Reducing drug deaths through harm reduction – News – seacoastonline.com

DOVER In the past eight years, state figures show 2,767 people have died in New Hampshire from drug overdoses, more people than the population of Rollinsford and other small towns. Sixty-eight percent of those deaths have come in the past four years.

It’s a public health crisis, but John Burns, director of SOS Recovery Community Organization, believes the state and federal responses haven’t treated it like one. While the state’s drug overdose deaths dipped in 2018 from its 2017 high of 488, it was only a 4% drop. The deaths are not only from those using heroin or fentanyl. Cocaine and methamphetamine, which sometimes is cut with fentanyl, have led to a number of overdose deaths as well.

Burns believes a drastic change in policy is needed to reduce the staggering number of deaths. While at SOS he is focused on recovery, Burns’ other passion is harm reduction – finding ways to help keep people from dying while providing pathways for recovery.

“No one is going to recover if they’re not alive,” he said.

In late April, Burns took a personal trip to Portugal, a country that made a drastic policy change in 2001. It was then when the country decriminalized possession of all drugs and implemented a robust public health response rather than a punitive one. Burns, paying his own way and not in his SOS role, went to attend the 2019 Harm Reduction International Conference in Portugal so he could see first-hand the country’s successes he has read about for years.

“It was powerful,” he said about harm reduction and supports the country put in place.

The latest numbers show Portugal had 4 deaths per million people with 26 overdose deaths overall, according to the 2018 European Drug Report published by the European Monitoring Centre for Drugs and Drug Addiction. In 2017, the United States had 185 drug-related deaths per million people, according to the American Enterprise Institute.

In New Hampshire, there were 344 deaths per million people in 2018, based on the 2018 U.S. Census population estimate of 1.35 million.

The United States’ and New Hampshire’s high overdose rate infuriates Burns. “What public health crisis could ever occur that could kill that many people for something that is completely preventable without a higher level of response from a public health standpoint?” he said.

Burns believes finding ways to reduce the death count isn’t rocket science. “The thing that struck me about the Portugal system is that it’s not that complicated. It’s simple in theory and would take some time to implement, but it’s not that complicated,” Burns said. “All they did was they took the money they were spending on their correction system, interdiction services and law enforcement (to treat its drug crisis), and they shifted it. They shifted that to health care services. The cost to their economy didn’t change.”

While Portugal and other countries have made strides in dealing with drug addiction challenges, Burns said the United States remains focused mostly on a punitive approach he says has a clear record of failure. “People don’t need jails. They don’t need to be arrested. They shouldn’t be punished. It’s a public health crisis, and we need to treat it as a public health crisis,” he said.

To induce politicians to make changes to state and federal policies, “We need a full community mobilization,” he said.

Burns argues state and federal policies have contributed to the rise in deaths.

“As we’ve amped up the ‘War on Drugs,’ we see more and more adulterants. Fentanyl is here because it’s cheaper, it’s easier to make and more concentrated, which makes trafficking it easier,” he said, noting these were his personal opinions and not those of SOS.

He also questions the effectiveness of the state prosecuting those who provided drugs that caused an overdose death. Most often those prosecuted are not high-level traffickers as the law was originally intended, but those also suffering from addiction, he said. The law doesn’t require a sale of a drug, just proving one person gave the drug to another. He worries the unintended consequences of the law are users not calling for help when an overdose occurs for fear of arrest. He say it runs in conflict of the ‘Good Samaritan’ law enacted four years ago that granted certain liability to people who report drug overdoses.

Burns says he’ll hear elected and other officials say society can’t arrest its way out of the current drug addiction, and but then fund punitive approaches like Granite Hammer and its renamed counterpart, Granite Shield. Many of those arrested over the years have been for possession or low-level sales. He argues policy makers are sending contradictory messages.

The harm reduction conference in Portugal included field trips to see some of the harm reduction policies in action. One was a mobile outreach unit that travels to the country’s rural areas to check on those in need, which could be dispensing methadone as a way to help opiate users better handle drug withdrawal symptoms, or it could be connecting a person with other treatment services.

“It’s not as controlled as it is here,” he said about methadone. In the United States, where users often have to go on a daily basis to a methadone clinic, it can take a week or more to get approved. Those in Portugal can get assistance immediately, he said.

“They know that it is going to reduce the likelihood of that person injecting drugs, so they’d rather give as needed to reduce that harm,” Burns said of the mobile units.

The country also has a variety of treatment services, such as in-patient, out-patient and residential services to help those in need. Burns said getting into treatment happens quickly, which is often not the norm in the United States. There is also a focus on mental health treatment.

Being in possession of drugs is still illegal, but the response is not punitive. If law enforcement determines the possession of a drug is for recreational use, the user can be fined. If they determine the possession is related to a substance use issue, they can refer a person to treatment services. Up to a 10-day supply of a drug falls under the decriminalization law. If similar a response was implemented locally, Burns believes it would capture about 90 percent of the drug arrests and prosecutions he sees now.

While some may argue that would be effectively encouraging drug use, Burns said that fear is not based on science. Portugal’s change in policy has drastically cut usage rates over the years as well as dramatically reducing the number of HIV cases that can come with shared used needles.

The conference included about 1,200 attendees from 87 different countries with many presenters from other countries. Some topics included the use of drug consumption rooms, a place where those with addiction can use a drug, such as an opiate injection, under the supervision of a health professional.

One presenter was from the United States detailing an underground drug consumption room in an undisclosed location, which was detailed in a study by the American Journal of Preventative Medicine. Burns said the presenters discussed that since 2014, there have been nearly 9,000 injections in the underground room without any deaths, though there were overdoses. There were no reports of violence or reports from neighbors.

“That’s 9,000 injections that didn’t occur on the streets,” he said.

There are other legal drug consumption rooms, also called injection sites, in other countries, such as Canada. Burns said there hasn’t been a recorded drug death in those rooms, and it also connects users with medical professionals that could lead to treatment, which wouldn’t occur if used on the street.

Burns said his interest in recovery and harm reduction is a personal endeavor. He’s in long-term recovery himself and has had family members who have struggled with addiction too.

“As a person in recovery, I’m very passionate about keeping people alive,” he said.