U.S. Surgeon General Now Endorses Harm Reduction
What is “Harm Reduction?”
Harm reduction is a construct that is often related to behavior that is generally seen as negative. While many assume that the best method of removing the risks of these behaviors is to stop the behaviors, others recognize that some people are unable to stop and others may not want to stop. In the context of hepatitis C, for example, one of the most common forms of transmission is through the use of unclean needles, typically experienced during IV drug use. Much information is focused on a person’s need to stop using IV drugs as the way to not become infected with the hepatitis C virus. While no longer being in contact with unclean needles would certainly significantly lower a person’s risk of contracting the virus, it is not always what the person is able to do or wishes to do. In these situations, rather than to tell a person to quit the behavior, knowing this is unlikely to occur, some health professionals choose to recommend options that are focused in harm reduction. This means that their recommendations may be rooted in ways to lower the frequency of IV drug use or they may recommend options of where to obtain sterilized needles or where to go in the event of an overdose.
Why Would the Surgeon General Endorse This?
Although there is medical proof that acknowledges that stopping the harmful behavior stops or significantly lowers the risks of infection or death, the Surgeon General recognizes that this may not be realistic advice for some patients. If the only advice given is an all or nothing approach, many in need may feel unheard and they may continue their risky behavior, which does not help or support them in any way. Instead, the Surgeon General has become aware that making choices about one’s behavior and habits is a patient’s right and it is the medical community’s responsibility to do all they are able to advocate for patients and their rights. This includes recognizing that some patients may not be in a position to simply stop their harmful behaviors. By offering alternative solutions, the risks may be reduced and the patients can feel heard and in control of their choices and treatment options. Over time, this can lead to overall harm reduction in entire populations of people, which may translate into lower rates of hepatitis C and other viral transmissions and infections.
What Does This Mean For the Future?
This remains uncertain, especially in a time when a new Surgeon General is being appointed in the new American government of 2017. However, this typically means that medical practitioners are becoming more open to the concepts related to harm reduction. While they are likely to continue to encourage patients to stop using drugs, to stop visiting unlicensed tattoo parlors, and to stop engaging in other behaviors that directly lead to disease and illness, it is also becoming increasingly likely that professionals will become more aware of alternative behaviors or methods which they can recommend to their patients.
In some cities, this may mean that there are needle exchange programs where people can bring used needles and trade them for sterilized needles. This acknowledges that people are continuing to use IV drugs and encourages them to minimize their risks by providing needles that will not expose them to blood borne viruses. In some places, there may be opportunities for drug users to obtain a single dose of a drug that helps to counteract an overdose. This acknowledges that people are continuing to use drugs that can kill them but also provides them the opportunity to stop an accidental overdose before they or someone with them dies.
In addition, and possibly most importantly, having a Surgeon General who endorses harm reduction encourages professionals to reexamine their beliefs and trainings regarding addiction and reconsider whether the current methods of discussing these behaviors with clients and patients is the best method. It also allows the general public to begin to reexamine their beliefs regarding people who are labeled addicts or drug abusers. By separating a person who desires to not risk their health from the action of engaging in risky behaviors, it is possible that patients may be seen as whole people rather than based on one aspect of their identity, which can potentially lead professionals and the overall public to begin viewing them in a more positive light while minimizing judgments about them based on their behavioral choices. This can lead to a reconsideration of how society views addiction and how society values addiction treatment options.1-4
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