Discussion about this post

User's avatar
KB's avatar

I have worked in harm reduction for nearly 20 years. I work internationally - not in the US. There are so many excellent programs that work so well, yet Americans seem almost totally unaware of them, and in the US, programs that are not best practice are set up again and again, spending a lot of $$, taking a lot of money from the most vulnerable people - ie users and their families are getting ripped off, and then the program does not work long-term for most people. The most likely time for someone to die from overdose is after they get out of one of those detox programs, because, when they relapse, they don't know how much is safe to take and they take the same dose that they were taking before detox. Switzerland is a good-practice example, and so is Portugal. UNODC has clear guidelines, and programs that follow those guidelines save lives. Key services are "medically assisted treatment" MAT (this is an American term, the rest of the world calls this opioid substitution therapy - OST) with methadone or buprenorphine (this is not a detox program - adequate dosing, longterm, NOT drawing down the dose, works best) and MAT should be outpatient, in community settings (not hospitals) with take-home doses. MAT should be easily available in jails and prisons too. Clean needles should be provided for HIV and Hep C prevention - I'll bet HIV infection rates are really high in injecting communities. Naloxone should be readily available for anyone to carry, especially users, because they are the ones most likely to be around people who are overdosing. Giving naloxone to police is very suboptimal, because most users avoid the police. There are also great international guidelines on rights-based programming for stimulant users - no mystery there, the evidence is already there and other countries are implementing those life-saving programs. An excellent program for women is Sheway, in Vancouver. There should be safe injection rooms - as there are in Canada and Switzerland. Nick Kristof - I am just telling you what works and the programs that have saved lives all over the world, and that the UN supports. There is no need for you to run around the United States trying to figure this out. There is a vibrant, informed community of people globally who know what needs to be done and know about all the excellent effective programs that exist. You could tap into that. The United States is abysmally behind and stubbornly unwilling or unable to learn from other countries. That is why there are so many dead Americans from overdose, and so few Swiss who die from overdose. Anyway - maybe this will help you - I won't put it on your Facebook page because the discussion is too vitriolic on Facebook and I am tired of being verbally assaulted by angry Americans. Good luck.

Expand full comment
Barbara's avatar

I am a retired treatment program developer and manager. Mr. Kristof is exactly right. We need more treatment programs pretty much everywhere and for people of every age. We need to stop using jails and prisons as treatment facilities. They are not equipped to do the job. We need treatment that addresses not just addiction itself but underlying mental illness that frequently accompanies it. We need to address systemic and family issues that exacerbate addiction. And we need follow-up for every patient, long term, not just a few weeks. It's easy to quit drugs (though not pleasant). It's much harder to stay off them. If we believe that addiction is an illness--and it is--then we need to treat it like one. We must give teachers and others who come into contact with young addicts the wherewithal to recognize drug use. I know from experience that many school teachers and counselors don't know the signs of addiction. Yet it is not uncommon for children as young as 8 or 9 years old to already be using drugs. I've known some who were even younger. Every state must put money into prevention and treatment. In the long run, it not only saves lives and families when we spend money up front, it also costs less, due to lower incarceration and fewer hospitalizations and deaths.

Expand full comment
14 more comments...

No posts