Maxim in heroin treatment: limit harm

Among those who treat and analyze heroin addiction, an increasing
theme is "harm reduction" - an approach that seeks to prevent deaths
by heroin overdose.

In King County, the number of deaths has doubled since 1990, to a
record 144 in 1998. Nationally, the number in 42 cities increased 17
percent in recent years: from 3,653 in 1994 to 4,270 in 1997. More
users, increased availability and stronger drugs have all contributed
to the trend, experts say.

Harm reduction "is an approach to reducing the negative consequences
of those who cannot stop using drugs today," said Ethan Nadelmann,
director of the Lindesmith Center, a private New York and San
Francisco-based drug-policy institute. "The challenge is to reduce
death, disease, crime and suffering."

Nadelmann was in Seattle last week for a conference titled "Preventing
Heroin Overdose," where a variety of experts talked about ways to
reduce the drug's deadly toll.

Nadelmann told the more than 400 treatment specialists, researchers
and others at the conference that harm reduction is common sense -
akin to policies that encourage bicycle helmets, automobile seat belts
and needle exchanges.

"The ethical argument is that when you're trying to help people, you
don't judge them. You meet them where they're at," Nadelmann said.
"You may judge them on their behavior towards others, but don't judge
them on their drug use as they come through the door."

Nadelmann said a harm-reduction policy is not intended to encourage
heroin use. Rather, it offers precautions that many drug users,
especially new ones, don't know about. It could, he said, reduce the
number of overdose deaths by half.

Nadelmann asked those who work with drug users to spread the word
about precautions and to think about policy changes:

Heroin is especially dangerous when mixed with alcohol or other drugs,
particularly benzodiazepines - a group of anti-anxiety agents, muscle
relaxants, sedatives and hypnotics.

Someone who has not used heroin in a while should not start up again
with the same dose he or she was using before.

Learn CPR. It could save a friend's life.

When police are called about an overdose, they should not
automatically seek to arrest others at the scene who might have been
involved in illegal drug use. If drug users knew of such a policy,
they might be more inclined to call for help.

More information

Two Web sites are available for families who deal with drug abuse,
according to Susan Hubenthal, mother of a young man who died of an
overdose in 1996:

Grief Net: Has much information and discussion groups about how to deal with
the death of a loved one, including deaths due to overdose.
http://www.griefnet.org

Family Watch: Contains information for families struggling with drug abuse,
with an emphasis on children who use drugs. http://www.familywatch.org