Dr. Joseph Kanter: Reflections from the 2018 National Harm Reduction Conference

Author: Dr. Joseph Kanter, assistant state health officer and Region 1 regional medical director

Last month I had the pleasure of representing our department at the National Harm Reduction Conference in New Orleans.  The panel I hosted explored avenues for harm reduction practices in the emergency department.  We enjoyed a lively discussion and learned from true pioneers in the field but, far more substantive, were the organized listening sessions and informal hallway conversations throughout the event.  This is a markedly different type of public health conference.  Participants, many of whom have struggled with addiction, used injection drugs, or work closely with those who have, drove the conversation and were generous in sharing their own experiences.  Presenters did less talking and more listening.  The sabotaging effect stigmatization can have on one’s ability to enter and thrive in recovery was a common theme.  This created an atmosphere of commodore and collaboration—a gathering of 500+ professionals and individuals with lived experience, working together to improve the lives of people suffering with addiction.

I left with two sentiments I’d like to share.  First, we have a role to play in helping legitimize the practice of harm reduction.   Many conference participants spoke of feeling ignored or even victimized by “mainstream” institutions like governmental agencies, police departments, and universities.  To paraphrase one women who fought addiction, was in recovery, and worked as a peer support specialist helping others make similar transitions, “government officials existed to help others, never me.”  Comparisons came to mind with the early days of the HIV epidemic where patients were relegated to separate hospital wards away from “normal” patients and some high-ranking government officials refused to even say the word AIDS in public.  As the conference progressed I made effort to introduce myself to others and, with pride, proclaim myself with the Louisiana Department of Health.  Implied message: LDH cares about improving the lives of those struggling with addiction and values the harm reduction approach.  The more we can endorse the harm reduction approach and cloak it in “government-approved” legitimacy, the less its beneficiaries (our patients and constituents), will perceive institutional stigma.

Second, I left the conference inspired to bring outside-the-box thinking to my everyday work.  Some tenets of harm reduction, like access to sterile syringes to prevent transmission of Hepatitis C and HIV, were considered by many to be controversial twenty years ago but are now commonplace, well-accepted best practices.  Other ideas, like supervised injection sites, remain in active debate.  But the clear sentiment expressed was in an epidemic, nothing is off the table.  Many bedrock tenets of modern medicine and public health, from the notion patients have agency in their own medical decision-making to key elements of the sanitary code to even the practice of surgery itself began as heretical ideas.  We need not wait for an epidemic like the opioid and addiction crisis-- with 72,000 overdose deaths across the US last year and fatality counts still rising—to innovate in our day-to-day work.  When working on behalf of the public’s health, no idea is too outrageous to at least consider.  Reflecting on the conference after a month’s time, I hope to keep this inspiration with me and share it liberally.