CHANGING METHOD OF TREATMENT FOR DRUG ADDICTION

S.F. Models 'Harm Reduction' Theory

After Tony Trimingham's son Damien died of a heroin overdose in 1997,
Trimingham didn't go after drug dealers or shrink in shame. Instead, the
Australian psychologist spearheaded an effort in Sydney to provide a place
where junkies could go and shoot up safely.

"Watching people doing this turned my stomach," Trimingham said of the
church-based shooting gallery that police shut down after nine days. "But
the sad reality is: If a facility like this had been available, Damien
might not have died."

No one is suggesting San Francisco open up spaces for addicts to inject
drugs -- yet.

But at a city-sponsored conference last week, drug treatment professionals
listened to Trimingham and others preach the gospel of "harm reduction," a
controversial but growing movement that doesn't see abstinence as its
overriding goal when dealing with addicts.

Quietly last September, San Francisco became the first city in the nation
to adopt harm reduction as its official policy. That means the dozens of
agencies the city hires to provide drug and alcohol treatment must have
harm-reduction programs and policies in place.

Among the signs of the new philosophy:

- -- The Department of Public Health last year began offering care at the
city's needle exchange sites and at a special clinic, treating
injection-related skin infections before they grow into raging,
life-threatening wounds.

- -- The city is teaching jail inmates how to perform CPR on their friends
who may be overdosing on drugs. A media campaign aimed at teaching addicts
how to reduce deaths from heroin overdose is in the works.

- -- And a pilot project is expected to start in a few months that will put
the prescription drug naloxone -- a heroin antidote -- in the hands of
addicted couples, so they can administer it to their partners in case of an
overdose.

"The war on drugs has encouraged users to lie to their providers (drug
counselors) and not seek out help when they are struggling with addiction,"
said Dr. Joshua Bamberger, medical director for housing and urban health at
the San Francisco Department of Public Health. "Harm reduction opens the
doors to honesty and allows providers to move addicts one positive step at
a time toward better health."

Proponents of harm reduction focus on the ill effects of addiction, from
homelessness to the spread of AIDS and hepatitis and overdose deaths. They
seek to treat clients "where they are," instead of insisting that they be
clean and sober before getting services.

Approaches vary widely. Among other things, conference speakers talked
about bringing medical care to the streets and using acupuncture and
marijuana to help addicts reduce their craving for harder drugs.

Many harm-reduction strategies, including safe injection rooms and
prescription heroin, are already used in the Netherlands, Switzerland and
Germany. And following the uproar in Sydney over the injection room, the
Australian government has promised to open an official site, to debut next
month.

But the ideas are so controversial in the United States that conference
organizer Alice Gleghorn said people urged her not to use the phrase "harm
reduction" in the title. And she acknowledged losing funding and some
speakers by including it.

"I get calls all the time -- 'We can't call it that where we live. Can't
you change the name?' " Gleghorn said.

Yet the concept of harm reduction has been around for years. Using
methadone as a replacement for heroin is a form of harm reduction. So, for
that matter, is putting filters in cigarettes.

But the term "harm reduction" and the development of it as a broad
philosophy can be traced to the AIDS epidemic and efforts to distribute
clean needles to addicts to halt the spread of HIV.

It is also a tacit acknowledgment that the war on drugs isn't winnable, and
a better strategy may be to help people deal with their addictions in the
best way possible.

Not surprisingly, the movement has plenty of critics. Katherine Ford, a
spokeswoman for the Drug Free America Foundation, called harm reduction
"harm promotion," since it teaches people how to continue drug use safely.

The organization's executive director, Calvina Fay, said most needle
exchange programs she's seen do little or nothing to steer people into
treatment. Instead, they end up being a social club for drug users and a
magnet for prostitution and crime, often in neighborhoods that are already
on the margins, she said.

A significant portion of those who promote harm reduction are really after
a more far-reaching policy change: the legalization of drugs, Fay said.

"Not everyone who supports harm reduction falls into this category," she
said. "But there is definitely a movement in the country to promote harm
reduction, and it's rooted in groups who are receiving large amounts of
funding from business people who make no pretense about" their support for
legalization.

Last week's conference was funded by the Lindesmith Center, a drug-policy
organization that gets most of its money from billionaire George Soros, who
has said he favors legalizing and regulating many illegal drugs. He and two
other businessmen paid for the successful statewide campaign for
Proposition 36, which requires treatment instead of jail for nonviolent
drug offenders.

Fay and others say that by not insisting that addicts swear off drugs,
harm-reduction programs actually enable people to stay on drugs longer than
they would had they been left to "hit bottom."

Ernesto Escalante, a former addict and now a drug treatment specialist in
Fresno, said scaling back his drug use led to rebounds that were
increasingly harmful. Abstinence, he said, was the only approach that
worked for him.

But Escalante attended last week's conference, hoping to find elements in
the harm-reduction approach that he could use in his own drug-treatment
practice.

"I think harm reduction will work with hard-core heroin and meth addicts,
but it's not something to be used across the board," he said.

What it provides, he said, is a way to connect with people who are so
strung out they won't come in to treatment on their own. "You can't go in
there and say, 'We're going to save you,' when they don't want to be
saved," he said.

But even that won't be an easy sell back home. "Fresno is stuck in the
'70s, " he said. "It's going to be a slow process."

Meanwhile, in San Francisco -- home of a half-dozen medical pot clubs and a
long-running needle exchange program -- officials are waving the
harm-reduction flag proudly.

Mayor Willie Brown, District Attorney Terence Hallinan and Supervisors
Gavin Newsom and Mark Leno all spoke at the conference. Newsom in
particular has been pushing for new approaches to treating addiction,
including lobbying the federal government to allow physicians to prescribe
methadone out of their offices.

"We are doing our best to move the agenda, particularly in reference to
drug abuse," Brown told conference attendees Thursday. "Things that would
be considered controversial in almost every other place, are almost routine
here in San Francisco."