Maia Szalavitz, Author of Harm Reduction, Presents to the Pittsfield, MA District Attorney
PITTSFIELD, Massachusetts (AP) —Maia Szalavitz first encountered the term “harm reduction” in 1986, when an acquaintance urged her to sterilize a shared needle for intravenous drug usage.
She subsequently credits this individual with saving her life, as she would have most certainly caught HIV in that situation if the advice had not been provided.
Szalavitz’s book “Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction” was released decades later, cementing the once radical notion that people deserve to live whether they get high or not.
The journalist and best-selling author has written on addiction, recovery, childhood trauma, and empathy (including several books with Dr. Bruce D. Perry). Her most recent book, “Undoing Drugs,” was released this year and examines addiction as well as the history and application of harm-reduction strategies.
On Thursday, Szalavitz talked digitally to public health officials and prosecutors at the Berkshire District Attorney’s Office.
District Attorney Andrea Harrington supports harm reduction principles and is concerned that evidence-based remedies are not being implemented uniformly, especially when the county has witnessed an increase in overdoses eight times greater than the state generally.
“So our community, we have a significant opioid problem. Six percent of the population here is addicted to opioids,” she said. According to recent statistics, we’ve seen a big increase in fatal overdoses. This office is responsible for investigations into all of those overdoses. We had a 44 percent increase here in this county, that was in 2021, of fatal overdoses and across the state, there was only a 5 percent increase, so we’re in a tough spot
“I meet with the parents of people who have died of fatal overdoses here in this room and the big thing that they share with me is that it was the shame and stigma that their children felt prevented them from really getting the help that would keep them alive.”
Harrington emphasizes that drug addiction is a health concern. Rather than continuing the “war on drugs,” which refers to severe enforcement and sentencing of drug-related crimes, she advocates spending resources to address the causes that contribute to substance use and to provide alternatives for users.
“In this office, we do not prosecute possessions of personal use amounts,” she said. “We think it makes a strong statement about the fact that we should treat substance use disorder as a public health issue and not a criminal matter, so I feel proud of us that we’ve been leaders in that.”
Harm reduction tries to lessen the negative consequences of drug usage. According to Szalavitz, it applies the Hippocratic oath’s primary principle of “do no harm” to addiction therapy and drug policy.
Berkshire Health System’s Healthy Steps program, for example, works with active-injection drug users to dispose of used needles and provide them with sterile supplies to avoid the spread of HIV and Hepatitis C.
According to the Centers for Disease Control and Prevention, syringe service programs reduce HIV and HCV infections and are an effective component of comprehensive community-based prevention and intervention programs that include additional services.
“When we practice harm reduction as a philosophy, it’s transformative because we all have gifts to give, and we all contribute to the world, yet we also do harm as well, even when we’re trying not to,” Szalavitz said.
“Harm reduction is a gift from people who use drugs to all of us. It says you matter whether you take drugs or not, it says you deserve to live, whether you get high or not, and it says you can contribute and you can reduce harm, and that’s really what we all want to know, how to make a difference, to heal, to care, to be cared for.”
“We mostly don’t change overnight and we all take risks that can do harm, but if we work together, we can minimize that and empower each other to do better.”
More than 35 years ago, Szalavitz was using heroin with a companion in an East Village, New York, apartment when her worldview was altered. Her buddy’s girlfriend, who came from San Francisco to make sure her friend got care, instructed Szalavitz how to protect herself by avoiding sharing needles and, if necessary, sterilizing them with bleach.
Szalavitz, a habitual newspaper reader, claimed she had no knowledge that intravenous drug usage put her at risk of the human immunodeficiency virus. She took the advice to heart, becoming “obsessed” with sterilizing her needles and spreading the news to others.
She was enraged because no one had warned her about the dangers.
Shortly after the encounter, Szalavitz’s East Village friend was diagnosed with AIDS, and she realized that the stranger’s remarks had had a significant influence on her life.
After much digging, Szalavitz eventually identified—and contacted—the lady as Maureen Gammon in 2020. In the 1980s, Gammon sought to disseminate the gospel of harm reduction on the West Coast.
That simple act of kindness inspired Szalavitz to care for herself until she recovered, and then to chronicle American harm reduction from its inception.
Szalavitz emphasized the beginnings of current harm reduction, which began during the AIDS (acquired immunodeficiency syndrome) crisis, as well as the activists who shaped the movement.
These include a Puerto Rican activist who instigated hunger strikes in the Riker’s Island jail’s AIDS ward and convinced ACT UP NY to participate in a needle exchange; a group of San Franciscans who promoted the idea of cleaning needles with bleach to save lives; and working-class drug users in Liverpool, England, who promoted harm reduction principles.
She also said that reducing the medicinal opiod supply—which has apparently been lowered by 60% since 2011—in order to prevent overdose deaths has had the opposite effect, increasing the incidence of fentanyl.
“Harm reductionists had predicted that this approach would backfire. For one, it drives people with addiction to street drugs, not recovery; taking away a drug does not cause somebody to recover; and secondly, because smaller drugs are easier to smuggle, crackdowns tend to push dealers toward more potent and therefore more risky products, “Szalavitz said.
“Our policy also increases disability and suicide among pain patients because cutting off medical opioids doesn’t cure pain either.” Studies now show that forcibly tapering or ending opioid prescriptions can be deadly.
An assistant district attorney asked Szalavitz whether there was anything prosecutors could do in court to alleviate the stigma and humiliation associated with addiction, expressing a sense of having her hands constrained.
“We’re already dismissing the simple possessions, and when we do that, the case gets called, and obviously the commonwealth is not going to go forward, and then when the person turns around to leave, I always say ‘Good luck, Mr. or Miss so and so,'” she said.
Sometimes they say thank you, and sometimes they don’t, and it is frustrating because it is still a crime and there’s no public health treatment, and so it feels a little frustrating and not very helpful. I can dismiss them over and over again, but the other thing that’s hard is sometimes I dismiss their case, they walk out the door, and I don’t see them again because they overdose.
Szalavitz suggested that people whose cases are turned down have access to outreach in the courts or other types of help that are not required.
“People often don’t stop because they fear that treatment is going to be horrible, and oftentimes, they’re correct, and they fear that they are basically going to give up the only thing that makes life worth living for them, and then have nothing,” she had said earlier in the presentation.
“You’re talking about a population that is at least 50 percent mental illness, at least 50 percent severe histories of childhood trauma, massive amounts of despair. This is not a population of people who are like, ‘I need extra pleasure, and I’m really lazy.’ So sort of recognizing that itself helps destigmatize, recognizing the pain that people are trying to deal with, however, ineptly.”
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