In a recent Baltimore Sun op-ed, Patrick Hahn asks: If addiction is a disease, why haven’t we cured it? This question is misguided. There are not yet cures for cancer. HIV. diabetes, schizophrenia, Parkinson’s, or Alzheimer’s, but I think we can all agree these are diseases, and so is addiction.
The study of addiction is still relatively new. Alcoholism was the first type of addiction to be recognized as a disease by the American Medical Association, and it wasn’t until 1956 that it received this classification. While there is good science behind many addiction treatment methods currently available, there is not yet a comprehensive cure. That doesn’t mean that we should stop treating it as a disease, striving to cure it, or to better manage it.
Hahn is correct to say that we shouldn’t medicalize away willpower. Many people have been able to overcome addiction through willpower and self-determination. That is one path to recovery, and it can work for many.
Similarly, many people are able to manage high blood pressure with proper diet and exercise—many people, but not all. Some people just have high blood pressure, no matter how rigorously they adhere to their doctor’s recommendations about lifestyle, diet, and exercise.
The same is true for addiction. Some can overcome it on their own, but for others, it is too deep, too insidious, and to tell them to deal with it on their own is to consign them to a lifetime of suffering and an early death.
Hahn says that we should make moral judgments in regard to addiction—that we should go back to chastising the person struggling with addiction for their poor life choices. You chose to do this, to be this way, so this is all your fault. The moral failing argument is convenient if we’re looking to avoid the problem. Addiction has existed for millennia, and so has willpower, but addiction is still here and we deal with it every day in Baltimore and across the country.
We need a different approach. We need compassion, to recognize the addict as a human being, and to help each other be as safe as possible while navigating this debilitating disease.
Harm reduction is one practical way of doing this, working to minimize the risks of drug use, while also providing a pathway to treatment for those who are ready.
One longstanding harm reduction approach is needle exchange programs (NEPs), which have been in place in Baltimore for many years. These programs let people trade in their used needles for clean ones, lowering their risk of contracting HIV, hepatitis C, and other blood borne infections. Baltimore’s NEP also refers its clients to drug treatment centers and provides testing for syphilis and HIV.
Naloxone is another important harm reduction response to addiction. The drug, which reverses opioid overdoses in progress, has saved countless lives. Since January 2015, Baltimore’s health department has trained over 20,000 people on how to administer the drug and distributed over 15,000 units of it to city residents. Contrary to Hahn’s ridiculous assertion that harm reduction is somehow responsible for Baltimore’s rising overdose death rate, naloxone has saved over 800 Baltimoreans from potentially fatal overdoses since 2015.
While these harm reduction measures have seen great success, more is needed. The city’s increased overdose fatalities are largely due to the rise of fentanyl—a cheap, synthetic opioid used to cut heroin and other drugs that is vastly more potent than other opioids. This year, the health department will begin distributing drug testing kits that allow people to test their own drugs for the presence of fentanyl, so that they can know what they are using and reduce their dosages so as not to overdose. These kits—along with education such as naloxone training and encouraging people not to use in isolation—have the potential to address the city’s rising overdose rate.
One final harm reduction approach the city should consider is the use of monitored spaces where people receive medical supervision and care while using their own drugs. These spaces, sometimes called overdose prevention centers, safe injection facilities, or safe drug consumption rooms, do not encourage drug use or draw people into addiction. Rather, they acknowledge that thousands of people use drugs and provide a place that is safer than an alleyway or an abandoned building where people can receive care while they use—and connection to treatment, if they’re interested. Insite, one such program in Vancouver, has medically supervised over 2 million injections since its creation in 2003. In that time, it has seen zero overdose deaths. Zero.
It’s time for a new approach—one that is rooted in compassion, oone that reduces the harms of addiction rather than continuing to stigmatize our friends, families, and neighbors.
