It was great to see Jennifer Walker's story about Del. Daniel Monhaim's package of General Assembly bills designed to change the conversation about the public health crisis of addiction. After years of policy debates, this year represents a unique opportunity to promote the concept of harm reduction, the umbrella term that encapsulates strategies aimed at reducing negative consequences associated with drug use. While none of Morhaim's bills passed, it was the first time that several key harm reduction concepts, like treatment on demand and safe injection facilities, were even considered by the General Assembly. As Walker described, the concept of harm reduction undergirds many of the recent efforts to stem the epidemic of opioid overdoses in Maryland and improve the well-being of people at all stages of substance use, from active users and those in treatment to those working on their long term recovery.
OSI-Baltimore's Drug Addiction Treatment program has been a steadfast backer of several of the harm reduction initiatives described in Walker's story, including the Health Department's Staying Alive program and Behavioral Health System Baltimore's dontdie.org public awareness campaign. We've also supported life-saving naloxone training and distribution for the Baltimore Police Department and the Law Enforcement Assisted Diversion (LEAD) program, which gives police options to address addiction other than with criminal sanctions. The bills currently before the legislature build on these efforts.
Harm reduction is sometimes described as "the movement for social justice built on a belief in, and respect for, the rights of people who use drugs." Some people resist efforts at harm reduction because they have a misguided fear that such strategies will send a message that drug use is "okay," or even worse, that it will lead to an increase in drug use in their communities. But there has been significant research showing that harm reduction is quite effective at both decreasing immediate harms associated with drug use and engaging people where they are until they ultimately are ready to seek out treatment options, while not increasing overall drug usage in communities.
While addiction to heroin and other opioids has spiked in recent years, the broader problem of addiction has existed for decades. Some have said that local, state, and national policymakers have ignored the issue and point to a lack of investment. The truth is the United States has invested more in addressing addiction than almost any other country in the world, but it has been an ill-conceived use of resources. We as a nation have invested billions in a War on Drugs, which has proven to be an ineffective and haphazard response that uses the criminal justice system to address the public health crisis of addiction. Now that we, as a country, have spent enormous amounts of money and destroyed countless lives, everyone from key law enforcement officials to parents who have lost children to overdose have recognized that the War on Drugs has been an absolute failure.
This consensus comes as the crisis of addiction has morphed, with the vast spread of addiction to heroin and other opioids, not just in numbers, but in geography—beyond urban centers and into suburban and rural areas. In Maryland alone, there were 889 fatal overdoses in 2015, a 91 percent increase from 2010. As The New York Times among others has pointed out, when the drug problem was defined by the crack epidemic and based largely in inner cities, the popular response was the criminal justice system. But now that the heroin epidemic has spread to suburban and rural communities (according to the Times, "nearly 90 percent of those who tried heroin for the first time in the last decade were white"), people are more open to alternative solutions.
Harm reduction has proven very effective in countries all around the world. Insite, the Vancouver supervised injection facility that Walker described, opened in 2003 and the neighborhood has experienced a 35 percent decrease in overdoses (compared to only 9 percent in the city overall) and has saved an estimated $1.8 million per year from the prevention of HIV infections. The program also made over 3,500 referrals to detox treatment in just eight years. Over 12,000 individuals have registered to use the site, which shows that a supervised injection facility can be an important tool for engaging active users. Most importantly, more than 2 million injections, which otherwise would have occurred in back alleys, on the doorways of local businesses, in parks or other unsanitary and unsafe spaces, have taken place in a safe, supervised space.
Open Society Institute-Baltimore has worked with others to bring harm-reduction efforts to Baltimore, in the form of life-saving naloxone training and distribution and diversion efforts that give police options to address addiction other than with criminal sanctions. We're glad that the General Assembly is thinking outside of our historical responses to addiction and considering innovative strategies that will make Maryland a better community for all.
Scott Nolen is director of OSI-Baltimore’s Drug Addiction Treatment program