Transcript

Harm Reduction · Talking FACS

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Welcome to Talking Facts.
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This nationally recognized award winning podcast is hosted by the University of Kentucky Family and Consumer Sciences Extension Program.
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Hello and welcome to Talking Facts.
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What you need to know about family food finance and fitness.
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I'm your host,
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Mindy mcculley Extension Specialist for instructional support at the University of Kentucky.
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I am pleased to be joined today by Doctor Alex Elswick,
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our extension specialist for substance use prevention and recovery.
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Welcome,
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Alex.
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Good morning,
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Mindy.
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Thanks for having me.
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We are going to talk about harm reduction and I,
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I'm going to guess that that's not something that people talk about sitting around the dinner table most times.
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I think that's exactly right.
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It's not your typical fireside chat.
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No,
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it's not.
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Um But it is an important topic that people are beginning to talk more about and that's becoming misunderstood.
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So I thought it was a good time to get out in front and start talking about it.
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Definitely.
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Yes.
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Um And because I,
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I know that it's important.
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My Children are grown now,
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but when they were young,
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um I probably should have been talking harm reduction with them.
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So when we talked a little bit ago,
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you um said that we define harm reduction in a couple of ways.
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So we have big hr and little hr can you explain those for me?
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Yeah,
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this is my favorite way to talk about harm reduction.
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So there's kind of capital H,
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capital R R harm reduction and lowercase H lowercase R harm reduction.
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So lower case hr is the practical set of strategies that reduce harm associated with drug use.
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So in a very straightforward way,
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it's things you'll recognize like Narcan or naloxone,
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which is the drug that can reverse an overdose.
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So when naloxone first really became publicly available,
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there was a lot of controversy over,
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are we enabling drug use or is this a good or bad thing?
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And today,
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it's,
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it's pretty widely recognized.
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This is a really important tool to keep people alive until they can recover.
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Another example might be um syringe exchange programs.
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So it's a practical strategy that reduces the harm associated with the drug use.
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That's the lower case.
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Hr Big H big R harm reduction really refers to a philosophy.
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It's a way of thinking about drug use.
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It's a way of thinking about human beings.
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It's a,
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it's a philosophy built on a respect for the rights of people who use drugs.
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So just to clarify what that means.
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It doesn't necessarily mean we believe that people should have the right to use drugs or whoever they want.
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It means that just because a,
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a person is using drugs doesn't mean they relinquish their human rights.
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So,
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it's a,
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it's a philosophy based in that belief and the reality is whether they're illicit drugs or legal drugs,
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many of us take drugs every day.
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Right.
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Absolutely.
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Whether you're talking about caffeine or nicotine,
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whether you're talking about prescription drugs that are legally prescribed to you or whether you're talking about alcohol.
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And it's always bothered me that we,
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we use the phrase drugs and alcohol,
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which suggests that alcohol is not a drug when it absolutely is a drug in liquid form.
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And it actually happens to be one of,
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if not the most harmful drugs that we have on the planets,
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we have talked about drugs in the past,
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we have talked about the use of drugs in the past.
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So it helped me understand how this conversation links into those previous conversations that you've had.
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Yes.
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So it can be helpful first to think of harm reduction in everyday life the way that we use harm reduction all the time.
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So,
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for instance,
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this morning,
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I went to the gym and I drove my car because it's about six miles to the gym.
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And even though I could be harmed in driving my car,
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there's inherently some risk every time I would get behind the wheel.
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I still choose to drive because I don't want to walk those six miles and have to walk those six miles back.
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So,
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what I did instead was I observed speed limits for the most part almost entirely.
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I wore my seat belt.
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Right.
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I did all of these things that are,
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I used my turn signals.
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I,
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all of these things that are reducing the,
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the harm associated with the behavior of driving.
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Um Over the weekend,
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I had the chance used to play golf with my dad and we were out in the sun for four or five hours,
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which can be harmful.
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And so we wore sunscreen,
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right?
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We're,
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we're not gonna avoid the sun just because the sun can be harmful.
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Instead,
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we're gonna find a way to reduce the harm associated with it.
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And ok,
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so that,
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that just makes perfect sense.
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And I like that.
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So you have shared with me some principles of harm reduction and we're talking about the capital H capital R harm reduction.
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So let's just run through those and you can um explain them a little bit more for me.
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Ok.
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So one of the principles is that it accepts for better or worse that illicit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn.
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Yeah.
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In many ways,
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this is the keystone to the arch.
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It's the keystone principle of harm reduction.
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It holds everything together because it's different from the current approach that we're using.
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The current approach that we use today.
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We,
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we think we call it a prohibition approach.
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So drugs are prohibited.
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And our vision under that approach is drug free communities.
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So we use that language a lot and we talk about trying to sort of eradicate drugs from the face of the earth.
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And harm reduction says,
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look,
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that's,
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that's a delusion.
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That sounds nice and it would be nice if we could get rid of drugs so that we could all be safe.
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But the reality is since the beginning of time,
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there have been people who use drugs in every civilization and we're gonna,
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we're gonna live in that reality.
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And so harm reduction says it's an uncomfortable fact that people use drugs and because people use drugs,
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we're gonna try to find a way to minimize their harmful effects.
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Ok.
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OK.
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Our next principle understands drug use as a complex multifaceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence and acknowledges that some ways of using drugs are clearly safer than others.
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All right.
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So that one's a mouthful half of that sentence is the most important part.
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It acknowledges that some ways of using drugs are clearly safer than others.
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So,
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whereas an abstinence based um or a prohibition based approach um to prevention,
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for instance,
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so if we're teaching kids about alcohol,
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the prohibition approach would be to simply say alcohol's bad.
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Don't drink alcohol until you're 21.
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Just don't do it,
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period.
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Drugs are bad,
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just say no.
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And what that does is it precludes us from having any meaningful conversation with kids about why is alcohol harmful?
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Under what conditions might alcohol be more harmful for whom might alcohol be most harmful?
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And what are the ways that,
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that you can make alcohol less harmful because it's an uncomfortable fact that a certain percentage of youth are going to use alcohol.
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And so they need to be armed with strategies to,
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to keep themselves safe so that they don't do unnecessary harm.
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So by acknowledging that some ways of using drugs are safer,
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then you can teach people about those is basically what that means.
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So when we teach kids the standard number of drinks,
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how quickly we metabolize alcohol and how quickly that it increases our,
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our blood alcohol concentration,
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those sorts of things that's harm reduction because we're not just saying as a blanket statement,
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don't drink.
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We're saying it's safest.
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If you don't drink,
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that's the best way to reduce your harm.
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But if you're a person who's gonna choose to drink,
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then you should be armed with the facts so that you can do it as safely as possible.
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And the reality is is that alcohol is probably in many,
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many homes where kids are as well.
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And so if that's gonna be so readily available,
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then they need to be armed with the information.
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Absolutely.
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And you're right to point out the ready availability of alcohol because we talk about cannabis as the gateway drug.
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But for all intents and purposes,
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alcohol and nicotine are really the gateway drugs.
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Ok.
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So our next principle establishes quality of individual and community life and well-being,
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not necessarily cessation of all drug use as the criteria for successful interventions and policies.
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Now,
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this is an important one and a big departure from the way we think about it today.
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Typically the prohibition approach under the the war on drugs or prohibition approach.
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The idea is abstinence is the goal we want.
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Really,
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we just want everyone to be abstinent,
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at least abstinent of illicit substances.
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And what harm reduction says is that's really not our goal.
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And the way I like to think about this mindy is like when I go into communities and we're doing coalition building and I say,
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what's your vision for your community?
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What do we want if we,
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if we do good recovery work here,
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how do we know we,
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we've accomplished that?
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What's your vision?
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Nobody has ever said to me.
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I want everyone in my community to be able to pass a 12 panel drug test.
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That's my vision,
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right?
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Nobody said that what people say is I want less crime.
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I want my community to be safer for my kids.
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I want,
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I don't want needles lying around.
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I want um people to be employed.
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I want people to be happy.
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What we're talking about really his quality of life.
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And so harm reduction reorients.
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Our goal and says we're not just trying to get people to stop using drugs because if we have a bunch of people who are abstinent and miserable and everybody's miserable and angry with each other,
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we haven't done anything positive,
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right?
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What we want is a,
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is,
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is quality of life and,
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and that reorientation I think is,
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is helpful,
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not just for people who work in treatment,
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not just for a researcher,
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but for a family member or for a friend to,
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to help understand it's not just about your friends,
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not putting drugs in their body.
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It's also about helping them to be happier and find ways to do it in a,
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in a yeah,
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healthier way.
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And this principle probably explains best for people who wonder why you are employed with family and consumer sciences because quality of life for the individual and for the family and for the community is one of our tenants.
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And so that's why it makes perfect sense for you to be one of our specialists.
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Our next principle calls for the nonjudgmental,
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non coercive provision of services and resources to people who use drugs in the communities in which they live in order to assist them in reducing attendant harm.
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Mhm I think nonjudgmental makes sense to most people that if you're,
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if you're judging somebody,
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it's harder to develop a rapport and be able to,
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to really work with them and,
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and change their behaviors.
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But non coercive might be something people are less comfortable with.
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And we could probably do a whole separate podcast on whether or not forcing people is effective because there's kind of some conflicting evidence.
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But basically,
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one way of thinking of this is um I had a,
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a clinical mentor who taught me how to do therapy,
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who said to me in,
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in all of his 30 years of clinical experience,
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he never solved a problem for someone who didn't think they had a problem.
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That makes sense.
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It makes a lot of sense,
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doesn't it?
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And so when I think about my friends who have struggled with addiction when they're in the stages where they're experiencing or ambivalence,
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whatever you wanna call that where it seems like they have a problem.
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And I think they need help,
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but they don't think they need help.
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That's really not a position where we tend to be very effective at forcing people to do much of anything because if their goal isn't to get sober,
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they're probably not gonna get sober.
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So in that context,
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what what this principle of harm reduction means is by having non coercive services instead of forcing that person into treatment,
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we can meet them where they are.
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So we can say,
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look,
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I understand that you're using drugs right now.
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It's not what I want for you,
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but it's not about what I want for you,
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it's about what you want for you.
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And if you're using drugs right now,
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I can still be connected with you and I can still provide you with some resources that are gonna make you safer,
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that are going to improve your quality of life even while you continue to use drugs.
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Ok?
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A as a way to make sure that we reduce the harm associated with your drug use.
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Ok.
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Our next principle ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve it.
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So when you started to say earlier that this next one is why you're in family and consumer sciences,
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I thought this was the one you were going to because I'm a person with a history of drug use.
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And I am of course biased by this principle,
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but I think it's critically important that people who have firsthand experience are involved in making policies and developing programs.
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Because to be frank,
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we know something that the rest of the world,
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doesn't we know something about the experience about the challenges,
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the,
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the feelings,
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the,
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the supports that people need to recover.
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And so it's a really important part of involving people in decision making and um it helps to add sort of some nuance.
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So it's not just people who have good old fashioned book learning,
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which is important and has a place but experience has a place as well.
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Definitely,
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our next principle of harm reduction affirms people who use drugs themselves as the primary agents of reducing the harms of their drug use.
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And seeks to empower P W D to share information and support and support each other in strategies which meet their actual conditions of use.
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Yes,
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another mouthful.
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Basically what it means is when we say affirming people who use drugs as the primary agents,
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it means that people who are using drugs are themselves best positioned to reduce harm associated with their drug use.
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So rather than your doctor or your mom or your friend being the one trying to reduce the harm,
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you yourself are the one in the best position to do that.
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And so harm reduction is in,
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in that word,
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empower or affirm is important because I,
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I really think that's what we're trying to do is to say you're the one who makes choices for your own life.
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And so you're the one who has the personal responsibility to reduce your own harm.
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And that really hasn't been the approach we've taken with prevention because again,
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when we take the old approach where we just say drugs are bad and we're not gonna have any more conversation about it,
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then we're not empowering kids,
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we're not empowering with the information and we're not empowering them to be agents to keep themselves safe.
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Um Which is AAA really important strategy.
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So our next principle recognizes that the realities of poverty,
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class,
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racism,
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social isolation,
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past trauma,
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sex based discrimination and other inequalities affect both people's vulnerability too and capacity for effectively dealing with drug related harm.
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Yeah,
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this one is,
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is really important.
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No,
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two addictions are the same.
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No two recoveries are the same because no two people are the same,
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right?
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We've all have different mental disorders,
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different family histories,
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different trauma histories and all of those things determine the risk that we have for being harmed by,
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by drug use.
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It's a principle of harm reduction,
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but it's also just sort of a fact that,
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that these things are true and so harm reduction lives in that reality.
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Um,
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and tries to work out of that framework.
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Our last principle does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use.
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And this one is,
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is I'm,
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I'm glad in many ways that this is a tent of harm reduction because I think many times harm reduction is misunderstood as enabling drug use or just minimizing its effects.
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Um It's none of those things.
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It's actually exactly the opposite harm reduction.
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Again,
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living in reality,
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it says,
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yes,
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people use drugs and drugs are harmful and we have a vested interest,
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all of us in protecting ourselves and our communities from that harm.
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It doesn't try to pretend like it's,
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it's ok for someone to,
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um,
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you know,
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to use heroin,
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like there aren't gonna be health consequences there.
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Of course,
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there are health consequences and harm reduction wants to reduce those.
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Well,
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and that is probably the main reason we need to do this podcast because we need people to understand that we're all part of it,
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of harm reduction.
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It's not just something that the person who is living with substance use or the per the families that are living with substance use need to be involved in,
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but that we all need to be involved.
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That's right,
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Alex.
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I thank you for your time today.
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I think we're gonna come back and have another podcast um about some of the other issues surrounding harm reduction.
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And so I,
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I think that this has been a great discussion and,
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and I know that we'll have more.
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All right,
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look forward to part two.
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All right.
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