This month, I happily came on board as Phoenix House's new Chief Clinical Officer. As I began settling in, a Fox 5 correspondent and his camera crew arrived at my office to interview me about a New York City Department of Health pamphlet that has recently created quite a stir.
The 16-page booklet, "Take Charge, Take Care," provides tips on how to prep and inject heroin in a way that presents fewer risks to the user. Advice includes "shoot correctly to avoid infection" and perhaps the most controversial, "Jump up and down to show your veins." This incited sensationalist headlines, like this one from the New York Post: "Heroin For Dummies: City Flier 'Smacks' of Lunacy".
When the hour-long Fox interview was edited down to the usual 30-second sound bite, what was left was my criticism that the first six of the pamphlets ten "tips" provided detailed information on using and injecting heroin--with the remaining four offering scant information on treatment and getting tested for HIV. I would have liked it to be the other way around, with the majority of space devoted to treatment and fewer tips on shooting up.
However, I don't want us to confuse a less than desirable pamphlet with what is, in reality, a good policy. The goal of the brochure--to minimize the damage injection drugs can cause--is one I wholeheartedly support. Despite my hope that individuals who are suffering the devastating effects of drug abuse can find a better life without drugs, I recognize that some users will continue to decline treatment, no matter how many times it's presented to them.
With this in mind, harm reduction efforts to stop the spread of AIDS and keep IV drug abusers in touch with the health system on a regular basis are medically responsible initiatives. The intention of the Department of Health was not to provide a guidebook for those interested in learning to inject heroin, nor is it likely to be misused for that purpose. Anyone who's curious could easily find the information online. Rather, the Department's aim was to distribute the pamphlets to the city's needle exchange programs, which not only provide clean syringes, but testing and treatment referrals, as well. The programs are places to get the word out that while heroin use can never be safe, there are ways to reduce the likelihood of injury or disease--which is precisely where a more balanced brochure could make a difference.
The question boils down to this: If someone is intent on using, do we want them to do so based solely on the how-to's they've received from other IV drug abusers--or armed with a public health perspective? The answer, to me, seems clear.