Abstinence Versus ???

 Medication:

• If medications became the main form of addiction treatment, the pharmaceutical industry would benefit — an outrageous outcome, critics of the approach believe, given the industry’s role in creating the opioid epidemic. 
• But medication-focused treatment would also threaten residential programs (for-profit companies). They charge an average of $15,000, and up to $26,000, for a monthlong stay, though many of its patients have private insurance that covers most of the cost
• Holistic Narratives: “If we went purely science-based, nobody would come to treatment because it would be boring,” Mr. Perez said.
• the methadone treatment program is one of numerous changes Connecticut has made to help inmates successfully re-enter society. 
• But for most jails and prisons, such programs are out of the question. 
• Much of the criminal justice system still takes a punitive approach to addiction. 
• Many who work in corrections believe, incorrectly, that treatments like methadone, itself an opioid, allow inmates to get high and simply replace one addiction with another. 
• And many officials say they have neither the money nor the mandate to provide the medications.

Moderation Management:

• The UK is much more open to a harm-reduction approach (and less religion-focused), and the idea of incremental steps and adopting a strategy that doesn’t make the threshold of getting treatment so high. 
• They take the approach of, ‘Let’s get people started thinking about their drinking’ and they see reducing drinking as a success, whereas in this country if you reduce you’re still an alcoholic with a problem, which is not actually what the addiction literature suggests.”

Supervised Consumption:

• Philly may become the first city in the United States to open a safe-injection facility, or SIF. 
• SIFs, which are also called “supervised consumption” or “overdose prevention” sites, are essentially syringe exchanges that allow people to inject on-site, under the supervision of a nurse or a trained naloxone administrator. 
• Some of these places are immaculate, medical-style facilities complete with on-site services and referrals to treatment programs; others are little more than tents. 
• But in each case, the mission is the same: to save lives by reducing needle sharing and other unsafe practices—and by reversing overdose if it occurs.
• Vancouver, unlike Philadelphia, is home to more than half a dozen safe-injection sites, most of which have set up shop in this neighborhood. 
• These include Insite, the first SIF opened in North America, and seven pop-up SIFs—in some instances, little more than tents where people with naloxone can monitor people who are using—which have been authorized by the government to deal with the current overdose crisis.

Needle Excahnge:

• “We really understand people’s concerns about syringe litter,” said Dr. Karen Smith, the state’s public health officer. “The challenge for us is communicating that the syringe exchange programs is one of your most potent tools for decreasing syringe litter.”
• Reducing injection sites (illegal)
• As much as this has been a series of victories for public health officials who see how needle exchanges — also called syringe exchanges — stymie the spread of blood-transmitted diseases, it has been a triumph of public health policy research. 
• For years, research has shown the benefit of needle exchanges, but now that the opioid epidemic and infectious diseases have affected their own communities, lawmakers are listening.

Unequal Access:

• While all drug crises have their trademark horrors—the turf-driven gunfights of the crack years, the drawn-out agony of AIDS pre-1995—these differences mask an important truth: 
• Addiction is always with us, and it always hits hardest among those made vulnerable by poverty, racism, downward mobility, dislocation, trauma, and mental illness. 
• The drugs and their associated harms may change, but the vulnerabilities remain mostly the same.
• If people seek pleasure or relief from approved drugs like alcohol, caffeine, and tobacco, they have human rights—and their drugs are regulated for purity and dosage and aren’t even seen as drugs. 
• But if people take anything else, they are criminalized—and if they die from using black-market drugs, they, unlike almost all other consumers, are thought to have deserved it.
• Harm reductionists also recognized that the basis of the system that makes legal distinctions between drugs has little to do with their comparative dangers: 
• There’s no risk-based or scientific way, for example, to justify illegal marijuana in the context of legal alcohol and cigarettes. Indeed, anti-drug laws—including alcohol prohibition in the 1920s—have almost always been powered as much by racist and anti-immigrant panic as by genuine public-health considerations.

Naxolene (Overdose drugs):

• National Harm Reduction Coalition

Goal of Harm Reduction:

securing safe places for people to inject drugs under medical supervision as a means of minimizing the overdose risk. Such places exist in nearly 100 sites across 10 countries, including Australia, Canada, Denmark, France, Germany, and Switzerland. There are none, however, in the United States.

• The absence of US-based safe-injection facilities isn’t surprising, given this country’s long, puritanical, “just say no” approach to drug use and addiction. But it goes against decades of evidence supporting not only the safety of these sites but also their health and treatment benefits. 

• Every injection taken at any one SIF is a chance to avoid a round of Russian roulette with street drugs