Public Health Workers Advocate For Controversial Strategies To Keep Opioid, Other Drug Users Healthy

Nov 9, 2018

Public health workers at Thursday’s Drug User Health conference at Allegheny General Hospital advocated for several controversial strategies for helping people with opioid and other substance use disorders.

Perhaps the most contentious is the idea of allowing people to continue to use a substance while going through treatment; many rehabilation centers require a "cold turkey" approach. Presenters said this is a high bar for people who often also struggle with housing and food security and chronic medical conditions.

“If we start to provide those services along the way, what we find is that eventually [people] are much more likely to enter into a recovery process,” said Philadelphia-based Devin Reaves, the executive director of the Pennsylvania Harm Reduction Coalition.

Reaves added that because substance use disorder is so stigmatized, it’s important to meet people where they’re at; otherwise they might not seek treatment. This might mean broadening the definition of success to include things like the use of clean needles or always carrying naloxone, which can revive someone from an opioid overdose.

“Changing one’s relationship to any drug overnight is not usually possible,” said keynote speaker Sharon Stancliff, the associate medical director for harm reduction and health care at New York Department of Health's Aids Institute. “We’ve got people [for whom] it’s hard to develop trust because they’re made to feel like failures so, so often.”

Opioid addiction experts also increasingly advocate for medication assisted treatment, wherein a patient takes buprenorphine or methadone to reduce cravings and withdrawal symptoms.

“One of my early patients came in and said, ‘I want to use buprenorphine and shoot heroin on the weekend,’” said Stancliff. “He came in after a couple months, he said, ‘I didn’t use any heroin this week or last week, but I’m still going to use it when I want to.’”

Some of these strategies for which Stancliff advocates, like medical assisted treatment and needle exchange, are becoming more common. That could be because many who are addicted to opioids are white and middle class.

Brooke Feldman is the founder and president of Sparking Solutions, a behavioral health systems consultant firm in Philadelphia. She said that because opioids are affecting communities with more economic and social power, people who are addicted to this type of drug are sometimes seen as more deserving of resources than those who use other illicit substances.

“In essence,” said Feldman, “we’re creating systems that really treat opioid use disorders in a different way than, say, someone who is struggling with their crack cocaine use.”

Feldman pointed to is the recently passed bill that increases resources to opioid addiction treatment, but not other substance use disorders. 

"I want to see the compassion and empathy expand to all people who use all drugs," said Feldman. 

90.5 WESA receives funding from Allegheny Health Network.