News that Congress is on the verge of repealing federal strictures against needle exchange programs serves -- well, as a much-needed shot in the arm for humane, science-based and sane drug addiction policies. Such a reversal of decades-old prejudice will also save thousands of lives. As Bill Piper, director of national affairs for the Drug Policy Alliance has pointed out, "Hundreds of thousands of Americans will get HIV/AIDS or hepatitis C if Congress does not repeal the federal syringe funding ban."
As a medical doctor, I've most recently worked at Insite, North America's only supervised injection site, in Vancouver, British Columbia. At Insite people are provided with clean syringes, alcohol swabs and tourniquets to assist sterile and less traumatic self-injection, in a warm, clean, well lighted facility where they can self-administer their drugs under medical supervision. We have over five thousand clients registered at Insite. The place hums with activity eighteen hours a day.
The fact that such an institution even exists is a puzzle to many, anathema to some.
Needle-exchange programs and the supervised injection site are part of a larger program, called harm reduction. Though supported by any number of scientific studies attesting to its life-saving value, harm reduction is still seen by its opponents as somehow "enabling" the addiction, as keeping people from joining abstinence-based programs that would -- so the theory goes -- help them leave their self-destructive habits completely behind. But in reality the distinction between harm reduction and abstinence is artificial.
It's easy enough to see that a person injecting with sterile water instead of puddle water is less likely to become ill; that a person using a fresh needle over cleansed skin s not going to receive or transmit hepatitis or HIV, or to develop abscesses in the body surface or in the internal organs; that such a person will suffer much less and cost society much less in medical expenses. But the essence of harm reduction goes beyond such necessary and salutary considerations.
The harm reduction approach acknowledges that some people -- many people -- are too deeply enmeshed in substance dependence for abstinence under present circumstances. There is, for now, too much pain in their lives and too few internal and external resources available to them. In practicing harm reduction we do not give up on abstinence -- on the contrary, we may hope to encourage that possibility by helping people feel better, bringing them into therapeutic relationships with caregivers, offering them a sense of trust, removing judgment from our interactions with them and giving them a sense of acceptance.
Such acceptance can create an opening to help addicted human beings to let go of the desperate and isolating view of life that has them relying on drugs to soothe their self-loathing, their emotional pain based on past trauma, and their distress as ostracized and rejected pariahs at the margins of society. Far from enabling addiction, needle exchange can serve as small but indispensable first step toward recovery. U.S. legislators are to be lauded for their courage and vision.
Dr. Gabor Maté is the author of In The Realm of Hungry Ghosts: Close Encounters With Addiction, to be published on January 5, 2010 by North Atlantic Books. A Canadian Broadcasting Corporation documentary on Insite, including an interview with Gabor Maté, may be seen here.
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