By Elise Meyer
Last week marked the first of three posts summarizing the content of a white paper produced from an interdisciplinary roundtable on Chicago-specific responses to the opioid epidemic. This post is part two, which investigates the second prong of a three-point plan forwarded by the white paper: harm reduction.
Harm reduction is a public health strategy targeting individuals with substance-use disorder (SUD) who are currently using drugs. Given the extreme addictiveness of opioids, which can garner physical dependence after just a few days, and the intense physical symptoms of withdrawal, harm reduction is an essential part of any plan to address the opioid epidemic.
The harm reduction strategy focuses on allaying the immediate dangers of the opioid epidemic such as opioid-related overdose death. The white paper highlights four important issues relevant to opioid use harm reduction in Chicago: (1) stigma, (2) use of naloxone, (3) safe consumption sites, and (4) the regulation of illicit opioids.
Stigma associated with SUD stems from the common misunderstanding that those with SUD are “morally weak” or making a “willful choice” rather than suffering from a legitimate medical condition. Research shows stigma prevents individuals from utilizing needle exchanges, seeking treatment, and completing treatment. In addition, stigma affects public policy decisions regarding allocation of resources, availability of care, and types of care offered. Direct destigmatization efforts through public education campaigns and specific educational programs for health professionals can help decrease stigma. The white paper also suggests decriminalizing opioid use, and increasing insurance coverage of treatments.
Harm reduction can also be achieved with naloxone – or Narcan – a drug used to prevent opioid overdose by “block[ing] opioid receptor sites, reversing the toxic effects of the overdose.” Naloxone is easy to administer and has limited negative side effects. As such, the white paper recommends Chicago follow the lead of naloxone’s successful use across different sectors as an immediate step to address opioid-related overdose deaths. First responders have used it when responding to overdose calls. Doctors have issued naloxone co-prescriptions when prescribing opioids to patients. And prisons and jails have distributed naloxone kits to at-risk incarcerated persons upon release.
A 2015 Illinois state law requires law enforcement to carry naloxone but many police departments are in violation – including Chicago Police Department, which is only this year beginning the process of implementing a naloxone program – citing the rising cost of the drug. While naloxone is, in the words of Dan Bigg from the Chicago Recovery Alliance, “‘almost as cheap as… salt water’” to make, and historically been priced accordingly, with the rise of the opioid epidemic, big pharmaceutical companies have raised the price of naloxone, making hundreds of millions of dollars as the industry continues to profit off of the epidemic it created.
The third harm reduction policy forwarded by the white paper is the opening of safe consumption facilities, “professional supervised healthcare facilities providing safer and more hygienic conditions for drug users to take drugs.” Typically, safe consumption facilities reduce harm by “providing clean injecting equipment…good light, clean surfaces and sharps disposal; facilitating individually tailored health education, and promoting access to healthcare and drug treatment.”
Here in the United States, no legal safe consumption facility has been established although facilities in Seattle, Philadelphia, and other cities may open soon. While a matter of great debate, many have argued that safe consumption facilities are an effective part of a harm reduction model, including the American Medical Association and the new Surgeon General, Jerome Adams.
The final aspect of harm reduction discussed in the white paper is to change the existing criminal law surrounding opioids. While controversial in the United States, there are documented benefits to decriminalization of opioids. In particular, decriminalization could save the government billions of dollars, which could be redirected to the opioid response. Indeed, research shows the potential for “immense savings in the costs of prosecution, incarceration, and defense counsel” as well as in the cost of police resources. Alternatively, a decriminalization measure could include “diverting infraction revenues away from law enforcement coffers” and instead into public health budgets.
The opioid epidemic in Chicago and its surrounding counties continues to rage. Northwestern’s white paper, developed from a full-day roundtable of interdisciplinary experts, provides evidence-based solutions specific to the Chicago area. Next week, we will culminate the series of posts on the white paper with a look at addressing the opioid epidemic through recovery.
Looking for more? Read the full white paper here.
Elise Meyer is the Schuette Clinical Fellow in Health and Human Rights at Northwestern Pritzker School of Law where she supports the Access to Health Project.