Changing Method Of Treatment for Drug Addiction

Changing Method Of Treatment for Drug Addiction
Posted by FoM on January 15, 2001 at 07:43:38 PT
By Ulysses Torassa, Chronicle Medical Writer
Source: San Francisco Chronicle 
After Tony Trimingham's son Damien died of a heroin overdose in 1997, Trimingham didn't go after drug dealers or shrink in shame. Instead, the Australian psychologist spearheaded an effort in Sydney to provide a place where junkies could go and shoot up safely. "Watching people doing this turned my stomach," Trimingham said of the church-based shooting gallery that police shut down after nine days. "But the sad reality is: If a facility like this had been available, Damien might not have died." 
No one is suggesting San Francisco open up spaces for addicts to inject drugs -- yet. But at a city-sponsored conference last week, drug treatment professionals listened to Trimingham and others preach the gospel of "harm reduction," a controversial but growing movement that doesn't see abstinence as its overriding goal when dealing with addicts. Quietly last September, San Francisco became the first city in the nation to adopt harm reduction as its official policy. That means the dozens of agencies the city hires to provide drug and alcohol treatment must have harm- reduction programs and policies in place. Among the signs of the new philosophy: -- The Department of Public Health last year began offering care at the city's needle exchange sites and at a special clinic, treating injection- related skin infections before they grow into raging, life-threatening wounds. -- The city is teaching jail inmates how to perform CPR on their friends who may be overdosing on drugs. A media campaign aimed at teaching addicts how to reduce deaths from heroin overdose is in the works. -- And a pilot project is expected to start in a few months that will put the prescription drug naloxone -- a heroin antidote -- in the hands of addicted couples, so they can administer it to their partners in case of an overdose. "The war on drugs has encouraged users to lie to their providers (drug counselors) and not seek out help when they are struggling with addiction," said Dr. Joshua Bamberger, medical director for housing and urban health at the San Francisco Department of Public Health. "Harm reduction opens the doors to honesty and allows providers to move addicts one positive step at a time toward better health." Proponents of harm reduction focus on the ill effects of addiction, from homelessness to the spread of AIDS and hepatitis and overdose deaths. They seek to treat clients "where they are," instead of insisting that they be clean and sober before getting services. Approaches vary widely. Among other things, conference speakers talked about bringing medical care to the streets and using acupuncture and marijuana to help addicts reduce their craving for harder drugs. Many harm-reduction strategies, including safe injection rooms and prescription heroin, are already used in the Netherlands, Switzerland and Germany. And following the uproar in Sydney over the injection room, the Australian government has promised to open an official site, to debut next month. But the ideas are so controversial in the United States that conference organizer Alice Gleghorn said people urged her not to use the phrase "harm reduction" in the title. And she acknowledged losing funding and some speakers by including it. "I get calls all the time -- 'We can't call it that where we live. Can't you change the name?' " Gleghorn said. Yet the concept of harm reduction has been around for years. Using methadone as a replacement for heroin is a form of harm reduction. So, for that matter, is putting filters in cigarettes. But the term "harm reduction" and the development of it as a broad philosophy can be traced to the AIDS epidemic and efforts to distribute clean needles to addicts to halt the spread of HIV. It is also a tacit acknowledgment that the war on drugs isn't winnable, and a better strategy may be to help people deal with their addictions in the best way possible. Not surprisingly, the movement has plenty of critics. Katherine Ford, a spokeswoman for the Drug Free America Foundation, called harm reduction "harm promotion," since it teaches people how to continue drug use safely. The organization's executive director, Calvina Fay, said most needle exchange programs she's seen do little or nothing to steer people into treatment. Instead, they end up being a social club for drug users and a magnet for prostitution and crime, often in neighborhoods that are already on the margins, she said. A significant portion of those who promote harm reduction are really after a more far-reaching policy change: the legalization of drugs, Fay said. "Not everyone who supports harm reduction falls into this category," she said. "But there is definitely a movement in the country to promote harm reduction, and it's rooted in groups who are receiving large amounts of funding from business people who make no pretense about" their support for legalization. Last week's conference was funded by the Lindesmith Center, a drug-policy organization that gets most of its money from billionaire George Soros, who has said he favors legalizing and regulating many illegal drugs. He and two other businessmen paid for the successful statewide campaign for Proposition 36, which requires treatment instead of jail for nonviolent drug offenders. Fay and others say that by not insisting that addicts swear off drugs, harm- reduction programs actually enable people to stay on drugs longer than they would had they been left to "hit bottom." Ernesto Escalante, a former addict and now a drug treatment specialist in Fresno, said scaling back his drug use led to rebounds that were increasingly harmful. Abstinence, he said, was the only approach that worked for him. But Escalante attended last week's conference, hoping to find elements in the harm-reduction approach that he could use in his own drug-treatment practice. "I think harm reduction will work with hard-core heroin and meth addicts, but it's not something to be used across the board," he said. What it provides, he said, is a way to connect with people who are so strung out they won't come in to treatment on their own. "You can't go in there and say, 'We're going to save you,' when they don't want to be saved," he said. But even that won't be an easy sell back home. "Fresno is stuck in the '70s, " he said. "It's going to be a slow process." Meanwhile, in San Francisco -- home of a half-dozen medical pot clubs and a long-running needle exchange program -- officials are waving the harm- reduction flag proudly. Mayor Willie Brown, District Attorney Terence Hallinan and Supervisors Gavin Newsom and Mark Leno all spoke at the conference. Newsom in particular has been pushing for new approaches to treating addiction, including lobbying the federal government to allow physicians to prescribe methadone out of their offices. "We are doing our best to move the agenda, particularly in reference to drug abuse," Brown told conference attendees Thursday. "Things that would be considered controversial in almost every other place, are almost routine here in San Francisco."Note: S.F. models 'harm reduction' theory.Source: San Francisco Chronicle (CA)Author: Ulysses Torassa, Chronicle Medical WriterPublished: Monday, January 15, 2001Copyright: 2001 San Francisco ChronicleAddress: 901 Mission St., San Francisco CA 94103Contact: letters sfchronicle.comWebsite: - DPF Articles - Narcotics
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Comment #3 posted by freedom fighter on January 15, 2001 at 13:24:31 PT
Drug Free America Foundation
is based on a cult. That group have killed so many children.Anyone who work for that group have commit crime against humanity. As long we let them do their thing, we are just as bad as they are. It is time to tell them to start packing their bags and get out of this country. It is truly a shame.
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Comment #2 posted by sm247 on January 15, 2001 at 12:47:02 PT
look listen and learn
Harm reduction is a step in the right direction .  Drug Free America Foundation needs to find a new foundation to base their organization about  how about alcohol free america  ...oh ya they tried that in the 20's what makes them think drugs will be any different. Get a life K.F.
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Comment #1 posted by Ethan Russo, MD on January 15, 2001 at 08:03:43 PT:
Reasonable Alternative
"No one is suggesting San Francisco open up spaces for addicts to inject drugs -- yet." Considering attendant crime, HIV, Hepatitis B and C, from a public health, safety and fiscal point of view, that is one of the things they should be doing as a part of overal harm reduction. The reason it will not happen: moral posturing by politicians and self-righteous know-nothings.
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