion, and respect, regardless of circumstance or condition.
  • Utilizing evidence-based, feasible, and cost-effective practices to prevent and reduce harm;
    Accepting behavior change as an incremental process in which individuals engage in self-discovery and transition through “stages of change;”
  • Active and meaningful participation of drug users, former drug users, and community stakeholders in shaping sensible policies and practices around drug use;
  • Focusing on enhancing quality of life for individuals and communities, rather than promoting cessation of all drug use;
  • Recognizing complex social factors that influence vulnerability to drug use and drug-related harm, including poverty, social inequality, discrimination, and trauma;
  • Empowering drug users to be the primary agents in reducing the harms of their drug use;
  • Commitment to defending universal human rights.

Harm reduction encompasses a broad range of activities and interventions designed to improve the health and quality of life of individuals and communities. These include:

  • Outreach and peer education to reduce risks associated with drug use;
  • Needle and syringe exchange programs (SEPs);
  • Opioid substitution therapies (OST) for drug dependence, including methadone and buprenorphine;
  • Confidential counseling and testing for HIV, hepatitis, and other sexually transmitted or bloodborne infections;
  • Wound care;
  • Overdose prevention activities, including Naloxone (a prescription drug to prevent overdose) and first aid training;
  • Provision of primary care and treatment for HIV and other sexually transmitted or blood-borne infections;
  • Referrals to drug treatment programs.