Why Police Should Support Harm Reduction for People Who Use Drugs, Part I
Part I of II. Read Part II Here.
Mikayla Hellwich: How do you personally define harm reduction? What does it mean to you?
Chief Mark Spawn (Ret.) — Any initiative or program that lessen risks in public health and safety. This includes needle exchanges and supervised injection facilities or “SIFs,” [also called supervised consumption spaces, or SCSs] to name a few.
What is the biggest misconception about people with drug addictions?
One of the biggest misconceptions is the image people have — the person who’s down on his luck, maybe a homeless person with a criminal record. The reality is that addiction affects men and women of all races, socioeconomic statuses, people in rural and urban areas. It cuts across all demographics.
What role does stigma play in this misconception?
It’s the negative stigma of someone being a “drug addict” that can prevent the person from seeking help or even talking to their families about it. For a person with an addiction, seeking out help from even the closest family members and friends can be difficult because of social perceptions.
Negative stigma can also affect a person getting public health services. They might be afraid of being seen going into a syringe exchange.
What do you think is the biggest contributor to the recent spike in heroin deaths?
There are a number of factors here. Street heroin has become more affordable and the purity may be very weak or very strong — if you take a weaker shot today and a hot shot tomorrow, it could be the last one you take.
Prescription opioids have been the subject of a lot of scrutiny — we hear about a culture of over-prescribing of prescription painkillers, which is exacerbated by the diversion of prescriptions where drugs intended for one person end up in the hands of another. People in a household can abuse substances prescribed to another member of the home.
Where do you see the balance between needing to protect pain patients and preventing drug diversion? We don’t want to make it impossible for pain patients to get the medicine they need, but there’s clearly a spillover problem.
There needs to be a balance between the treatment of people who are in pain, while ensuring that they are not being set up for dependence. Physicians should engage in counseling of their patients to warn about the consequences of addiction and alternative options for pain management. Like anything else, the practices need to be reasonable and rational. I recently had some dental work done and was given a prescription for pain meds. I was shocked at how much medication was in the bottle. Turns out that I didn’t need the meds, but it caused me to ask, ‘Why were there so many pills in one script, and is this part of the problem?’
What advice do you have for people with a loved-one suffering from addiction?
It’s going to be tough! It’s so easy for me to say, “Don’t give up,” but if you hear the cries and anguish of parents who have lost someone to addiction, they say they wished they’d done something more. It’s especially hard when the addicted person is in denial. In most areas there’s usually not enough treatment options available, and we often expect them to quit on the first try, which is unrealistic. That’s probably one of the most important pieces of advice for family and friends of a person with addiction — even when they want to quit, it will probably take several tries before they can get a handle on it.
Describe the continuum of services we can provide to people who are at different stages in their recovery process.
The syringe exchange model — if you are an injecting drug user who doesn’t want to quit or isn’t ready to quit, the services of many syringe programs are intended to keep you healthy — sterile syringes, bandages, blood testing, wound care, etc. The collateral services provided by syringe exchange programs can also include job assistance, laundry and showers, food, and sometimes medical care.
If you’re someone who wants to quit but is just waiting for the right time, syringe exchanges are also tremendously helpful for helping people get into treatment.
The strategy here is keeping the person healthy and safe, which will in turn keep the rest of the community safe.
What are your feelings on supervised consumption spaces?
These can be quite controversial, but I think it’s important to first understand the circumstances that brought about SIFs. Some injection drug users inject surreptitiously under unsanitary conditions — it can be in a bathroom stall, under a bridge, in an alley. Not only are these unsanitary, but the lighting is usually poor, all of which contributes to improper injecting which can lead to infections and wound abscesses. Some infections are contagious and pose huge health concerns, not only for the drug user, but also for their intimate partners, family, friends, and first responders. Supervised facilities provide a well-lit location, sanitary supplies, and medical supervision.
As you can imagine, supervised injection facilities are controversial but in recent years there has been more public acceptance to the concept. But it is critical that they be implemented properly with deliberation given to engaging the public, properly locating the site of a facility, and responding to community concerns.
Just to give you an example of how unhygienic some injection practices can be, I spoke with an Australian nurse who told me she was surprised at how unsanitary people’s practices are because they simply don’t know any better. She explained that when she monitored her very first injection, the user licked the tip of the hypodermic needle for ‘good luck’ before she was going to insert it into her arm. The nurse stopped her to explain how dangerous that was. Had it not been for the medical supervision, that practice would never have been detected. Why is that important? First, it’s the right thing to do no matter what your personal views may be on drug addiction and persons with addiction. But you also need to think about the health of people who are in contact with the drug user. And for first responders, we routinely come into contact with people suffering from addiction or who have overdosed. When the drug user’s health is better, overall public health is better. And there’s also the financial side to consider — providing preventative care can be a lot cheaper than responding to a health crisis, and we have seen health crises in many areas across the United States, particularly hepatitis.
Chief Mark Spawn (Ret.) served the Fulton Police Department in New York for 24 years and spent 12 years as Chief. He is an expert in harm reduction, community-driven policing, sexual assault investigations, procedural justice, and transparency and accountability in law enforcement. He’s now a speaker for the Law Enforcement Action Partnership and lives in Costa Mesa, California.
Mikayla Hellwich is the Media Relations & Speakers Bureau Director for LEAP.