Pubdate: Mon, 15 Jan 2001
Source: San Francisco Chronicle (CA)
Copyright: 2001 San Francisco Chronicle
Contact:  901 Mission St., San Francisco CA 94103
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Author: Ulysses Torassa

CHANGING METHOD OF TREATMENT FOR DRUG ADDICTION

S.F. Models 'Harm Reduction' Theory

After Tony Trimingham's son Damien died of a heroin overdose in 1997, 
Trimingham didn't go after drug dealers or shrink in shame. Instead, the 
Australian psychologist spearheaded an effort in Sydney to provide a place 
where junkies could go and shoot up safely.

"Watching people doing this turned my stomach," Trimingham said of the 
church-based shooting gallery that police shut down after nine days. "But 
the sad reality is: If a facility like this had been available, Damien 
might not have died."

No one is suggesting San Francisco open up spaces for addicts to inject 
drugs -- yet.

But at a city-sponsored conference last week, drug treatment professionals 
listened to Trimingham and others preach the gospel of "harm reduction," a 
controversial but growing movement that doesn't see abstinence as its 
overriding goal when dealing with addicts.

Quietly last September, San Francisco became the first city in the nation 
to adopt harm reduction as its official policy. That means the dozens of 
agencies the city hires to provide drug and alcohol treatment must have 
harm-reduction programs and policies in place.

Among the signs of the new philosophy:

- -- The Department of Public Health last year began offering care at the 
city's needle exchange sites and at a special clinic, treating 
injection-related skin infections before they grow into raging, 
life-threatening wounds.

- -- The city is teaching jail inmates how to perform CPR on their friends 
who may be overdosing on drugs. A media campaign aimed at teaching addicts 
how to reduce deaths from heroin overdose is in the works.

- -- And a pilot project is expected to start in a few months that will put 
the prescription drug naloxone -- a heroin antidote -- in the hands of 
addicted couples, so they can administer it to their partners in case of an 
overdose.

"The war on drugs has encouraged users to lie to their providers (drug 
counselors) and not seek out help when they are struggling with addiction," 
said Dr. Joshua Bamberger, medical director for housing and urban health at 
the San Francisco Department of Public Health. "Harm reduction opens the 
doors to honesty and allows providers to move addicts one positive step at 
a time toward better health."

Proponents of harm reduction focus on the ill effects of addiction, from 
homelessness to the spread of AIDS and hepatitis and overdose deaths. They 
seek to treat clients "where they are," instead of insisting that they be 
clean and sober before getting services.

Approaches vary widely. Among other things, conference speakers talked 
about bringing medical care to the streets and using acupuncture and 
marijuana to help addicts reduce their craving for harder drugs.

Many harm-reduction strategies, including safe injection rooms and 
prescription heroin, are already used in the Netherlands, Switzerland and 
Germany. And following the uproar in Sydney over the injection room, the 
Australian government has promised to open an official site, to debut next 
month.

But the ideas are so controversial in the United States that conference 
organizer Alice Gleghorn said people urged her not to use the phrase "harm 
reduction" in the title. And she acknowledged losing funding and some 
speakers by including it.

"I get calls all the time -- 'We can't call it that where we live. Can't 
you change the name?' " Gleghorn said.

Yet the concept of harm reduction has been around for years. Using 
methadone as a replacement for heroin is a form of harm reduction. So, for 
that matter, is putting filters in cigarettes.

But the term "harm reduction" and the development of it as a broad 
philosophy can be traced to the AIDS epidemic and efforts to distribute 
clean needles to addicts to halt the spread of HIV.

It is also a tacit acknowledgment that the war on drugs isn't winnable, and 
a better strategy may be to help people deal with their addictions in the 
best way possible.

Not surprisingly, the movement has plenty of critics. Katherine Ford, a 
spokeswoman for the Drug Free America Foundation, called harm reduction 
"harm promotion," since it teaches people how to continue drug use safely.

The organization's executive director, Calvina Fay, said most needle 
exchange programs she's seen do little or nothing to steer people into 
treatment. Instead, they end up being a social club for drug users and a 
magnet for prostitution and crime, often in neighborhoods that are already 
on the margins, she said.

A significant portion of those who promote harm reduction are really after 
a more far-reaching policy change: the legalization of drugs, Fay said.

"Not everyone who supports harm reduction falls into this category," she 
said. "But there is definitely a movement in the country to promote harm 
reduction, and it's rooted in groups who are receiving large amounts of 
funding from business people who make no pretense about" their support for 
legalization.

Last week's conference was funded by the Lindesmith Center, a drug-policy 
organization that gets most of its money from billionaire George Soros, who 
has said he favors legalizing and regulating many illegal drugs. He and two 
other businessmen paid for the successful statewide campaign for 
Proposition 36, which requires treatment instead of jail for nonviolent 
drug offenders.

Fay and others say that by not insisting that addicts swear off drugs, 
harm-reduction programs actually enable people to stay on drugs longer than 
they would had they been left to "hit bottom."

Ernesto Escalante, a former addict and now a drug treatment specialist in 
Fresno, said scaling back his drug use led to rebounds that were 
increasingly harmful. Abstinence, he said, was the only approach that 
worked for him.

But Escalante attended last week's conference, hoping to find elements in 
the harm-reduction approach that he could use in his own drug-treatment 
practice.

"I think harm reduction will work with hard-core heroin and meth addicts, 
but it's not something to be used across the board," he said.

What it provides, he said, is a way to connect with people who are so 
strung out they won't come in to treatment on their own. "You can't go in 
there and say, 'We're going to save you,' when they don't want to be 
saved," he said.

But even that won't be an easy sell back home. "Fresno is stuck in the 
'70s, " he said. "It's going to be a slow process."

Meanwhile, in San Francisco -- home of a half-dozen medical pot clubs and a 
long-running needle exchange program -- officials are waving the 
harm-reduction flag proudly.

Mayor Willie Brown, District Attorney Terence Hallinan and Supervisors 
Gavin Newsom and Mark Leno all spoke at the conference. Newsom in 
particular has been pushing for new approaches to treating addiction, 
including lobbying the federal government to allow physicians to prescribe 
methadone out of their offices.

"We are doing our best to move the agenda, particularly in reference to 
drug abuse," Brown told conference attendees Thursday. "Things that would 
be considered controversial in almost every other place, are almost routine 
here in San Francisco."
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