Opioid Crisis: New Treatment Tactics Emerge

By Robert J. Budosck and Valerie Vainieri Huttle

Seat belts.  Bicycle helmets.  Designated drivers.  These and other common harm reduction tactics and strategies are almost universally accepted and have resulted in a drastic reduction of injuries and countless lives saved.  In that same vein, those of us in the drug treatment and recovery world have been investigating and trialing harm reduction strategies that have the potential to save lives, but perhaps more importantly, can start many on a path toward long-term recovery.

We’re all aware of the harm and potential for overdose death associated with illicit drug use.  It’s become a national epidemic. But previous tactics, from “just say no” to harsh prison sentences, have done virtually nothing to slow the rate of overdose deaths.  It’s time that we try new approaches – and document their effectiveness to create evidence-based tactics that prove successful.

It must be made clear that I’m not trying to minimize or ignore the real and tragic harm and danger associated with illicit drug use.  Far from it.  But as Einstein told us, the definition of insanity is doing the same thing over and over again and expecting a different result.  It’s time to tackle this problem from a different angle.

Recently, the New Jersey Senate passed legislation that will no longer require prior authorization before Medicaid patients with opioid-use disorder (OUD), can access medication-assisted treatment (MAT), ensuring that these recipients can gain quicker access to a proven, effective and clinical standard of treatment, that when coupled with traditional counseling, leads many to lasting recovery.  Although there is more work to be done to reduce the stigma of and to increase the access to MAT, we must celebrate the long-overdue victory.  At one time MAT was widely and incorrectly seen as replacing “one addiction for another.” But a reduction in the stigma associated with MAT combined with the removal of barriers for certain patients has resulted in a growing acceptance of this essential harm reduction strategy.

It’s also time that we had an enlightened, fact-based discussion of supervised injection facilities (SIFs).  This is the next logical step from clean syringe access programs (there are currently seven syringe access programs in New Jersey). SIFs take the harm reduction techniques one step further.  Like syringe access programs, SIFs don’t provide or administer drugs but provide individuals with clean syringes.  SIFs also provide individuals a safe place to use, where trained staff to answer questions about safe injection as well as monitor for and counteract accidental overdoses with naloxone.  And perhaps most importantly, SIFs provide individuals with an opportunity to connect with and learn more about treatment and recovery services.

In October of last year, Assemblywoman Valerie Vainieri Huttle introduced legislation (A4638) to authorize SIFs four “overdose prevention centers”, located in Northern, Central and Southern Jersey.  Under the bill, the Commissioner of Health would establish a one-year pilot program and application process to permit a municipality or county to operate a supervised drug injection facility where individuals may safely consume drugs that were obtained outside of the Center.

The bill is an informed step forward that recognizes the value of SIFs. SIFs have proven to be effective in Europe, Australia and Canada.  For example, in Vancouver, the Insite facility has successfully operated for over 15 years, reversed over 6,000 overdoses and there has never been a death on-site.  And the community has benefited.  Insite has found that the rate of drug use and fatal overdoses in the surrounding area has declined, people were less likely to share needles, thus incidence of HIV and hepatitis have decreased.  Perhaps most significantly, individuals who utilized the facility were more likely to enter a detox or recovery program.  Facilities across Europe have seen similar results, with no evidence to suggest that the availability of SIFs increases drug use or frequency of drug use.  Alternatively, SIFs facilitate rather than impede treatment and reduce public drug use.

SIFs, like many harm reduction techniques, are designed to complement, not replace, existing treatment options and allow those with OUD to feel like valued people again.  However, only around a dozen cities in the U.S. are considering proposals for SIFs.

We are in the midst of a modern day health epidemic.  Young Americans are dying from accidental drug overdose at an unprecedented rate.  These times call for exploring any and all interventions to slow the rate of overdose deaths.  At Integrity House, we focus on rebuilding lives.  Many of our citizens never have the opportunity for rehabilitation if their lives are cut short before they enter treatment.

Substance use disorder is a disease like any other. To help those with the disease, we must first reduce the associated harm, such as risk of overdose and other dangerous health conditions commonly caused by intravenous drug use.  SIFs are an important step in that direction.

Overdoses took the lives of over 3,000 New Jersey residents in 2018 alone.  It’s imperative that we focus on proven solutions that make sense.  Misconceptions and a lack of understanding surrounding harm reduction strategies like SIFs must be faced head-on.  We used to see the same lack of empathy and stigma surrounding MAT, but as the recent legislation to remove prior authorization for Medicaid patients shows, common sense can prevail.  We must keep people safe and alive before they can continue their path to recovery. Embracing harm reduction strategies, including SIFs, is the way to do so.

Robert J. Budsock is the president and CEO of Integrity House, one of the largest non-profit providers of substance use disorder treatment in New Jersey.

Valerie Vainieri Huttle, D-Bergen, represents the 37th Legislative District in the New Jersey State Assembly.