Speaking in Liverpool (about "addiction-proofing your children") -- the home of harm reduction, where clean needles were first provided to heroin users -- could be intimidating. Could be, that is, if I didn't enjoy being with Pat O'Hare, one of the founders of the international harm reduction movement, and his daughters Lucy and Madeleine, so much.
We four sat dining outside on a street that could have been a movie set -- and actually has been used to represent 19th century London. Meanwhile, the Liverpool Cathedral -- the last great European cathedral, constructed early in the 20th century -- loomed in front of us like a movie set backdrop, when it happened.
Pat had just uttered the infamous words, "I don't believe in physical addiction," when a woman at the next table interrupted us to tell us she was a nurse and that he should be ashamed. Such outlandish claims would cause addicts to die, she continued, and didn't he know about potassium and sodium.
Okay, I'm not sure what potassium and sodium have to do with addiction. I do know, however, that Pat has literally saved lives, in Liverpool and elsewhere. He distributed syringes that allowed the UK to escape the second wave of HIV infections, which the U.S. was enveloped with when AIDS went from being the "gay disease" to becoming a plague afflicting injecting drug users.
This was how we got onto the topic of methadone. Pat was bemoaning the new conservative government's retreat from support for methadone, represented by their insistence that there be a limited time frame for maintenance clients to leave methadone. This got us onto a discussion of how we appreciated the advantages of having methadone in our treatment arsenal; but that key methadone maintenance (MM) personnel insisted that MM was a permanent state since, they claimed, narcotic addiction was invariably a lifetime affliction.
Neither Pat nor I believe this to be true. We've seen too many "intractable" addicts quit too many types of addictions to accept addiction as an inbred or perpetual condition. At the same time, we both know that, for a myriad of reasons, people differ in their ability and willingness to come off narcotics. And -- while recognizing that such withdrawal is possible -- forcing it on unprepared people can be a life-threatening trauma.
We agreed, what's the hurry? This isn't a race -- it's people's lives. Some people who haven't managed to accomplish it for themselves, often because their surroundings were rife with drugs and poverty, are nurtured into having a chance for a life free of addiction. Or at least free from illicit drug addiction. Or at least free from addiction to street drugs. Or at least free from narcotic addiction. (Remember in the U.S. narcotic addiction now largely takes place with Oxycontin, a commercial pharmaceutical.)
And this shift away from harmful street addictions, and perhaps leading away from drug addiction of all sorts, is what harm reduction is about. It is about leading hopefully to a fuller and a healthier life (everyone at our table was engaged in some type of weight-loss program -- okay, we shouldn't have split that tiramisu). We know everybody should be perfect and addiction-free, but the world hasn't been trending that way for some time. (Do you know they find withdrawal from antidepressants traumatic -- that is, for the people who manage to break away from taking those drugs?)
This brings us back to the fray in the UK, the battle at the home of the Beatles, the flurry by the Mersey. Pat started going at it with the woman (who was, wouldn't you know, smoking throughout dinner), until Madeleine separated the rowdies by having the waiter change our table.
They say I'm always getting into brawls. But this was the first time in my 65 years I've ever witnessed a fight with a stranger at a restaurant over the meaning of addiction.