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By Helen Silvis of The Skanner News
Published: 28 November 2012

Alvin Jackson, (L) and Cecil Sutton work at a needle exchange run by Evergreen Health Services in Buffalo New York.

Overdose, disease, arrest and imprisonment are among the most serious consequences of injecting drugs.  Remove overdose and add the danger of being abused, and the same risks apply to prostitution. Drug users and sex workers take the brunt of these risks, but their families, children and the community also suffer.

National experts at the 9th Annual Harm Reduction Conference, "From Public Health to Social Justice", which convened in Portland Nov. 15-18, say the way we deal with drug use and sex work can make a big difference. The harm reduction approach works with people who currently use drugs or work in the sex trade, encouraging them to identify the risks involved and to take steps to minimize the resulting harm. 

"We started our needle exchange program 22 years ago in 1989," says Kathy Oliver Ph.D., executive director of the homeless youth nonprofit Outside In. "We did it because we didn't think it would work to just tell everyone not to take drugs. It allows us to meet people where they are at and move them toward a safer lifestyle, one step at a time."

A graphic artist recorded discussions at the harm reduction conference and translated them into visualizations. Here, a conference attendee learns what was discussed at the opening plenary.

Outside In still operates one of two needle exchange programs in Portland, and uses harm reduction alongside other less controversial approaches.  Multnomah County started the second needle exchange program 20 years ago. "In partnership with Outside in and Portland Women's Crisis Line, the county also coordinates a "Bad Date Line," that encourages sex workers to circulate descriptions of violent or abusive clients.

The conference included the voices of people who identified themselves as current drug users or sex workers.

"The cool thing about this conference is, it lets people who are living this experience come and have a voice, and share a place at the table to help make the community a safer place," said Nabarun Dasgupta, a researcher, epidemiologist and founder of the North Carolina nonprofit Project Lazarus, which seeks to prevent overdoses among heroin users.

Many speakers at the conference argued that drug use and sex work should be taken out of the criminal justice system altogether.  Instead they argue that decriminalization would make it much easier to prevent overdoses, disease, and also property and violent crimes. 

Kathy Brown, a licensed psychiatric technician and alcohol and drug counselor, attending the conference, said deaths could be prevented if people could seek medical help without fear of arrest.

 "We have a war on drug users in this country," Brown says. "It's called the war on drugs, but it's a war on drug users, and we have prisons that are stuffed with people who are there for nonviolent, drug-related crimes. So drug users are supporting interdiction and the millions and billions of dollars that go into that, all the people that work there. And the war on drug users is supporting all those who are employed in prisons."

You won't hear that kind of political statement from Kim Toevs, who manages Multnomah County's HIV and STD prevention program. Toevs' focus is on harm reduction as a crucial tool in preventing infectious diseases and helping those affected improve their lives.

The harm reduction approach allows staff to build trust with people who otherwise will avoid contact with health professionals, Toevs says.  Drug users and sex workers have access to health care, condoms and information from a trusted source.

"The fact of the matter is that people are using drugs," Toevs says. "And the reason they are using drugs is complex, and often connected to past trauma. Trying to get someone to stop using drugs who is not ready to stop using, is not very effective.

"We are an anonymous service, so it feels nonjudgmental and safe for people to come to us. That helps us to deliver a lot of health messages that prevent people from the worst harms of IV drug use.  And when people are ready to reduce their use, they come to us. So it's trust-based."

Malika Stokes (L) and Hadiya Charles are part of the harm reduction coalition. Charles is a Hepatitis C prevention advocate.

Multnomah County has lower rates of HIV transmission among drug users than many other parts of the country, a fact that Toevs attributes to the early adoption of needle exchanges. Nationally, the CDC says 9 percent -12 percent of new cases occur because of IV drug use. In Oregon, 7 percent of HIV cases identified in 2011 were attributed to IV drug use.

Hepatitis C, another serious disease, is a tougher nut to crack. Transmitted by contact with infected blood, through sharing needles, that virus lives longer outside the body, Toevs says. Between 30 -70 percent of IV drug users in Multnomah County already have Hepatitis C.

In 2011, Oregon saw an influx of cheap, easily available heroin. That was credited for a 20 percent increase in overdose deaths across the state, for a total of 143 deaths statewide. Another 130 people died from prescription drug overdoses.  State Medical Examiner Karen Gunson also recorded deaths connected to methamphetamines and cocaine.

Nab Dasgupta says deaths could be prevented if more people understood what a heroin overdose looks like. Based on what they see in movies, many people imagine an overdose causes people to flail around violently before collapsing.

 In fact, a heroin or prescription opiate overdose looks just as if the victim is nodding off and falling into a deep sleep. People in an opiate coma may even snore.  But when the snoring stops, it's because the person has stopped breathing.   Other signs include clammy skin and a low pulse rate.

The bottom line? An IV drug user who can't be roused needs immediate medical help.

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