Harm Reduction - More Like Harm Inflation!!!

I recently wrote a blog about my how I understand that in some circumstances harm reduction is necessary. However, as I have more and more exposure to our methadone system I still think it does more harm than good. The Ontario Addiction Treatment Centres (OATC) is where the majority of addicts who use methadone go to take their daily dose. It was brought in so that people didn’t have to travel long distances to seek methadone treatment. Methadone is used for people wanting to stop using opiates. It’s part of the whole harm reduction model. Good in theory but in many cases it’s just enabling people to continue with in their addictive behaviours.

Someone who is on methadone must carry out regular urine testing so that doctor’s prescribing the drug can know if the person is using other substances. If this is the case there’s a good chance the person may not be suited for the methadone program. For over 10 years I’ve worked at various addiction centres where urine testing is a regular part of treatment. The credible centres have “supervised urine tests” to ensure the client is not providing fake urine. I’ve met many people who receive methadone from the OATC and they tell me there is no supervised urine testing. A person can sneak clean urine in and pass the test with ease.

Methadone does not provide freedom from addiction. Granted, people are not seeking out drug dealers or shooting up using dirty needles (those who actually follow the harm reduction program) but they still are tied to the clinic they are associated with as they need that daily methadone drink. I have a client who was all happy because her father plans to take her on vacation to South America. What she hasn’t taken into consideration is that the OATC clinic she goes to isn’t going to give her a few weeks of methadone carries, and if they did, she wouldn’t be able to take them across the border.

Many of the people I come in contact with are using crack, cocaine, marijuana and/or a plethora of other substances on top of their daily methadone dose. These people tell me, they are providing fake urines to the OATC so that they can continue to abuse the system. What is happening is that their addictions become worse and they don’t have to face the consequences of their actions. The majority of these clients are on Ontario Works so the good old taxpayer is footing the bill for the methadone. This is not harm reduction – it’s harm inflation and no one benefits. In my opinion a better system would be to provide methadone with a goal towards abstinence. This would be more beneficial, health wise, to the client, and financial wise, to the taxpayer. Maybe the province needs to look at paying for Suboxone which is a much better tool to help an opiate addict achieve abstinence.

Until the province stops basing addiction strategies on pie-in-the-sky thinking and begins taking a more reality-centred approach the harm in harm-reduction will only become worse.

Dave the Dude

Not everyone gets it!

One the reasons that fellowships like Alcoholics Anonymous, Cocaine Anonymous, etc. work so well is that people are able to identify with each other. Stories, feelings and thoughts I comfortably share in AA would probably shock many people not in the fellowship. If not shocked they probably wouldn’t find something humorous that myself and other recovered alcoholic/addicts do. For example one of my favourite jokes is: What is the difference between and alcoholic and an addict? An alcoholic will steal your wallet. An addict will not only steal it but also help you look for it. To an “earth person” (someone not in recovery) this is not funny at all but to many people in AA, CA, etc. it is.

I was lucky enough to change careers when I entered into recovery. I became an addictions counsellor working with alcoholics/addicts. The majority of staff that I worked alongside with were also in recovery and/or had a family member who were. I got used to making comments, jokes, etc. that they understood and did not need an explanation for. I’m now realizing how great that was.

Due to unexpected occurrences that I’ve faced as I trudge the Road of Happy Destiny I no longer work primarily as an addictions counsellor. My co-workers today are not part of any fellowship and therefore have no insight into how an alcoholic/addict’s mind works – how my mind works. I know this but am so used to sharing things in my previous jobs that I often forget. The other day when someone was talking about a client’s dealings with a crack dealer I made a comment along the lines that my crack dealer wasn’t like that at all. At my old job this would have sparked a few chuckles but at my present one there were just some uncomfortable looks. It reminds of me of the time when I spoke at a meeting and my Dad (an earth person, God rest his sole, Chag Sameach) attended. I was only a few years into recovery and shared the amounts I used to consume on a daily basis. After the meeting I could tell my Dad was quite shocked. Fortunately it was an AA meeting and sticking to the Primary Purpose I did not mention the other substances I consumed regularly. I guess what I’m trying to say is if you are in recovery and work aside others who are also in recovery consider yourself fortunate. If you don’t – remember who your audience is.

Dave the Dude

Misconceptions of Acceptance

One of my favourite readings from the Basic Text of Alcoholics Anonymous (The Big Book) is from the personal stories in the back entitled Acceptance is the Answer. The following is an excerpt from that story (the part most often quoted):

And acceptance is the answer to all my problems today. When I am disturbed, it is because I find some person, place, thing, or situation—some fact of my life —unacceptable to me, and I can find no serenity until I accept that person, place, thing, or situation as being exactly the way it is supposed to be at this moment. Nothing, absolutely nothing, happens in God’s world by mistake. Until I could accept my alcoholism, I could not stay sober; unless I accept life completely on life’s terms, I cannot be happy. I need to concentrate not so much on what needs to be changed in the world as on what needs to be changed in me and in my attitudes.

Shakespeare said, “All the world’s a stage, and all the men and women merely players.” He forgot to mention that I was the chief critic. I was always able to see the flaw in every person, every situation. And I was always glad to point it out, because I knew you wanted perfection, just as I did. A.A. and acceptance have taught me that there is a bit of good in the worst of us and a bit of bad in the best of us; that we are all children of God and we each have a right to be here. When I complain about me or about you, I am complaining about God’s handiwork. I am saying that I know better than God. (From page 417 of The Big Book of Alcoholics Anonymous)

One of the biggest misconceptions people have of this reading is that it promotes accepting abuse from another human being, I would beg to differ. It’s talking about acceptance but it doesn’t say we accept being treated badly, accept staying in toxic relationship or accept abuse of any kind. Part of the reading says, “accept…the situation as being exactly the way it is supposed to be at this moment”. If at that moment something bad is happening it doesn’t mean we have to accept that it is okay. What I would say is we have to accept that it has occurred and if it is something bad, accept that we need to change it. For example, early in my recovery I got into a relationship and we were both handling disagreements with one another in a very unhealthy manner. We both had to accept the status-quo was not healthy and make the decision to either change or break-up. We decided to work on ourselves (i.e. – work the 12 Step Program) and change our thinking and actions (Steps 3, 6, 7). I’m glad we went this route as we are still together today and continue to change for the better.

This reading also taught me an important lesson in resentments. I have to make sure my acceptance of situations is always higher than my expectations to avoid resentment. If the reverse happens I am returning to my character defect of trying to control everything which is part of the insanity of addiction. The only thing I can control is my reactions and actions towards people and situations.

When I completed the 12 Steps I finally accepted that I was an alcoholic/addict and could not take another mind-altering substance again. I accepted that my way of thinking and behaving was toxic and I had to change. The 12 Steps allowed me to discover that acceptance is, indeed, the answer.

Dave the Dude

The Opioid Crisis - let's get rid of the road blocks

Except for a brief foray into Percocet I am extremely grateful that my addiction never took me into opioids. Opioids are extremely addictive and are killing people on a regular basis across the nation. Just over a decade ago, when I first became an addictions counsellor, I began to see a lot of people addicted to OxyContin. Many of these people were prescribed the medication to deal with a pain-related injury and over time became addicted to the drug. The sad thing was this medication was originally advertised as non-addictive. Doctors were, and still are, prescribing OxyContin like Tic-Tacs. I also saw that dentists were prescribing it as well. It seems to me that it’s standard operating procedure for a dentist to hand out OxyContin for someone who has had dental surgery. To me – that’s crazy. I remember having four wisdom teeth taken out at once and the strongest thing the dentist gave me was codeine – that was enough. It seems irresponsible to prescribe opioid medication willy-nilly. Hip-hop artist Mackelmore came out with a song entitled Drug Dealer with the following lyrics:

My drug dealer was a doctor, doctor

Had the plug from the big pharma, pharma

He said that he would heal me, heal me

But he only gave me problems, problems

I think he trying to kill me, kill me

He tried to kill me for a dollar, dollar

I think those lyrics sum it up pretty nicely. I could also say the same for the whole methadone industry but that’s a whole different blog. What started with Percocet and OxyContin has now ballooned into Hydromorphone, Fentanyl and the deadly Carfentanil where just two grains of it (size of two grains of salt) can kill someone. For some reason Carfentanil, an elephant tranquilizer, is getting into the substances people use. It has even been found in marijuana.

Due to the death toll, from opioid overdoses, the Ontario Government was quickly able to put together a response to help prevent these deaths. Part of the response has been in the form of providing Naloxone Kits to anyone requiring them. Naloxone is a drug that helps prevent death in case of an opioid overdose. If someone has an OHIP (Ontario Health Insurance Plan) Card the kit is free. For those who don’t the price is approximately $30. This, of course, is great news. Unfortunately very few pharmacies are carrying these kits due to the requirements the province has attached to handing them out. When someone wants to get a kit they have to sit through a lengthy training session in order to receive it. The training sessions includes lessons on how to administer the drug, signs to look for in a person suffering from an overdose, basic CPR training, etc. The majority of pharmacies don’t have the manpower and/or time to spend this amount of time with one person which is why they chose not to carry the kits. In a perfect world this knowledge would be great but we don’t live in a perfect world. Most of the time the person injecting the Naloxone isn’t the one who got the kit, and therefore the training, to begin with. The training doesn’t do someone much good if they’re unconscious. This type of  illogical thinking is often the case with government programs. The intellectuals who come up with these plans often don’t understand the logistics and reality of a situation. Often times they don’t even understand something they are for or against. The perfect example is the non-government support of 12 Step programs due to the misbelief that 12 Steps is a religious program. I can assure you it is not. Religions tell you what their God is – 12 Step do not. Religion has certain requirements to join – 12 Step you only need a desire to stop what the Fellowship is designed to help with. That’s just a couple differences. But I digress.

For the Ontario Naloxone Kit Program to be even more effective this “training session” should be stopped. Better to have the kit with no training then not have it and someone overdoses. This along with more money for residential treatment centres (including 12 Steps) would go a long way in saving people’s lives.

Dave the Dude