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A philosophical debate on Harm Reduction

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Many debate the true effects, outcomes, and rationales behind the philosophy of harm reduction. Much of what I’ve learned pertains to loss, enabling, and radical lifestyle changes in all that are involved lives. Harm reduction is sensitive for many people to talk about, as many have tried it, many want to know about it, and many debate trying it as a last case scenario.

On the other hand there are people who consider a first time cure and there are some who are familiar with the concept, but for those who are not this is a philosophical breakdown on “harm reduction methods.” The methods may seem out of whack with the normal culture, but who says addiction culture is any more “normal.” I know—let’s just beat a dead horse; we all bite our tongues when we ask, “What is normal?” None of the world is normal and we are made with certain imperfection (character defects most call). It is how we deliver ourselves and develop new concepts.

I don't endorse this method, I plan on staying subjective to let you decide what works for your sobriety, although many of you might consider using it! I cannot endorse certain methods up for controversial debate, but I can give you the unbiased truth on a subject that many consider, “Last case-First case Scenario.”

The two extremes--feeding addiction or helping maintain it--are up for debate, but where does harm reduction lie? Make your choice, be swift, be certain, and don’t be too severe! Just be clear and use empathy as a tool to guide you from here to there.

My main concern around “Harm Reduction” is that it looks like enabling the user to continue using rather than helping him/her to stop. Many would see this as helping the user continue to use, rather than forcing them to hit their rock bottom. The issue is, what if this is saving a life, rather than condemning it? This is an issue that many debate around harm reduction, “Am I helping or am I hurting?” or "Am I creating more of an addiction or am I helping keep it at a minimal rate?"


Co-author Mike S. elaborates on his perspective from the U.K.

Co-author Mike S. says that, in the UK, most harm reduction that he has experienced has been aimed at drug users rather than alcoholics. Mike S. having 31 years in sobriety and various certifications in addiction studies and alcoholism goes on further, “There are a number of approaches one of which is to prescribe the heroin substitute Methadone.”

courtesy of i2.wp.com harm reduction A philosophical debate on Harm Reduction 93077 f496Mike's observation of this and as reported by users who reach in-patient treatment, is that the use of heroin continues as well as the use of Methadone or the Methadone is sold to support the heroin use. So where does the harm reduction lie? Who is helping whom with this disease that won’t quit until the addict officially says, “I’m done!” This is where the perspective of enabling comes into play as much debate is giving methadone to a heroin addict as a replacement reducing harm? Or is it creating more harm? Methadone in “some” cases are being resold just for heroin and creating more of an addiction, yes this is happening, but is the supplementation really working?

Many say the methadone itself is creating a high just the same as heroin, too. If methadone is giving the effect of heroin for an entire day, while keeping you out of harms way then is there a difference? Take this idea that if you do not feel the need to go steal, prostitute, or lie in your life for a heroin fix, and methadone is giving you an opportunity to maintain yourself, is it helping? On the other hand, many are stating that those on methadone are still getting high nonetheless. The question just lies in are they truly changing the behaviors around the abuse in the first place?

For example:


“Methadone is a prescription drug, and is part of a group of drugs known as opioids. Opioids are depressant drugs, which means they slow down the messages travelling between the brain and the rest of the body.” – See more at: http://www.druginfo.adf.org.au/drug-facts/methadone#sthash.S0dh67Pq.dpuf

Many methadone programs last months or years, or even a lifetime. They are gradually given an increased dosage of medicine (the methadone) and increased to a relatable tolerance to their addiction, but in efforts to keep them from overdosing or obtaining heroin in an illegal manner. This is the effort of harm reduction, Ie. reducing harm brought on by addiction, rather to maintain a stable lifestyle when given substitutes.

But some debate where is the harm really being reduced if the tolerance from an opiate (heroin) is switched to methadone for “long-term maintenance?” Many say they are trading addiction and causing addiction, while others call this harm reduction. Yet again two extremes but which is right, which is normal? Is there a normal in this case?

It is reported that Methadone withdrawal can be worse than heroin as the half-life of methadone is longer. [The half life of a drug is the time it takes for the body to metabolize half of a given dose. For example if the half life of a drug (prescribed or otherwise) is 12 hours.

Then after 12 hours of a given dose of say 2mg, then there is a leftover of 1mg still in the body. If the instruction is to take 2mg every 12 hours, then at the next dose 2mg will be added to the 1mg still remaining from the first dose. 3mg are now in the body.

Then after 12 hours there will be 1½mg and so on with the cycle of tolerance. Thus the amount of drug in the body gradually increases. Given that users do not follow a set pattern but use whenever possible, once detoxification starts this process has to be unwound so may take some time depending on the drug/s used.]


Another provision in harm reduction is needle exchange, in the hope of reducing some or all of the risks of using old needles, which may have been shared by others and carry the possibility of passing on several unpleasant diseases such as HIV, Hepatitis B, C & D and other infections. Again, I would contend that this enables continued use and goes no way to encouraging a user to stop. But, on the other hand many argue that giving clean needles enforces that addicts do not have to share, or spread disease.

The purpose and goal of the needle exchange is to take people who are actively using get them clean needles so they don’t have to share and contract any of these diseases, some amounting up to AIDs. But, is the low return rate even helping? It is shown that there is a remarkably low return rate for users to go to a needle exchange program, but they are still using the same amounts.

Where they get needles if they are not easily accessible besides a friend or the needle exchange program? If not there then how many people are sharing needles? These are all questions debated in resolution to harm reduction and people who critique the philosophy as well. Where does the blame lie, if there is any, and is the addict the most to blame? Are we preventing HIV in users and preventing possible deaths from Hepatitis C the common disease for intravenous drug users to contract? With little or no cost is the needle exchange working or even being impleted by the government yet? Here’s what a leading professional on it has to say (NIH.GOV) had to say about it:

“According to Lurie and Drucker, if the U.S. government had embraced harm reduction and implemented a national needle exchange program from 1987 through 1995, a conservative estimate of between 4,394 and 9,666 HIV infections could have been prevented.”

See more at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC419716/


Co-author Mike S. elaborates now that alcoholics and drug users harm those closest to them. The families/friends need help to minimize this harm.  This form of Harm Reduction is much more helpful and important but very difficult, at times, to put in place. People, places, and things get in the way.  Al-Anon and Families Anonymous are out there and are free but not as ubiquitous as we would all like.

Mike continues to give personal accounts of harm reduction:

“From my time in the USA I observed that Al-Anon and Families Anonymous are much more available than in the UK. Denial is the “villain” that keeps both families and friends and users “sick”.  Harm reduction for families/friends means helping them to break down their denial so that they can look after themselves and leave the user to suffer and perhaps hurt enough to seek help.

The difficulty for family and friends is that there is still love for the user.  It can be hard to see that the most loving thing to do is to detach form the user.  We detach with love meaning that while we may love the user we do not love the disease and its effects on our loved one. This is sometimes referred to as “Tough Love”, tough on the family and tough on the user.   When applied consistently, it definitely can lead to a reduction in harm by leading to the user finally seeking help.courtesy of rasingsmallsouls.com harm reduction A philosophical debate on Harm Reduction tough love

The aim of any harm reduction process is not only to reduce harm to the user but also for the community, which is suffering from burglary, theft, shop lifting, over use of police time and many other negative social effects.  Many users will take up space in penal institutions with the concomitant costs. There is an extreme economic benefit to harm reduction if it was worked properly, but it is not being taken advantage of by those who have the biggest power to do so.

One form of harm reduction is that treatment can be offered in prison and this has been shown in the UK to have some success, despite, unfortunately, the ready availability of drugs in prison.

It can be argued that harm reduction works. While it may lessen the major “harms” in a given area, it does not stop the using, so all the illegal activities related to acquiring and using drugs continue. The reduction in harm is mainly for the user, allowing the using to continue with fewer consequences. Is this helpful?”

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