My Day Job

I had a really vivid dream last night that someone in my immediate family (not naming names because it obviously wasn't true) was incredibly upset and disgusted by the work I do, so much so that s/he couldn't stand to be in my presence. Until our extended family was affected by the kind of work I do, and then s/he was suddenly all "The work you do is great!"

In my dream I took to this blog to righteously talk about it. And now I really am...totally meta, man!

I am a health educator for a hospital system in Maine. For the first couple years in this position I did pretty mild stuff, educating providers and patients about medication safety and diabetes prevention.

Then I was pulled into a different program. And while I'm still planning on and working towards an eventual career change, I've found something to be passionate about.

Part of the reason I'm passionate about it is because I'm contrary, I like to be controversial, and I like to root for the underdog. But I really do believe in the work I do.

I usually avoid telling people just what EXACTLY I do, but here goes. I work with our harm reduction program, helping drug users.

Harm reduction is "a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use." Some central tenets:

Harm reduction

• Accepts, for better and or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.
• Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.
• Establishes quality of individual and community life and well-being–not necessarily cessation of all drug use–as the criteria for successful interventions and policies.
• Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
• Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.
• Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.
• Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.
• Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.

I like to compare it to sex ed / providing condoms for high school students (which is unfortunately also still controversial). Abstinence-plus education really is harm reduction - it emphasizes that not having sex is safest, but recognizes that no matter what we do or say, some of those dang kids are gonna be hooking up. So we try to make it safer for them by providing safe sex education and condoms.

Unfortunately no matter what we do, some people will use drugs. Harm reduction recognizes this, and tries to make it safer for those folks.

Probably the most controversial way we do this is through a syringe exchange program. For every dirty needle someone brings us, we'll give them a clean one. We'll also give them clean "works" supplies, like alcohol wipes, cotton, sterile water, tourniquets, and antibiotic cream.

Some of you may be spluttering in outrage right about now. "Aren't you just enabling them?!?!" "Oh great, MORE needles on the street, just what we need!"

Just hear me out.

Syringe exchange programs are proven to help reduce disease transmission. Instead of using someone else's dirty needle that could be infected with HIV or hepatitis C, folks can come get enough clean ones to use a new one every time. That can also help prevent bacterial infections like abscesses, "cotton fever," cellulitis, and endocarditis.

To talk in cold financial terms: Clean needles = less morbidity = less visits to the emergency room = reduced cost to you the healthcare consumer.

It also means less needles on the street, in the park, in the gutter, in the public restroom. We safely dispose of all needles...last year we took in over 50,000.

Another benefit to the syringe exchange is that it gives us access to a population that is hard to reach. Although our consumers belong to just about every class and occupation, quite a few are un- or under-insured and un- or under-employed. They might not go to the doctor because they can't afford it, and/or they're afraid of (unfortunately very real) stigma-based negative reactions and treatment from healthcare staff.

So we are able to help connect them with primary care providers and medical financial assistance. We can do HIV and hepatitis C testing for free. We can educate about preventing disease transmission. We can give them the most up-to-date information on treatment and counseling resources when they're ready. We can help them find housing, employment, and legal assistance to start getting them out of the cycle of drug abuse, poverty, mental illness, etc.

I'm sure you all know about the opiate addiction issue in the US. We lose 100 people EVERY DAY to drug overdose.

Some may say (and we've heard it) essentially "Good riddance." or "It's their own fault." But I implore you to at the very least think about their family and friends.

Chances are that you know someone who struggles with addiction or is in recovery. More and more veterans are facing addiction after being treated for chronic pain. Prescription painkiller use is on the rise among high school athletes. Heroin users are now whiter, older, and more suburban than ever before. Hundreds of thousands of senior citizens are misusing painkillers.

There is a great movement picking up speed that is aimed at increasing access to naloxone. Also known as Narcan, naloxone reverses opiate overdoses. It kicks the opiates off of the brain's receptors, sending the person into immediate withdrawal. It can be administer intranasally, intramuscularly, and intravenously. It quite literally brings back the dead. People who have overdosed, were not breathing and didn't have a heartbeat, were saved by naloxone.

Naloxone has been around since the 1970s used by paramedics and hospitals, it has no side effects (other than the effects that come with withdrawal), and doesn't interact with other medications. It only works on opiates; if it's administered during a non-opiate overdose, it doesn't do anything, good or bad. There's absolutely no chance of abuse because it doesn't produce a high or really any effect.

Put like that, doesn't it seem stupid that naloxone isn't readily available to anyone and everyone?

And yet it remains controversial.

Our lovely Maine governor tried unsuccessfully to block a law that would give more folks access to it by allowing naloxone to be prescribed to family members of people at risk, and to allow law enforcement officers and firefighters to carry and administer it. His reasoning was that it enables drug users and would encourage them to push themselves to the "edge" since they would have a "safety net".

My response is this:
a) Overdoses don't just occur among those who are abusing drugs. Children can get into medications, different medications can dangerously interact, and other medical conditions can put people at higher risk of overdose. In my hospital system, the largest number (by a big margin) of medication poisonings / overdoses are among folks 65 and older.

b) Let's say it is that hoodlum on the street, stealing drugs and injecting them. S/he paid quite a lot of money for the drugs...if it was oxycodone, it's $5 - $10 a milligram.  By having naloxone used on him/her, that just wiped out a very expensive high AND put him/her into withdrawal which is something drug users tend to actively try to avoid. It is not in his/her best interest to get to the point of needing naloxone.

I was fortunate enough to be part of the team implementing a naloxone program in Maine. During a period of four months (March to June of this year), we gave Emergency Opiate Overdose Kits that included intranasal naloxone to 530 patients of the system's pain clinic. We educated most of them on recognizing and responding to overdose as well as how to use the kit.

We have already heard of nine overdose reversals with the kit since the program started in March. That's nine lives saved, nine families and friend circles that didn't have to grieve for a lost loved one.

So there you have it. I really am proud of the work I do.

If you have any questions or thoughts, please don't hesitate to express them! The job is not without its moral quandries and I'm often fighting my own prejudices so I can understand a lot of different viewpoints on the matter.