The harm reduction model of drug addiction treatment
-
0:01 - 0:05I remember the first time
that I saw people injecting drugs. -
0:06 - 0:10I had just arrived in Vancouver
to lead a research project -
0:10 - 0:14in HIV prevention in the
infamous Downtown East Side. -
0:15 - 0:18It was in the lobby of the Portland Hotel,
-
0:18 - 0:21a supportive housing
project that gave rooms -
0:21 - 0:23to the most marginalized
people in the city, -
0:23 - 0:26the so-called "difficult to house."
-
0:27 - 0:30I'll never forget the young woman
standing on the stairs -
0:30 - 0:34repeatedly jabbing herself with a needle,
and screaming, -
0:34 - 0:36"I can't find a vein,"
-
0:36 - 0:38as blood splattered on the wall.
-
0:40 - 0:44In response to the desperate
state of affairs, the drug use, -
0:44 - 0:49the poverty, the violence,
the soaring rates of HIV, -
0:49 - 0:53Vancouver declared a public
health emergency in 1997. -
0:53 - 0:57This opened the door to
expanding harm reduction services, -
0:57 - 0:59distributing more needles,
-
0:59 - 1:00increasing access to methadone,
-
1:00 - 1:04and, finally, opening
a supervised injection site. -
1:04 - 1:08Things that make injecting
drugs less hazardous. -
1:09 - 1:11But today, 20 years later,
-
1:11 - 1:16harm reduction is still viewed
as some sort of radical concept. -
1:16 - 1:20In some places, it's still illegal
to carry a clean needle. -
1:20 - 1:22Drug users are far more likely
to be arrested -
1:23 - 1:25than to be offered methadone therapy.
-
1:25 - 1:28Recent proposals for
supervised injection sites -
1:28 - 1:32in cities like Seattle,
Baltimore and New York -
1:32 - 1:34have been met with stiff opposition:
-
1:35 - 1:40opposition that goes against
everything we know about addiction. -
1:40 - 1:42Why is that?
-
1:42 - 1:44Why are we still stuck on the idea
-
1:44 - 1:50that the only option is to stop using --
that any drug use will not be tolerated? -
1:51 - 1:55Why do we ignore
countless personal stories -
1:55 - 1:57and overwhelming scientific evidence
-
1:57 - 1:59that harm reduction works?
-
2:01 - 2:05Critics say that harm
reduction doesn't stop people -
2:05 - 2:06from using illegal drugs.
-
2:07 - 2:10Well, actually, that is the whole point.
-
2:10 - 2:13After every criminal and societal sanction
-
2:13 - 2:14that we can come up with,
-
2:14 - 2:18people still use drugs,
and far too many die. -
2:19 - 2:22Critics also say that
we are giving up on people -
2:22 - 2:26by not focusing our attention
on treatment and recovery. -
2:27 - 2:29In fact, it is just the opposite.
-
2:29 - 2:30We are not giving up on people.
-
2:30 - 2:33We know that if recovery
is ever going to happen -
2:33 - 2:35we must keep people alive.
-
2:35 - 2:38Offering someone a clean needle
or a safe place to inject -
2:38 - 2:41is the first step to
treatment and recovery. -
2:43 - 2:45Critics also claim that harm reduction
-
2:45 - 2:49gives the wrong message to
our children about drug users. -
2:50 - 2:54The last time I looked,
these drug users are our children. -
2:54 - 2:58The message of harm reduction
is that while drugs can hurt you, -
2:58 - 3:01we still must reach out to
people who are addicted. -
3:01 - 3:06A needle exchange is not an
advertisement for drug use. -
3:06 - 3:10Neither is a methadone clinic
or a supervised injection site. -
3:10 - 3:13What you see there are
people sick and hurting, -
3:13 - 3:16hardly an endorsement for drug use.
-
3:17 - 3:20Let's take supervised
injection sites, for example. -
3:20 - 3:24Probably the most misunderstood
health intervention ever. -
3:24 - 3:26All we are saying is that allowing people
-
3:26 - 3:30to inject in a clean, dry space
with fresh needles, -
3:30 - 3:32surrounded by people who care
-
3:33 - 3:36is a lot better than
injecting in a dingy alley, -
3:36 - 3:39sharing contaminated needles
and hiding out from police. -
3:39 - 3:41It's better for everybody.
-
3:43 - 3:48The first supervised injection site
in Vancouver was at 327 Carol Street, -
3:49 - 3:54a narrow room with a concrete floor,
a few chairs and a box of clean needles. -
3:54 - 3:56The police would often lock it down,
-
3:56 - 4:00but somehow it always
mysteriously reopened, -
4:00 - 4:03often with the aid of a crowbar.
-
4:04 - 4:05I would go down there some evenings
-
4:05 - 4:09to provide medical care
for people who were injecting drugs. -
4:09 - 4:12I was always struck with the
commitment and compassion -
4:12 - 4:15of the people who operated
and used the site. -
4:15 - 4:18No judgment, no hassles, no fear,
-
4:18 - 4:20lots of profound conversation.
-
4:20 - 4:24I learned that despite
unimaginable trauma, -
4:24 - 4:27physical pain and mental illness,
-
4:27 - 4:30that everyone there thought
that things would get better. -
4:31 - 4:37Most were convinced that, someday,
they'd stop using drugs altogether. -
4:39 - 4:42That room was the forerunner
to North America's -
4:42 - 4:47first government-sanctioned
supervised injection site, called INSITE. -
4:47 - 4:51It opened in September of 2003
as a three-year research project. -
4:51 - 4:56The conservative government was intent on
closing it down at the end of the study. -
4:57 - 5:00After eight years,
the battle to close INSITE -
5:00 - 5:03went all the way up to
Canada's Supreme Court. -
5:03 - 5:05It pitted the government of Canada
-
5:05 - 5:08against two people with a
long history of drug use -
5:08 - 5:11who knew the benefits of INSITE firsthand:
-
5:11 - 5:13Dean Wilson and Shelley Tomic.
-
5:14 - 5:20The court ruled in favor
of keeping INSITE open by nine to zero. -
5:20 - 5:24The justices were scathing in
their response to the government's case. -
5:25 - 5:26And I quote:
-
5:26 - 5:31"The effect of denying the services
of INSITE to the population that it serves -
5:31 - 5:34and the correlative increase in the risk
of death and disease -
5:34 - 5:39to injection drug users
is grossly disproportionate to any benefit -
5:39 - 5:41that Canada might derive
-
5:41 - 5:45from presenting a uniform stance
on the possession of narcotics." -
5:48 - 5:50This was a hopeful moment
for harm reduction. -
5:50 - 5:54Yet, despite this strong message
from the Supreme Court, -
5:54 - 5:57it was, until very recently,
-
5:57 - 6:00impossible to open up
any new sites in Canada. -
6:01 - 6:06There was one interesting thing
that happened in December of 2016, -
6:06 - 6:09when due to the overdose crisis,
-
6:09 - 6:14the government of British Columbia allowed
the opening of overdose prevention sites. -
6:15 - 6:19Essentially ignoring the
federal approval process, -
6:19 - 6:23community groups opened up
about 22 of these de facto illegal -
6:23 - 6:26supervised injection sites
across the province. -
6:27 - 6:28Virtually overnight,
-
6:28 - 6:31thousands of people could
use drugs under supervision. -
6:31 - 6:36Hundreds of overdoses were reversed
by Naloxone, and nobody died. -
6:37 - 6:41In fact, this is what's happened
at INSITE over the last 14 years: -
6:41 - 6:4675,000 different individuals
have injected illegal drugs -
6:46 - 6:50more than three and a half million times,
-
6:50 - 6:52and not one person has died.
-
6:52 - 6:56Nobody has ever died at INSITE.
-
6:59 - 7:00So there you have it.
-
7:00 - 7:06We have scientific evidence
and successes from needle exchanges -
7:06 - 7:09methadone and supervised injection sites.
-
7:09 - 7:13These are common-sense,
compassionate approaches to drug use -
7:13 - 7:16that improve health, bring connection
-
7:16 - 7:19and greatly reduce suffering and death.
-
7:21 - 7:24So why haven't harm reduction
programs taken off? -
7:24 - 7:29Why do we still think
that drug use is law enforcement issue? -
7:31 - 7:34Our disdain for drugs and
drug users goes very deep. -
7:34 - 7:38We are bombarded with
images and media stories -
7:38 - 7:40about the horrible impacts of drugs.
-
7:41 - 7:44We have stigmatized entire communities.
-
7:44 - 7:50We applaud military-inspired operations
that bring down drug dealers. -
7:50 - 7:53And we appear unfazed
by building more jails -
7:53 - 7:59to incarcerate people whose
only crime is using drugs. -
7:59 - 8:02Virtually millions of people are caught up
-
8:02 - 8:06in a hopeless cycle
of incarceration, violence and poverty -
8:06 - 8:12that has been created by our drug laws
and not the drugs themselves. -
8:13 - 8:17How do I explain to people
that drug users deserve care and support -
8:17 - 8:19and the freedom to live their lives
-
8:19 - 8:24when all we see are images of guns
and handcuffs and jail cells? -
8:26 - 8:27Let's be clear:
-
8:28 - 8:32criminalization is just a way
to institutionalize stigma. -
8:33 - 8:38Making drugs illegal does nothing
to stop people from using them. -
8:42 - 8:45Our paralysis to see things differently
-
8:45 - 8:50is also based on an entirely
false narrative about drug use. -
8:50 - 8:52We have been led to believe
that drug users -
8:52 - 8:56are irresponsible people who just
want to get high, -
8:56 - 8:58and then through their
own personal failings -
8:58 - 9:02spiral down into a life
of crime and poverty, -
9:02 - 9:06losing their jobs, their families
and, ultimately, their lives. -
9:07 - 9:11In reality, most drug users have a story,
-
9:11 - 9:15whether it's childhood trauma,
sexual abuse, mental illness -
9:15 - 9:17or a personal tragedy.
-
9:17 - 9:19The drugs are used to numb the pain.
-
9:22 - 9:28We must understand that
as we approach people with so much trauma. -
9:29 - 9:34At its core, our drug policies
are really a social justice issue. -
9:34 - 9:39While the media may focus on overdose
deaths like Prince and Michael Jackson, -
9:40 - 9:41the majority of the suffering
-
9:41 - 9:45happens to people who are
living on the margins, -
9:45 - 9:47the poor and the dispossessed.
-
9:48 - 9:50They don't vote; they are often alone.
-
9:51 - 9:54They are society's disposable people.
-
9:55 - 10:00Even within health care,
drug use is highly stigmatized. -
10:00 - 10:03People using drugs avoid
the health care system. -
10:03 - 10:06They know that once
engaged in clinical care -
10:06 - 10:09or admitted to hospital,
they will be treated poorly. -
10:09 - 10:12And their supply line, be it heroin,
cocaine or crystal meth -
10:12 - 10:14will be interrupted.
-
10:15 - 10:18On top of that, they will be asked
a barrage of questions -
10:18 - 10:22that only serve
to expose their losses and shame. -
10:22 - 10:24"What drugs do you use?"
-
10:24 - 10:26"How long have you been
living on the street?" -
10:26 - 10:28"Where are your children?"
-
10:28 - 10:30"When were you last in jail?"
-
10:31 - 10:35Essentially: "Why the hell
don't you stop using drugs?" -
10:36 - 10:41In fact, our entire medical
approach to drug use is upside down. -
10:41 - 10:42For some reason,
-
10:42 - 10:47we have decided that abstinence
is the best way to treat this. -
10:48 - 10:51If you're lucky enough,
you may get into a detox program. -
10:51 - 10:54If you live in a community
with Suboxone or methadone, -
10:55 - 10:57you may get on a substitution program.
-
10:57 - 11:01Hardly ever would we offer people
what they desperately need to survive: -
11:01 - 11:05a safe prescription for opioids.
-
11:06 - 11:11Starting with abstinence is
like asking a new diabetic to quit sugar -
11:11 - 11:14or a severe asthmatic
to start running marathons -
11:14 - 11:16or a depressed person to just be happy.
-
11:16 - 11:18For any other medical condition,
-
11:18 - 11:21we would never start with
the most extreme option. -
11:21 - 11:24What makes us think that strategy
-
11:24 - 11:27would work for something
as complex as addiction? -
11:29 - 11:31While unintentional overdoses are not new,
-
11:31 - 11:34the scale of the current
crisis is unprecedented. -
11:34 - 11:37The Center for Disease Control estimated
-
11:37 - 11:42that 64,000 Americans died
of a drug overdose in 2016, -
11:42 - 11:45far exceeding car crashes or homicides.
-
11:46 - 11:50Drug-related mortality is now
the leading cause of death -
11:50 - 11:54among men and women between
20 and 50 years old in North America -
11:55 - 11:56Think about that.
-
11:57 - 12:02How did we get to this point, and why now?
-
12:02 - 12:05There is a kind of perfect
storm around opioids. -
12:05 - 12:09Drugs like Oxycontin,
Percocet and Dilaudid -
12:09 - 12:14have been liberally distributed
for decades for all kinds of pain. -
12:15 - 12:19It is estimated that two million
Americans are daily opioid users, -
12:19 - 12:22and over 60 million people
-
12:22 - 12:25received at least one prescription
for opioids last year. -
12:26 - 12:30This massive dump of
prescription drugs into communities -
12:30 - 12:34has provided a steady source
for people wanting to self-medicate. -
12:35 - 12:38In response to this prescription epidemic,
-
12:38 - 12:43people have been cut off, and this
has greatly reduced the street supply -
12:44 - 12:47The unintended but predictable consequence
-
12:47 - 12:48is an overdose epidemic.
-
12:48 - 12:53Many people who were reliant on
a steady supply of prescription drugs -
12:53 - 12:54turned to heroin.
-
12:54 - 12:58And now the illegal drug market
has tragically switched -
12:58 - 13:00to synthetic drugs, mainly fentanyl.
-
13:01 - 13:06These new drugs are cheap,
potent and extremely hard to dose. -
13:06 - 13:09People are literally being poisoned.
-
13:11 - 13:16Can you imagine if this was
any other kind of poisoning epidemic? -
13:16 - 13:18What if thousands of people started dying
-
13:18 - 13:22from poisoned meat
or baby formula or coffee? -
13:22 - 13:24We would be treating
this as a true emergency. -
13:24 - 13:28We would immediately be
supplying safer alternatives. -
13:28 - 13:30There would be changes in legislation,
-
13:30 - 13:33and we would be supporting
the victims and their families. -
13:34 - 13:36But for the drug overdose epidemic,
-
13:36 - 13:38we have done none of that.
-
13:38 - 13:43We continue to demonize the drugs
and the people who use them -
13:43 - 13:48and blindly pour even more resources
into law enforcement. -
13:51 - 13:53So where should we go from here?
-
13:54 - 13:58First, we should fully embrace,
fund and scale up -
13:58 - 14:00harm reduction programs
across North America. -
14:00 - 14:03I know that in places like Vancouver,
-
14:03 - 14:07harm reduction has been a
lifeline to care and treatment. -
14:07 - 14:10I know that the number of overdose deaths
-
14:10 - 14:13would be far higher
without harm reduction. -
14:13 - 14:18And I personally know hundreds
of people who are alive today -
14:19 - 14:21because of harm reduction.
-
14:22 - 14:24But harm reduction is just the start.
-
14:24 - 14:28If we truly want to make
an impact on this drug crisis, -
14:28 - 14:32we need to have a serious
conversation about prohibition -
14:32 - 14:33and criminal punishment.
-
14:34 - 14:40We need to recognize that drug use is
first and foremost a public health issue -
14:41 - 14:48and turn to comprehensive social
and health solutions. -
14:49 - 14:51We already have a model
for how this can work. -
14:51 - 14:54In 2001, Portugal was
having its own drug crisis. -
14:54 - 14:58Lots of people using
drugs, high crime rates -
14:58 - 14:59and an overdose epidemic.
-
14:59 - 15:04They defied global conventions
and decriminalized all drug possession. -
15:05 - 15:07Money that was spent on drug enforcement
-
15:07 - 15:11was redirected to health
and rehabilitation programs. -
15:11 - 15:12The results are in.
-
15:13 - 15:16Overall drug use is down dramatically.
-
15:17 - 15:20Overdoses are uncommon.
-
15:20 - 15:23Many more people are in treatment.
-
15:24 - 15:27And people have been
given their lives back. -
15:29 - 15:35We have come so far down the road
of prohibition, punishment and prejudice -
15:35 - 15:38that we have become
indifferent to the suffering -
15:38 - 15:42that we have inflicted on the
most vulnerable people in our society. -
15:42 - 15:46This year even more
people will get caught up -
15:46 - 15:48in the illegal drug trade.
-
15:49 - 15:53Thousands of children will learn
that their mother or father -
15:53 - 15:56has been sent to jail for using drugs.
-
15:58 - 16:01And far too many parents will be notified
-
16:01 - 16:06that their son or daughter
has died of a drug overdose. -
16:06 - 16:09It doesn't have to be this way.
-
16:10 - 16:12Thank you.
-
16:12 - 16:17(Applause)
- Title:
- The harm reduction model of drug addiction treatment
- Speaker:
- Mark Tyndall
- Description:
-
Why do we still think that drug use is a law-enforcement issue? Making drugs illegal does nothing to stop people from using them, says public health expert Mark Tyndall. So, what might work? Tyndall shares community-based research that shows how harm-reduction strategies, like safe-injection sites, are working to address the drug overdose crisis.
- Video Language:
- English
- Team:
closed TED
- Project:
- TEDTalks
- Duration:
- 16:31
![]() |
Brian Greene edited English subtitles for The harm reduction model of drug addiction treatment | |
![]() |
Brian Greene edited English subtitles for The harm reduction model of drug addiction treatment | |
![]() |
Brian Greene edited English subtitles for The harm reduction model of drug addiction treatment | |
![]() |
Brian Greene approved English subtitles for The harm reduction model of drug addiction treatment | |
![]() |
Brian Greene edited English subtitles for The harm reduction model of drug addiction treatment | |
![]() |
Brian Greene accepted English subtitles for The harm reduction model of drug addiction treatment | |
![]() |
Brian Greene edited English subtitles for The harm reduction model of drug addiction treatment | |
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Helene Batt edited English subtitles for The harm reduction model of drug addiction treatment |