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Understanding Overdose

Understanding Overdose: A harm-reduction approach to drug use

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The steady drum beat of people dying from overdoses plays on, and the pace is quickening.

A person died from an overdose roughly once every two weeks in Cumberland County in 2013.

A person has died from an overdose once every four days so far in the county in 2017.

Last year, 66 people died of drug overdoses in Cumberland County, according to Coroner Charley Hall. As of Nov. 8, that number sits at 74 and climbing for the county this year.

Overdose deaths 2017

Overdose deaths have risen sharply since 2013, according to Cumberland County Coroner Charley Hall.

Current policies have not stemmed the rising tide of deaths attributed to opiates and, to some degree, may have contributed to it.

In February, former Pennsylvania Physician General Dr. Carrie DeLone told The Sentinel that an increase in deaths from heroin overdoses was expected with the implementation of the state’s prescription drug monitoring program and efforts to restrict over-prescribing painkillers like OxyContin.

If current policy has not solved the overdose crisis, is there a different approach?

Harm reduction

“Harm reduction is basically the idea of understanding where people are and to move them away from more risk to less risk,” said Leo Beletsky, associate professor of law and health sciences at Northeastern University School of Law. “You’re trying to move people away from more risk and more harm towards less risk and less harm.”

Harm reduction policies are not exclusive to drug use. Easy access to condoms, which has been shown to reduce sexually transmitted diseases, is an example of non-drug-use harm reduction response to a public health issue, Beletsky said.

These policies aim to reduce the risk and harm of drug use through things like the proliferation of the overdose reversing drug Naloxone, implementation of safe consumption facilities and easy access to medication-assisted treatment like methadone and Suboxone.

“We’ve often had a little bit of puritanical approach to things where we assume that just by wishing that something didn’t exist that can make it go away,” Beletsky said. “Like the fact that teens have sex or the fact that people use illegal drugs, these kinds of simple facts of life, we can just acknowledge they exist. Once we acknowledge that they exist, we can help people figure out how to make healthier choices.”


One of the only harm-reduction policies that has gained widespread use in Pennsylvania is the proliferation of naloxone, sometimes referred to by the brand name Narcan.

Naloxone is a drug that is administered to a person in the midst of an overdose to reverse the effects of opiates.

Policymakers have made access to naloxone easier as the overdose crisis has worsened. Recently, lawmakers made it easier for law enforcement officers to carry the overdose-reversing drug, and Gov. Tom Wolf announced efforts to allow residents to buy the drug at most pharmacies.

“We need to be the Band-Aid with naloxone so the other pieces work too. Recovery is a multistep, long-term process,” Cumberland Goodwill EMS Assistant Chief Nathan Harig said. “I understand that many people are looking for the quick fix, but the quick fix of pain relief through opioids caused this crisis.”

Cumberland Goodwill EMS has administered more than 170 doses of naloxone so far this year to nearly 100 patients, according to Harig.

Even as naloxone is being lauded for saving lives across the state and the country, some residents have grown weary after hearing stories about people being revived multiple times.

A let-them-die attitude has cropped up in some circles with claims that the proliferation of naloxone makes people more willing to use illicit drugs.

However, there is little evidence that this happens, according to the National Institute of Drug Abuse.

“The human condition is imperfect, which is why we have health care at all,” Harig said. “If people want to take this approach that they did this to themselves as justification for sentencing someone to death, then there is a long line of call types that we should stop responding to.

“The moment I’m told I’m no longer to show mercy, to no longer be a patient advocate for all patients no matter what their history, to let people die because I feel superior to them, that’s when I turn in my certification as a paramedic,” he said.

Safe injection sites

Illicit drug supplies are, by their very nature, not subject to any of the quality controls that prescription and legal drug sales go through.

This means the contents and potency of a bag of heroin can be drastically different from one sale to the next. With the introduction of drugs like fentanyl into illicit drug markets, the consequences can be deadly.

But beyond those concerns, illicit drug use, including intravenous drug use, is inherently risky.

One possible solution is the implementation of safe consumption facilities, which are clinical settings where people can use illicit drugs with support from medical personnel.

“We know they help reduce overdose,” Beletsky said. “We know they help reduce the spread of infectious disease. We know they help reduce street-based drug use. … There is some evidence that they help reduce crime as well.”

The first government-sanctioned safe consumption facility in North America was opened in Vancouver in 2003.

Again, Beletsky said one of the main pushbacks against safe consumption facilities is the argument that they will encourage more people to use drugs, something he said is not supported by empirical evidence.

“It’s problematic to base your policies and programs on flawed understanding of what are the drivers of human behavior,” Beletsky said. “In the case of safe consumption facilities there is no evidence that these kinds of facilities encourage people to use drugs.”

According to an article published in the peer-reviewed journal “Substance Abuse Treatment, Prevention, and Policy” in 2006, the safe injection facility in Vancouver did not lead to an increase in drug trafficking or traditionally drug-related crimes. However, following the implementation, other crimes like vehicle break-ins declined, according to the report.

Other research has found safe consumption facilities may help reduce drug use by assisting people with substance-use disorder treatment access.

There are no safe consumption facilities in the United States. But a few cities, including Seattle, Washington, have expressed interest.

During the campaign, Philadelphia District Attorney-elect Larry Krasner expressed support for safe consumption facilities in his jurisdiction.

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Email Joshua Vaughn at Follow him on Twitter at @Sentinel_Vaughn.


Cops & Courts Reporter

Crime & Courts Reporter at The Sentinel.