Pubdate: Wed, 28 Feb 2007 Source: Times-Standard (Eureka, CA) Copyright: 2007 MediaNews Group, Inc. Contact: http://www.times-standard.com/ Details: http://www.mapinc.org/media/1051 Author: Mike Goldsby Note: Mike Goldsby is program manager with the Health Education, Public Health Branch of the Humboldt County Department of Health and Human Services. Opinions expressed in My Word pieces do not necessarily reflect the editorial viewpoint of the Times-Standard. Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction) Bookmark: http://www.mapinc.org/heroin.htm (Heroin) Bookmark: http://www.mapinc.org/meth.htm (Methamphetamine) Bookmark: http://www.mapinc.org/find?137 (Needle Exchange) Bookmark: http://www.mapinc.org/rehab.htm (Treatment) MANY TOOLS NEEDED TO REDUCE DRUG ABUSE I have nothing good to say about methamphetamines. Working in drug abuse treatment from 1984 to 2002, I met hundreds of individuals and families that had been nearly destroyed by the drug. Speed, crank, crystal, meth -- no matter what you call it, it is a deadly toxin, harmful to minds and bodies, to families and communities. Right now, meth is drawing public attention to the problems caused by drugs. This attention is valuable and it serves to underscore the ongoing problems caused by alcohol, tobacco, marijuana, heroin, and prescription drugs. Drug abuse has been cited as an example of the economic model of supply equals demand. Law enforcement works to curtail the supply of drugs and treatment works to lower the demand. Prevention strategies are equally valuable, lowering the demand for drugs. And harm reduction strategies decrease the damage caused by drug use. A carpenter needs more than one tool in his tool box. A surgeon requires more than one instrument in her operating room. Our community needs more than one approach to reduce substance abuse. Everyone knows "An ounce of prevention equals a pound of cure," but the benefits of prevention are often long-term and not immediate. The Department of Health and Human Services has school-based programs like Project Alert and Project Success. Staff in these programs target junior high and high school age students, augmenting efforts that are already going on in our local schools. Prevention activities are evaluated to be as effective and age-appropriate as possible. Abstinence-based treatment programs are an essential piece of addressing our community drug problem. But many addicts are either unwilling or unable to participate in treatment programs. Even addicts in recovery may relapse due to the chronic nature of the disease of addiction. Law enforcement plays a vital role in holding addicts accountable for the consequences of their behavior. Law enforcement serves to protect society and create a deterrent to drug use. But there are not enough police or jails to arrest, convict and incarcerate every addict. Studies by the World Health Organization and the Centers for Disease Control found strong evidence that outreach programs and syringe exchange programs lower the transmission of HIV/AIDS. These programs reach the drug users who are most at risk to contract and spread diseases. They are also the users who are least likely to access more traditional ways of receiving information and health care. A health care worker described a client who tentatively came to a local clinic seeking to exchange used needles. After a few meetings, the client sought wound care for abscesses. Following that, the client sought medication and support services for detoxification. This is a client that had previously avoided medical care and addiction treatment. Harm reduction programs are growing in acceptance. Forty-eight states allow sterile syringe exchange and 46 states allow pharmacy sale of syringes. Harm reduction is exerting a positive influence here in our community. In Humboldt County there is a steady decline in the numbers of persons diagnosed with AIDS, HIV disease and hepatitis B and C each year since 2000, although the sample size is thankfully too small to determine statistically valid trends. For example, Humboldt County's rate of hepatitis B has declined from 32.2 (per 100,000 population) cases in 2001 to 5.3 in 2006. Hepatitis B can cause persistent infection, death and an on-going risk of spreading the infection to non-using sexual partners and to unborn babies. Hepatitis C has declined from eight cases in 2001 to one case in 2006. HIV has dropped from 52 in 2003 to four in 2006. While needle exchange is not a service the county provides, DHHS supports these harm reduction options and is encouraged by the drop in communicable diseases. DHHS operates street outreach services to provide medical testing for HIV/AIDS and hepatitis C. These programs also provide information on medical care and drug treatment resources. These programs do not make it any easier to get drugs but they do make it easier to avoid sharing contaminated needles. Needle exchange programs do not recruit new drug users. Nor do these programs promote increased drug use as many participants actually decrease the number of times they inject per day. At the County Alcohol and Drug Advisory Board meeting of Jan. 17, County Coroner Frank Jaeger observed that harm reduction strategies have contributed to a decline in the number of heroin overdose deaths. He attributed the recent increase in methamphetamine overdoses to smoking methamphetamine, not injecting. Needle exchange programs decrease human suffering and decrease the spread of diseases. Yet some people remain steadfastly opposed to these harm reduction approaches. The financial bottom line may be compelling. Every infection averted saves California taxpayers $13,000. I know there is still work to be done addressing the public health problem of drug abuse and addiction. It does take mobilizing all of our resources and utilizing a variety of approaches.