Published on June 17th, 2020 | by Erica Zimmerman0
Harm Reduction in the Age of Coronavirus
Current PrEvents — June 12, 2020 — The Times Argus
By ROBERT PURVIS
With the onset of the COVID-19 pandemic, we were introduced to a new phrase: “social distancing”. This phrase encompasses a set of practices that are designed to decrease the opportunities for the coronavirus to spread from person to person, and thus to slow the infection rate so that our medical facilities won’t be overwhelmed by patients sick with the virus, some fatally so. Thanks to the conscientious efforts of countless Vermonters, we have so far been successful at “flattening the curve”.
But as the director of one of Vermont’s twelve addiction recovery centers, the phrase “social distancing” carried for me a warning of danger to come. For those of us with substance use disorders, it was social distance—isolation—that fed our disease; it was through social connection—attending recovery meetings; supporting others in recovery, and being supported ourselves; participating in social activities of the recovery community—that we embarked on pathways to a new and healthy life in recovery. Take away our community and we are at risk of losing vital connections and relapsing into our addictions.
The Twelve Step communities in our area—Alcoholics Anonymous, Narcotics Anonymous, Al-Anon and Families Anonymous—were quick to set up online meetings using various videoconferencing platforms. Recovery centers, such as ours, took our All Recovery meetings, SMART Recovery groups, and various workshops online using Zoom. And our emergency department recovery coaches were able to continue engaging with patients at Central Vermont Medical Center using an iPad and Skype. Finally, our recovery coaches were able to continue meeting with their recoverees throughout this period using Zoom and phones. In this way people who had more or less established connections with a recovery community were able to maintain those critical relationships throughout the physical isolation of “Stay Home, Stay Safe”.
But what about people who barely had a foothold in recovery—or who had not yet found their way to the support they needed? These are the people that I (and my fellow recovery center directors) came to worry about most. We’ve heard constant stories of streets awash in drugs, of many people we know relapsing—and some overdosing. Our response has been to bring a renewed focus on harm reduction practices and programs.
To the uninitiated, “harm reduction” sounds inadequate, like settling for a band aid to stop the bleeding, when surgery is called for to heal the wound. But, at least as practiced in Vermont, harm reduction programs both mitigate immediate harm as well as offer those who are suffering a hand up and a way out. They proceed from a basic fact: as experts understand it, addiction is a relapsing disease of the brain, and recovery takes place in fits and starts, rarely in a straight line from diagnosis and treatment to a healthy life. If offered the right help at the right time, today’s seemingly hopeless addict on the street can become tomorrow’s productive member of the community.
The first order of business is to keep people alive and out of serious harm’s way. This is exemplified by syringe exchange programs, which offer intravenous drug users sterile needles in exchange for used ones, as well as instructions for safe use, thus decreasing the transmission of life-threatening diseases, such as HIV-AIDS and Hepatitis C, and accidental death due to syringe misuse.
But these programs do much more than this. The frontline workers offer drug users respect and an empathetic ear. Over time they form relationships of trust. They listen for the first sign that a person may be ready to talk about taking that first step towards recovery—and when they hear it, they take them by the hand and lead them there. Vermont Cares is the program in Washington County that operates syringe exchange programs. As Associate Director Theresa Vezina explained, “We meet them where they are, but we don’t leave them there”. Far from encouraging more addiction, syringe exchange programs have been shown to help reduce it.
This is what good harm reduction programs are all about—and they are best carried out through close collaboration by prevention, treatment, and recovery programs. This is the case in Washington County. Adding to the mix, the Vermont Department of Health has provided funding for a wide range of harm reduction efforts and has encouraged the cross-fertilization of information and resources across our varied programs.
Probably the most powerful example of a program that combines prevention, treatment, and recovery is Medication Assisted Treatment—referred to as MAT. Although there is a range of addiction medications addressing both opioid use disorder and alcohol use disorder, the dominant MAT medications are buprenorphine (known by the brand name Suboxone) and methadone. These medications quell the powerful cravings for opioids, thus enabling the person to function normally while restoring themselves to health and repairing the damage caused by active addiction.
But beyond the beneficial treatment aspects, a person on MAT is eight times less likely to die of an overdose than a similarly situated person with Opioid Use Disorder who is not on MAT. And when MAT is combined with active participation in recovery support groups, recent research is finding a powerful additive effect, greatly enhancing a person’s return to stable health and social functioning.
While we weather the COVID-19 pandemic, we at Turning Point are handing out Harm Reduction Packs (HRP’s), provided by the Health Department, containing information materials from Vermont Cares, Narcan, a fentanyl test strip, treatment referral information, cloth face masks, and other items. We hope that as a result more people will stay alive and relatively healthy until we can meet again. A handshake and a hug, too, are strong medicine.
Robert Purvis is executive director of the Turning Point Center of Central Vermont in Barre. Turning Point is currently open on Thursdays from noon to 3:00PM for the limited purpose of distributing Harm Reduction Packs and Narcan. For more information call Turning Point at (802) 479-7373 or email Mr. Purvis at firstname.lastname@example.org.
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