Panel explores addiction harm reduction strategies

A panel of health care professionals, addiction specialists and people with lived experience on the opioid crisis discussed harm reduction — strategies aimed at reducing negative consequences associated with drug use — at Greenfield Community College last week.

At the day-long Harm Reduction Summit on Friday, panelists discussed best practices for working with people who are impacted by addiction and ways that health care professionals, the justice system and the community can mitigate instances of overdose and relapse among those in addiction recovery.

The panel was moderated by Boston Medical Center Associate Director of Overdose Prevention Stephen Murray, and included Franklin County Probate and Family Court Associate Justice Alexandra Flanders, Baystate Medical Center Nurse Practitioner Leslie Galvin, Eliza’s Watch founder Daniel Harper, Whose Corner Is It Anyway Development Director Caty Simon and Baystate Medical Center Director of Harm Reduction Dr. William Soares.

“There has to be a lot of understanding and reframing, because it’s very easy for us to de-humanize [patients],” Soares said, explaining the importance of getting to know patients on a personal level. “When we teach this, a lot of it’s about just looking at them as people. Nobody started out their life thinking that they were going to have an issue with substances or thinking they were going to have an issue with alcohol. … Once you engage with someone, once they trust you a little bit, once you can have a little bit of that conversation, it makes for a much better patient interaction, especially in the Emergency Department.”

Discussing the challenges that come with treating those who use drugs, Simon explained many people who suffer from addiction fear treatment at hospitals, adding that they worry a visit from law enforcement might follow.

Simon added that those who use drugs often face harsher treatment in the hospital than their non-addicted counterparts, and called for an end to the war on drugs.

“We have got to cut the very, very clear connection between carceral systems and medical systems. I’ve been told by people in my organization, in 2018 … most of us feared and loathed medical professionals more than we feared and loathed cops,” Simon said. “That is because there have been so many people who have experienced being hurt, mistreated, abused, neglected, dismissed on one of the worst days of their lives. There is also a very clear hospital-to-prison pipeline that we are not talking about, that we are not confronting with fairer standards or with fairer policies.”

Flanders, discussing changes that the court system has implemented in her role as a judge, explained that retired Probate and Family Court Judge Beth Crawford led the charge of more compassionate treatment of people being processed through the criminal justice system who suffer from addiction.

Describing what she referred to as a “critical moment” in how the court system handles addiction, Flanders recounted an emergency case decided by Crawford in which a grandmother needed to be able to pick up a child whose mother had died of an overdose that day.

“[Crawford] was frustrated with the limited options for judges speaking about safety of children when their parents were using substances,” she said. “Often, the conventional wisdom was to completely cut off contact and put the burden on the parent who has a substance use disorder to do all this work and contact the court when they can show everything is fine — that just seemed problematic.”

When Murray asked about new harm reduction strategies that panelists believe could be helpful or have been helpful, Harper, whose daughter died from an overdose, explained that while the use of the overdose-reversal medication naloxone, or Narcan, has been helpful, he would like to see the use of devices that could immediately inform first responders of an overdose.

“For seven years, I’ve been focused on that one moment of why Eliza was not able to yell for help,” Harper said. “My daughter was upstairs and our Narcan was in the kitchen drawer. Everything was set to reverse that overdose. There was no ability for Eliza to call for help, and that is something that I wish I could say is available today.”

Galvin responded that while hospitals have been able to enhance their services by offering alternatives to opioids such as ketamine to treat pain in those who suffer from substance use disorders, she believes more can be done to prevent overdoses in those who have both a substance use disorder and other co-concurring ailments.

“When we talk about opioid use disorder and overdose deaths or overdose events, a lot is missed in terms of the patients who are not safely using or are on some sort of [medication for opioid use disorder] and have some sort of overdose prevention on board, however, still have much risk with regard to some of their health problems in general,” she said. “We have an incredible opportunity to help treat and engage in care, whether it be screening for sexually transmitted infections, whether it be patients coming in with back pain and they have infections in their spine, infections in their heart … There are frequent self-discharges for one reason or another, a lot of that being stigma.”

Flanders explained that while the court often used strict policies relating to substance abuse treatment under an older notion that leniency in treatment might condone drug use, those with addiction issues tend to know what works best for them.

“In the court system, we impose a lot of judgments and rules and obligations on people, and I think part of that comes from a fear that if you don’t say you have to be completely abstinent, that we’re condoning use,” Flanders said. “What I’ve seen is, if you give someone the opportunity to tell you what works for them, and you give them some supports to help them, if they wish to be abstinent, people will be able to do amazing things.”