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Harm reduction in the context of real life

Syringe - downloaded from the netA couple of weeks ago I attended a panel discussion about “harm reduction in a socio-political context,” sponsored by the Canadian Centre on Substance Abuse.

During the audience Q&As, a young man named Max Rowsell took the microphone. He told us that he has been using opiates intravenously for three years, and he just found out he has Hepatitis C. He works on the Harm Reduction Youth Advisory Committee of the Youth Services Bureau.

Max was interesting and articulate, and I wanted to hear the rest of his story, so we got together for dinner on Friday evening. I didn’t take any notes, so I hope my memory doesn’t let me down too much here. (For the record, Max gave me permission to identify him on my blog and said everything we discussed was bloggable.)

The first thing I noticed was that Max wasn’t making a lot of eye contact and his eyes were rolled back in his head a bit, so I figured he was probably high (he confirmed this later). Regardless, he was absolutely coherent: his thoughts and words were crystal clear. And he was intriguingly open and honest.

He doesn’t seem to blame anybody for his addiction, and he’s empathetic about his parents’ circumstances and the choices they made along the way. He describes his mother as “the most wonderful and nurturing woman you could imagine.” She moved to Norway when he was in his teens, and Max moved to Ottawa to live with his father.

Suddenly his whole world had changed – he had lost his family, his friends, his city, his school – and he was forced to adjust to an all-new family, friends, city and school.

Max says if someone had said to him, “You’re going to go to school one day and learn how to hit up in the bathroom,” he would have had trouble believing it. He would have thought “How could that happen?”

But that’s what happened. He was seventeen years old. Of the five friends who all started using together in that high school bathroom three years ago, four are still addicted.

I asked him how long it took him to become addicted. He says he’s not sure when he slipped over the line. But the difference is that an addict gets dopesick when he goes too long without drugs. He says it’s really hard to endure that kind of sickness when you know you can alleviate all your symptoms in 30 seconds.

“If you could go back to that day in high school,” I asked him, “Would you change it?”

“That’s a good question,” Max said, “I don’t think I would. I’ve had some bad experiences as a result of the drugs, but it’s also brought some really good people and experiences and opportunities into my life.”

I think we all carry around in our heads a stereotype of what a drug addict is. I know I do. Even though I’ve been an addict myself, and my own lived experience tells me that my stereotype is merely a caricature of an addict, I still can’t quite shake it.

Drug addicts are not all the same. Every addict is also a person with their own unique combination of qualities, quirks and flaws. There’s as much variation between addicts as there is between non-addicts.

But the drugs themselves do create commonalities among and differences between groups of addicts.

Max points out that the nature of crack, for example, makes crack addiction a full-time job. Within minutes of smoking it, you start craving it again. All your waking hours are devoted to smoking crack, looking for crack, or getting money to buy more crack. He says it’s important that crack addicts have a voice in harm reduction since they are the experts on themselves, but it’s harder to engage or mobilize them because of the all-consuming nature of their addiction.

Opiate addicts, on the other hand, aren’t usually so consumed. Opiates include heroin and pharmaceutical opiates/painkillers like codeine, demerol, dilaudid, meperidine, methadone, morphine, percocet and percodan. In Max’s case, he uses two or three times a day, and it takes about half an hour to become functional again after each use.

In practical terms, this difference between crack addicts and opiate addicts is huge. Opiate addicts tend to have far more time and capacity for other pursuits like school, work, hobbies, and community activities.

Max seems to be living a full, rich life – which includes school, work, activism, community, a relationship, friendships, conferences and public speaking engagements – while managing an active addiction. He credits harm reduction for making it possible for him to do all the other things.

He doesn’t see harm reduction as simply about disease prevention or needle exchange and crack kit programs. Harm reduction, in its broadest sense, is about employment and education and health and well-being – it’s about helping people be the best they can be.

A couple of weeks ago, at the Homelessness Forum, Rob Boyd said that pitting harm reduction against treatment – as some politicians like to do – makes no sense because harm reduction is at the front lines of treatment. They’re on the same side.

I asked Max about treatment. He said he thought he could quit if he chose to, and he spoke very knowledgeably about the various treatment options for opiate addicts. He’s done his research; he understands the biochemistry of opiates and the various treatment options.

Max says many drugs, including opiates, are not in and of themselves particularly harmful. The harm comes from the things one might do and the risks one might take in order to get and use the drugs, such as sex trade work, crime, sharing needles, etc. It’s the criminalization of drug use that makes it unnecessarily risky and creates much of the harm. The Conservative government, by focusing its drug strategy on prisons and punishment, is actually making things worse.

Since I started writing about addiction occasionally on my blog, I’ve had a few parents email me and ask how they can help their addicted child. I’ve always felt bad that I can never answer that question to their satisfaction or my own. I asked Max what he would tell them.

I’m paraphrasing here:

“Tell them that you love them and that you’ll support them no matter what, whether they’re actively using or not. Talk to them about harm reduction. Tell them you don’t want them to share equipment. Tell them you don’t want them to do sex trade work to get the money.”

I think if Conservative politicians were to meet Max they would change their minds about harm reduction. They would see a smart and likable young man with many qualities and strengths, who does give a damn about his own well-being and about his community, and whose future is clearly and undeniably worth protecting. How could they not see that?

We left the restaurant and walked for awhile. There was a beam of light sweeping the sky, and Max explained to me how it works and what its purpose is. He walked me to my bus stop, waited with me until the #14 arrived, then leaned way down (he’s 6’7″) and gave me a big hug goodbye.


Just Post AwardUpdate: This post won a Just Post award!


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28 comments to Harm reduction in the context of real life

  • Thanks for this post – it was so eloquent and non-judgmental. I appreciate Max’s willingness to be open and honest with you. I’m going to email this link to the social worker who works with not only my group, but the addictions & recovery group at my local mental health services.

  • You are a marvel Zoom. Thank you, thank you…

  • Good one … I will pass it on to my friend who needs to know these things.

  • XUP

    “It’s the criminalization of drug use that makes it unnecessarily risky and creates much of the harm.” — my own personal hobby-horse as well. One of the most winsome and engaging people I’ve ever know was a heroine addict. The criminilization of drugs and an extremely unsupportive father unfortunately led him to overdose in his early 30s. I would totally fall in love with this country all over again if it did the sensible thing and decriminalized drugs

  • Perhaps I’m a bad old cynic, but I doubt that any of the Cons would be convinced by Max speaking to them. An open mind and an open heart is a requirement, and those items happen to be in short supply among the Cons.

    Hearing Dr Gabor Maté speak, and reading his recent publication “In the Realm of Hungry Ghosts” did much to provide me with added insight, knowledge and compassion for individuals with chemical substance addictions. But I was already a supporter of harm reduction programs.

  • Carmen

    Thank you Zoom for blogging about Max. And thank you Max, for letting Zoom blog about your life experience with addiction. I am SO sending this to everyone in my circle.

  • I have to agree with deBeauxOs, with the added thought that even if the cons are the worst of the bunch there aren’t many pols I know of who would dream of cutting the police budgets and putting that money into treatment instead.
    The lobby from the cops, prisons, lawyers, etc who all get fortunes to “protect” us from the evil druggies are too large and too powerful.
    This in spite of the fact that just about every adult I know has used or does use recreational drugs. Not least the very cops, prisons, lawyers, and politicians that have set up this whole screwed up system.

  • Nat

    Great post. The Cons will never be convinced that throwing people in jail is not the right solution. (Wow double negative.)

    I don’t think we’ll ever see a decriminalization of opiates, nor would I approve of such a move. But I do agree that we need to support people with addictions with treatment options and harm reduction strategies rather than punishments that don’t work.

  • this was a wonderfully interesting read,thanks Zoom and good luck to Max

  • That’s a good post zoom.

  • That post is very interesting and evocative.

    It’s a real shame that Canada under the Conservatives seems likely to further emulate American drug policy. Given how theirs is probably the worst and most destructive in the rich world, it is a non-sensical course, as well as one profoundly lacking in empathy.

  • Also, as the people above indicated, it is very impressive that you went out and found this story.

  • WC – thank you. I think being non-judgmental is the whole foundation upon which harm reduction is built.

    Woodsy – thank YOU. You were instrumental in me having the opportunity to meet Max.

    BS – I hope it helps her. I know it’s not exactly the answer parents are hoping for, but it’s more realistic than a magic bullet.

    XUP – I’m sorry about your friend.

    deBeauxOs – I think if anybody could break down the stereotypes the Cons hold of drug addicts, it’s Max. Even if he could just give them a flicker of doubt about their staunchly held opinions on the subject, it would be a start. Where did you hear Dr. Maté speak?

    Carmen, send it far and wide!

    Bandobras, you’re a cynic after my own heart.

    Nat – absolutely. We already know what doesn’t work.

    Nursemyra, thank you. I believe Max is going to accomplish great things in life.

    Robin – thank you too.

    Milan – I agree absolutely. It’s ideology pure and simple that would compel our government to emulate the least successful, least humane, and most expensive drug policy in the world.

  • Thank you for telling us about your time with Max. It’s certainly an interesting perspective to hear about someone who seems generally content with their drug addiction. I’d be curious to hear how he feels a few years down the road.

    I was also fascinated with the contrast between opiates and crack. I have some close family members who have had long term battles with crack addiction. Even when clean, I find it very difficult to carry a conversation with them. It seems like their thinking has been really messed up from the drug use.

    Maybe it’s easy for me to say, since I don’t have kids myself…But I think I would find it very difficult to tell my child that I would support him/her no matter what. I guess it depends what is meant by “support”. Is support enabling? Is support an open door for being taken advantage of?

  • future landfill

    Why is Ibogaine so expensive?

    http://en.wikipedia.org/wiki/Ibogaine

    I learned of it out of curiosity after watching the Hunter S. Thompson movie a while back. Seems to me there’s a lot of heads in the sand about addiction and the possible benefits of this drug to shear the dependency cycle.

    Is there something I don’t know?

  • Hey everyone!

    I would like to take this opportunity to sincerely thank zoom! for letting me talk with her and giving me another route with which to spread my ideas. I’m in an extremely lucky position which enables me to speak in many different forums, give workshops and lectures on drug addiction and harm reduction, and give youth drug users a voice, which is sorely lost in our political and social systems.

    I would also like to thank all of you for leaving comments — they all made me smile and think about how smart people really are, if we could just get them to vote differently! I would like to extend the opportunity for anyone to talk to me, if you have any further questions, and I would also like to extend the invitation to bug zoom! into sitting down with me again in the future (let’s face it, we ALL had a good time, right?). If you’d like to talk with me about anything, just drop me a line at maxrowsell[at]gmail.com. Or check out my music at http://www.myspace.com/wholesalemusic and leave a comment.

    Thanks again, everyone, this has been a really enjoyable experience!

    Love, peace, forever and a day
    Max

  • Max, nobody’s going to have to bug me to sit down and talk to you again. I’m already looking forward to the next time – and I’ve already got more questions. (Like what about Future Landfill’s Ibogaine question?)

    Psychgrad, when I was an addict, I was pretty content for awhile. I got addicted because I loved how the drugs made me feel. I had no interest in quitting. But, over time, the high became more and more elusive and I often found myself coming down without having first gotten off, which was frustrating. The drugs and the lifestyle were taking their toll in various ways. All of this is just to say I don’t think it’s uncommon for young addicts to be content with their addiction and not want to quit yet.

    I know what you mean when you speculate about how it would feel as a parent to say you support your child no matter what. This raised questions for me too. For example (maybe Max can help us with this one), when Max advised parents to tell their kids not to turn to the sex trade to pay for their drugs – is he suggesting that the parents should help with those costs? That sounds like the proverbial rock and a hard place from a parent’s perspective!

  • Oh, zoom!, you’ve hit one of my favourite topics. It’s in an ideal, perfect world of parenting that a parent can see clearly. If they could, and they knew what was really going on (which they often don’t, because addicts always lie to their parents), then they would probably feel differently about this. For the first year or so of a parent knowing their child is an addict, and when the child can finally open up and express how difficult it is for them to live every day — and it IS difficult from a different perspective than the conventional one taken by people writing about addicts, and certainly different from the person who has never had an addiction, and does NOT understand it whatsoever “You can quit, just stop!” — and the parent can actually see that the reason their everyday life is so hard is because of the constant struggle to get the money together. I like to say that if an opiate addict (NOT a crack addict) won a million dollars, they would probably invest it and live off the interest, and their dope habit would probably not go up by much, if at all. They would just never have to be sick — and the harm from their lifestyle would be gone, and I mean gone. If they had access to a constant supply of the drug, clean equipment, and a place to use, there can literally be a no-harm addiction. This isn’t to say it’s manageable — often people will not have control over their addiction but they won’t be causing harm to themselves. And no addiction is without risk. But personally, and I see no reason why other opiate addicts couldn’t do this, as long as I have enough money to get me just enough to get by, I’m fine. I can go to school, work, anything, just like any other person (and in some cases more so than other people). I choose to not quit at this point in my life, for a whole bunch of reasons. As someone earlier commented, they thought I’d have a different opinion in a few years. To tell the truth, I don’t even think about it. I just focus on staying safe and productive today.
    But anyway, my point is, if a parent sees their child struggling, and they’re not quitting any time soon, and they’re out every night having anonymous unprotected sex with multiple partners and then buying drugs on the street and using in unsafe conditions — just to get by, mind you, because they have no other way to achieve this goal — then yes, maybe giving them $40 on a Friday night on the condition that they sit down and have supper with you or spend the night in together, you’d be amazed how the child would react. It’s showing empathy to the hurt caused by something that has control over them, and while not condoning or prohibiting the activity, making it safer and ensuring their child’s right to health and happiness. Because opiate addicts often live very happy lives.

    I know I do!

  • I don’t see how giving your child $40 to avoid the streets for a night is ensuring a child’s right to health and happiness. Maybe on a very temporary basis, save for any negative effects that may come with the drug use itself. But with that rationale, parents might as well give their child $40 on a daily basis (or whatever amount desired) if he/she can’t afford the desired drug of choice.

    Also – what about how the parents feel? I can’t imagine that a parent would feel healthy and happy knowing that their 40 bucks went to ensuring that their child will be off the street for a night. In fact, it seems pretty selfish for a child to put his/her parents in that position.

    I’m trying to be open-minded and resist the automatic use of social norms about drugs being taboo, which would probably shut down any sort of dialogue. With that said, if parents come to Zoom for advice on how to deal with a drug addicted child…(I’ll just say it flat out)…I don’t think it would be responsible advice to give.

  • Keep in mind that yes, it would be only for a night, but it’s a way to show you care in junkie language. It probably wouldn’t work universally, but all the junkies I know would felt as if they were understood and reached out to if their parents did something like that. And it reinforces the fact that there is a safer way to do things; my point was the parent showing that they don’t want their child in jail or beaten and raped by a bad john, for example.

    And the child wouldn’t be ASKING for the cash, I’m just saying it’s a way to reach out that junkies will understand better — because the way parents react now is not doing any good at all.

    And if someone came to zoom! for advice on a drug-addicted child, no, it wouldn’t be the first thing out of their mouths, of course not. I’m thinking more of a friend of mine named Dean Wilson, who is part of VANDU — he told me that the best thing his mother ever did for him was take him in for a night and make sure he wasn’t dopesick so that he could have a meal with her and spend the night. He’s been a heroin addict for 20-something years, so yes it’s a different situation… but I think the length of time they’ve been using is a big part of it. A parent finding out they’ve been using after they’ve been using for a week is different than years of addiction.

    I totally see where you’re coming from, psychgrad, and I agree with you to some degree. I just didn’t make myself clear enough, because what I said isn’t applicable in all situations. I think the thing to remember is what’s in the blog post — that if you tell your child you love them and support them no matter what they’re doing you will make a greater difference in their lives than tough love or ostracizing them.

  • sometimes the understanding comes after the fact. was i happy when my parents strong armed me into rehab? no. was i happy when they told me i wasn’t welcome home anymore if i continued using? no. did i live to be grateful for these (tough) decisions they had to make? yes.
    every situation is unique, but i benefitted more from my parents “tough love” stance on addiction than from their attempt to empathise with it.
    but yes, ultimately having parents/family who care enough to help in whatever way they feel will work best for the family is key. and i was fortunate enough to get a bed at a long term care facility. from what i understand, these facilities are few and far between now.

  • I think this is one of the best comment threads we’ve ever had here on knitnut.net.

    Max, I’m glad you clarified that. It’s easier to imagine a parent being able to make that symbolic gesture of unconditional love and compassion than to completely finance their child’s addiction. Your Dean Wilson example illustrated your point very well.

    Meanie, that’s interesting that you were rehabbed against your will. I don’t think that approach would have worked in my case, but like you say, each case is different. If you don’t mind me asking, what drug were you using and how long had you been using it?

  • i don’t mind you asking. and i admit i’m an unusual case. i was only fifteen at the time, so my parents were still “in charge”. it was either rehab, the streets or a group home. they sold me on rehab by lying to me; they said it was only 28 days, i could visit my friends whenever i wanted, there was a pool table and video games there and it was close to downtown. ha. it was in carleton place in the middle of nowhere and i was there for close to seven months. well played mom and day, well played.
    i pretty much did whatever i could get my hands on at the time. at the time it was acid, speed, alcohol, weed, hash and glue. i’m really glad i had a limited income and hadn’t yet been introduced to people who could get me harder stuff.
    i’m unique because now, at the age of 36, i can enjoy wine, occasionally overindulge, pay the price, and back off overdoing it. never touch drugs though. they still really scare me.
    after i posted that last post, i’ve been thinking really hard abou what approach i would take with my own kids if it were to (godforbid) ever happen. thanks for the thought provoking piece.

  • damselfly

    I find it really interesting that even addicts separate out the opiate users from the crack/crystal meth users. My sister is one of the latter. She is over 50 and with undiagnosed Borderline Personality Disorder as well as meth addiction, alcohol and marijuana use. She cannot hold a job. These days she is not even coherent most of the time. Our parents are deceased and she has very few family members left, none of whom live locally except me. Unfortunately I had to break off contact with her when she stole from me, assaulted me, threatened my family and generally made me afraid to be in the same room with her. I still love her and I’m truly sorry I can’t support her in any way (though we made sure she got her share of our mom’s estate after she passed away a few years ago). I see no positives in her current situation and no happy ending to the story.

    Which is a long way of getting around to stating the fact that there must be different consequences to different types of addiction. Max may be able to function adequately with his (at least for the moment), but my sister’s brain and personality have been forever altered and the life she could have had has been destroyed. She has no desire to seek help because she doesn’t believe she has a problem – everyone *else* does. Even if she had free access to her drug(s) of choice, it would only kill her faster. I have no solutions to offer and no hope of any being found for this situation.

  • [...] The December Just Post list was their last, and I was honoured to receive an award for my Bank Street Bully post. (My first Just Post award was in November, for Harm Reduction in the Context of Real Life) [...]

  • a.mori

    I know Max personally, and regardless of what he has done or does, he is an amazing person. He is bright and wonderful, and he touches people in such a way that at the end of the day you know you’re blessed to know him. No ones perfect, but Max is one of the only people I have ever known to accept full responsibility for his actions. Anyone who reads this and assumes he is some teenage drug addict, you’re sorely mistaken and you’re missing out on knowing a great person.

  • a.mori

    P.S. Zoom, you captured Max wonderfully. Congratulations on the award, and keep on writing.

  • Drug Addiction will not only ruin your body but it would also mess up your life.;:,