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Thinking about the intersection of harm reduction and treatment.

By Rob Kent, J.D.


I have been thinking a lot about the intersection of harm reduction and treatment. This is at the top of my mind based on my conversations with treatment program staff where they tell me that they believe, or have been told by their regulators, that they must treat folks who are unwilling, or uninterested, in accessing all of the services offered by their program and that they cannot refer folks to other, better suited services, in that instance.

We all need to acknowledge that there are a range of providers that offer a range of services, and that the full continuum accepts folks at all stages. I do not believe that every program should be required to serve individuals who only want medication and no counseling. In that instance, the programs should be able to make a real connection for that person to another program.

Some have told me that my work at OASAS (New York State’s Office of Addiction Services and Supports) has led to the current state of affairs. Let me clarify that the overriding principle of my work is that we must keep folks who use drugs engaged and connected, or they will die!

For me that translates to not conditioning access to essential medications on compulsory participation in counseling. That does not translate to keeping someone in your program if they never choose to participate in counseling, so long as you connect them to another program. That translates to finding someone another program when they continue to use harmful substances if you do not believe that you can help them. Treatment and harm reduction programs must be willing to refer folks to each other.

When we removed the New York state regulatory language that made abstinence the goal of treatment, we did not say that abstinence could never be the goal of treatment. The goal should be driven by the person seeking help in consultation with their provider! In the name of supporting harm reduction, it seems that some are making harm reduction the goal of treatment for all, without consulting those who seek help and those who offer it. If we want a full and real continuum of help, we need to invest in both harm reduction and treatment services. We cannot and should not make every program do the same thing, to offer the same services!

I am also very concerned about what I hear from the amazing folks who work in the addiction care system. They tell me about how heavy the work is, about how difficult, about how the pay offered makes many choose to work elsewhere, how those choosing to work in the system are “green” and inexperienced, about how their regulators in the name of harm reduction tell them that they cannot hold those in care accountable in any way, and that they cannot refer folks to other programs better suited for their current needs. They tell me about the lack of partnership from their government funders and regulators — that they are told what to do and not asked for input — about government audits and program reviews that focus on items that have absolutely nothing to do with good care!

This worries me greatly and makes me question whether current government efforts to reduce death and health consequences from drug and alcohol use are actually contributing to the bad outcomes. I hear many government regulators talk about being “data driven” and requiring the use of “evidenced-based” interventions. ​The data and evidence clearly show that the current approach is NOT working! We are losing more than 250,000 individuals to drug and alcohol use every year! The numbers are going up, not down!

The current approach where government bureaucrats decide what medications should be made available to those in need, and telling providers that they must all provide the same type of care will fail. A serious course correction is needed.

Rob Kent, J.D., is president of Kent Strategic Advisors. He was previously legal counsel for the White House Office of National Drug Control Policy, and before that, legal counsel for the New York state Office of Addiction Services and Supports. For more information go to www.Kentstrategicadvisors.com.

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