Scientific research has transformed our understanding of drug addiction.
The Centers for Disease Control, National Institute for Health’s National Institute on Drug Abuse, and the National Institute of Mental Health all concur that drug addiction is a disorder, an illness affecting the brain and behavior. As with any other disease, it demands treatment and compassion for those who suffer from it.
Despite this important change in the way many view addiction, stigma persists. Even people who understand that substance use disorder is an illness requiring treatment can find themselves frustrated by the nature of addiction, a disease characterized by multiple periods of relapse and remission. Relapse, though inevitable until recovery is complete, is seen as a failure; substance users are judged for their apparent weakness in fighting this monster.
As with other chronic illnesses, the treatment for substance use disorder requires a continuum of care that addresses patients at every stage of the disease. This includes efforts aimed at prevention and recovery, as well as management during relapse.
Access to care during relapse is a critical component because recovery is rarely a linear process. Frequent relapse is more the norm than the exception.
This stage of managing the severity of the disorder during relapse is called “harm reduction” in the field of addiction medicine. One of the chief mechanisms for harm reduction services is a syringe access program, which provides active drug users with the education and supplies needed to reduce the risk of contracting and spreading infectious diseases like HIV or hepatitis C from sharing used syringes.
In western Massachusetts, harm reduction services are currently provided by Tapestry at two syringe access and disposal sites in Northampton and Holyoke. Non-judgmental relationships built with program staff provide a gateway to medical services and education that helps clients avoid and reverse overdosing. They provide Narcan, often at no charge, and offer information about avoiding the most dangerous forms of the drug currently on the street.
Program staff at Tapestry offer consistent, compassionate support during times of both treatment and relapse to over 3,000 people annually.
We know syringe access programs save lives. The most recent Department of Public Health data on accidental overdose deaths, for example, show that while opioid deaths across the region have increased, in Northampton and Holyoke, where Tapestry provides syringe access, naloxone and counseling, these rates have decreased. In the last two years, Narcan given to clients at those sites has prevented over 300 fatal overdoses.
Community resistance to harm reduction efforts like syringe access programs stems in part from lingering stigma, but also speaks to a need for improved education about substance use disorder and its treatment. One common misconception about these programs is that providing syringes enables substance users to prolong their addiction. In fact, the opposite is true.
A study in the “Journal of Substance Abuse Treatment” (2010) demonstrated that syringe access programs do not promote either increased crime or drug use, but rather increase the likelihood that someone will enter a recovery program by a factor of five. Clients engaged in care with a syringe access program are more likely to seek treatment not only for their substance use disorder, but for other health conditions which might end them up in the hospital if untreated.
In 2011, the Office of US Surgeon General Dr. Regina Benjamin reported that syringe access programs “are widely considered to be an effective way of reducing HIV transmission among individuals who inject illicit drugs and there is ample evidence that (syringe access programs) also promote entry and retention into treatment.”
An effective fight against the opioid crisis requires more services across the treatment continuum in all three components: prevention, harm reduction and recovery. We are fortunate to live in a state where our leaders at the highest level have eschewed the stigmatization of substance users and turned their efforts to providing comprehensive care for the disorder.
Gov. Charlie Baker last year proposed a strong initiative to enhance both prevention and recovery efforts, and a change in Massachusetts General Law this summer lifted a two-decades-old cap on the number of syringe access programs allowed in the state. This change has already had an impact on increasing access to harm reduction programs.
There is still much work to be done, but the pieces are coming together to increase our odds of success against this devastating epidemic.
Cheryl Zoll has been CEO at Tapestry for two years. Tapestry is a community-based nonprofit that provides sexual and reproductive health care, HIV health and prevention services, syringe access and disposal, overdose prevention and WIC family nutrition programs in western Massachusetts.
She is one of several individuals affiliated with the Hampshire HOPE opioid task force who contribute to a monthly column in this space about local efforts underway to address the opioid epidemic.