Could This Controversial Practice Help Drug-Addicted Veterans?
Treating the “invisible wounds” of veterans is one of the most challenging areas of care for doctors. Post-traumatic stress disorder, brain injuries, and chronic pain often lead service men and women—people accustomed to being resilient and self-sustaining—to turn to prescription painkillers and opioids, such as heroin, at alarming rates. Perhaps the most sobering statistic of all: 22 veterans commit suicide every day.
Human Rights Watch released a scary report Wednesday that shows the ways alcohol and drug dependence among U.S. veterans connects to homelessness and mental health problems.
Considering all the problems vets face, the research makes a strong pitch for widely implementing policies and practices that are commonly known as “harm reduction.”
Harm reduction is a public health philosophy that argues that drug and alcohol users should be able to do so safely and without criminal consequences. Harm reduction doesn’t encourage drug use. But proponents believe that rather than urging drug users to quit, we should help them stay safe while using and minimize the risk of overdose or death by making things such as clean needles and Narcan (naloxone), a prescription drug that can reverse overdose, widely available.
While harm reduction is still more popular in other parts of the world than it is in the United States, in a pilot program in the town of Quincy, Mass., using Narcan reversed overdose 95 percent of the time. A 2003 study found that in cities with needle exchanges, HIV rates dropped nearly 20 percent a year, while cities without needle exchanges saw HIV-infection rates grow by 8 percent.
Critics of harm reduction say there is no way to “safely” use drugs, and that the philosophy and the approach make drug use more socially acceptable. But the VA and the Veterans Health Administration are slowly embracing harm reduction and putting these theories to the test in residential treatment facilities across the country.
At the Louis Stokes Cleveland VA Medical Center in Cleveland, doctors have been distributing naloxone “kits” to patients with histories of opioid use.
Eric Konicki, chief of psychiatry at the medical center, told Human Rights Watch, “We want to educate veterans so if they are going to use, they use more safely.” There are other pilot programs for naloxone use in VA residential drug treatment centers across the country.
The VHA is also working to increase the availability of medications such as methadone or buprenorphine to treat opiate addiction. These drugs safely and effectively relieve cravings, prevent withdrawal, and decrease the effects of drugs like heroin.
According to the National Institute on Drug Abuse, “taking these medications as prescribed allows patients to hold jobs, avoid street crime and violence, and reduce their exposure to HIV by stopping or decreasing injection drug use and drug-related high-risk sexual behavior.”
Timothy, a Vietnam veteran, told Human Rights Watch, “Before I was on methadone I was nothing more than the walking dead. Being on methadone gave me my life back."