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What is substance use harm reduction?

Staff Report

Disclaimer: The A.C.T.I.O.N Coalition in no way is endorsing or condemning any of the information contained in this article. It is being submitted to allow the community to understand and make informed decisions regarding the poll in The Tomahawk about the community-wide acceptance or denial of harm reduction techniques.

Harm reduction is a set of practical strategies and ideas aimed at reducing the negative consequences associated with drug use. These evidence-based practices and procedures have been proven to be effective at reducing the effects of substance use on society as a whole and are endorsed by the Centers for Disease Control (CDC).

“The two we will look at are Syringe Exchange programs and Medically Assisted Treatment (MAT),” said Certified Prevention Specialist and Action Coalition Executive Director, Trish Burchette. “Many individuals faced with the proposition of complete abstinence refuse treatment of this sort. A harm reduction approach considers some positive change is better than no change at all. When we consider abstinence the only acceptable recovery outcome, positive change is limited. This is because individuals refusing abstinence will make no change at all. Harm reduction seeks to maximize positive change by reducing harm to addicted persons without insisting upon abstinence.”

According to Burchette, Substance Use Disorder is certainly a cultural problem. “To treat Substance Use Disorder at this level we must examine not only how society affects individuals, but also how addicted individuals affect society. The social costs of Substance Use Disorder are enormous. “We all pay the price for Substance Use Disorder. Substance Use Disorder contributes to higher healthcare costs, crime, premature deaths, destruction of property, lost productivity, and many other losses (to list of personal costs),” Burchette said.

A harm reduction approach to Substance Use Disorder operates from the premise that many individuals with Substance Use Disorder problems may never achieve lasting abstinence. Harm reduction accepts this unfortunate fact. Therefore, it seeks to limit the harm to addicted people. At the same time, harm reduction decreases the cost of Substance Use Disorder to society as a whole. In some cases, a harm reduction approach serves to keep addicted persons alive long enough for recovery to begin.

One example of a harm reduction approach is the advent of nicotine replacement products. Tobacco products create a vast cost to society. For individuals who cannot break the nicotine Substance Use Disorder, several nicotine replacement products are available. These include gum, patches, lozenges, and inhalers. These products do not totally eliminate the risks associated with nicotine use such as cardiac problems and hypertension. However, they significantly reduce the harm of nicotine Substance Use Disorder by eliminating the delivery of nicotine in the dangerous forms of smoking or chewing tobacco.

Cigarettes and chewing tobacco contain not only nicotine but also toxic, cancer-causing agents as well. Smoking tobacco products not only harms the individual smoker but also puts others at risk. Designated, no-smoking areas represent another type of harm reduction. Designated non-smoking areas protect non-smokers from exposure to smoke.

Another type of harm reduction is tobacco regulation and anti-smoking campaigns. These are intended to reduce harm to society by reducing the number of people who become addicted to cigarettes. Medically Assisted Treatment programs come in different shapes and sizes, some such as suboxone clinics dispense pills to those in need to help reduce the cravings of substance use. Others such as Overmountain Recovery in Gray TN, seek to find the underlying cause of the SUD through therapy and counseling services along with a regiment of medication designed to lessen the effects of withdrawal while tapering the individual off the medication for the long term. They seek to help individuals understand the cause of their SUD and help them learn other coping mechanisms to be able to maintain an active, productive life in their communities.

More information on Overmountain Recovery can be found at their website at

The following information was taken from the only Syringe Exchange Program located in East Tennessee. More information can be found on their website at may/nr_syringeexchangeprogram.aspx.

“East Tennessee State University’s Center of Excellence for Inflammation, Infectious Disease and Immunity will now provide new, unused needles and naloxone to people who inject drugs through participation in a new statewide program to help prevent the spread of HIV/AIDS and viral hepatitis. The Syringe Trade and Education Program of Tennessee (STEP TN) is being developed in collaboration with Cempa Community Care, an AIDS Service Organization in Southeast Tennessee. The harm reduction and education program for individuals who inject drugs is designed to reduce the spread of HIV, viral hepatitis, including hepatitis C (HCV) and B (HBV) and other blood-borne infections. The program also provides safe disposal of needles and syringes.”

“Other goals of the program include reducing needlestick injuries to law enforcement officers and other emergency personnel and to encourage individuals who inject drugs to enroll in treatment,” said Dr. Jonathan Moorman, a professor of medicine at ETSU’s Quillen College of Medicine and section chief for Infectious Diseases at the Quillen Veterans Affairs Medical Center. “Education about overdose prevention with naloxone will be provided, along with referrals to substance use, mental health, and social services throughout East Tennessee.”

According to data compiled by ETSU’s Center for Prescription Drug Abuse Prevention and Treatment, there are an estimated 1.3 million people who inject drugs in the United States and an expected 4,000 new HIV infections per year among this group. Another 2.7-3.9 million people in the nation have chronic hepatitis C, with the most common means of transmission being injection drug use.

In Tennessee, reported rates of acute hepatitis C increased 100 percent from 2010-2015, and in 2016 rates of HIV diagnoses among adults and adolescents were 12.8 per 100,000. Tennessee ranked 16th among the 50 states in new HIV diagnoses in the most recent rankings.

“Research indicates public funding of syringe service programs such as STEP TN is associated with lower rates of HIV and greater numbers of health and social services provided,” said Angela Hagaman, director of operations at the ETSU Center for Prescription Drug Abuse Prevention and Treatment. “Many studies show that syringe exchange programs decrease drug use by connecting people to treatment.”

“We at A.C.T.I.O.N Coalition are seeking to only do the best we can to help provide resources for those in need of recovery from Substance Use Disorder,” Burchette said. “At the same time, we value our community and its members’ opinions. Please take the time to fill out the short survey located on the Tomahawks website and Facebook. Thank you for taking the time to give us your feedback.”

For questions, please feel free to contact Action Coalition at 423-727-0780.