PITTSFIELD, Mass. — Maia Szalavitz first experienced the use of "harm reduction" in 1986 when, in the throes of her addiction, an acquaintance advised her to sanitize a shared needle for intravenous drug use.  

 

She later credits this person for saving her life, as she would have likely contracted HIV in that instance without the advisory.  

 

Decades later, Szalavitz's book "Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction" was published, driving home the formerly radical view that people deserve to live whether they get high or not.

 

The best-selling author and journalist has written about addiction, recovery, childhood trauma and empathy (including several books with Dr. Bruce D. Perry). Last year's "Undoing Drugs" is her latest look at addiction and the history and use of harm-reduction techniques.   

 

Szalavitz spoke virtually to public health professionals and prosecutors at the Berkshire District Attorney's Office on Thursday. 

 

Harm reduction principles are supported by District Attorney Andrea Harrington, who is bothered that there are evidence-based solutions that are not being embraced across the board, especially as the county has a seen a jump in overdoses eight times higher than the state overall. 

 

"So our community, we have a significant opioid problem, 6 percent of the population here is addicted to opioids," she said. "According to recent statistics, we've seen a big increase in fatal overdoses. This office is responsible for investigations in all of those overdoses. We had a 44 percent increase here in this county, that was in 2021, of fatal overdoses and across the state, there was only a 5 percent increase so we're in a tough spot.

 

"I meet with the parents of people who have died of fatal overdoses here in this room and the big thing that they share with me is that it was the shame and stigma that their children felt prevented them from really getting the help that would keep them alive."

 

Harrington prioritizes drug abuse as a health issue. Rather than following the "war on drugs," a phrase for the strict policing and sentencing of drug-related crimes, she calls for allocating resources to address the issues that lead to substance use and to solutions for users.

 

"In this office, we do not prosecute possessions of personal use amounts," she said. "We think it makes a strong statement about the fact that we should treat substance use disorder as a public health issue and not a criminal matter so I feel proud of us that we've been leaders in that."

 

Harm reduction aims to reduce negative consequences associated with drug use. It applies the core of the Hippocratic oath to "do no harm" to addiction treatment and drug policy, Szalavitz said.

 

A local example of the approach is Berkshire Health System's Healthy Steps program that works with active-injection drug users to discard used needles and provide them with sterile supplies in hopes of preventing the transfer of HIV and Hepatitis C.

 

This method is well supported, as the U.S. Centers for Disease Control says  syringe services programs reduce HIV and HCV infections and are an effective component of comprehensive community-based prevention and intervention programs that provide additional services.

 

"When we practice harm reduction as a philosophy, it's transformative because we all have gifts to give, and we all contribute to the world and yet, we all also do harm as well, even when we're trying not to," Szalavitz said.

 

"Harm reduction is a gift from people who use drugs to all of us, it says you matter whether you take drugs or not, it says you deserve to live, whether you get high or not, and it says you can contribute and you can reduce harm, and that's really what we all want to know, how to make a difference, to heal, to care to be cared for ...

 

"We mostly don't change overnight and we all take risks that can do harm but if we work together, we can minimize that and empower each other to do better."

 

Szalavitz was doing heroin with a friend in an East Villiage, N.Y., apartment more than 35 years ago when her worldview was changed. Her friend's girlfriend, who visited from San Franciso to ensure that her partner got help, taught Szalavitz to protect herself by not sharing needles and if there was no other option, sanitizing them with bleach.

 

Though she was a regular reader of the newspaper, Szalavitz said she had no idea that intravenous drug use put her at risk for the human immunodeficiency virus. She took the guidance to heart, becoming "compulsive" about sanitizing her needles, she said, and spreading the word to others.

 

She was furious that nobody had told her about the risks.

 

Shortly after the incident, Szalavitz's East Village friend fell ill with AIDS and she knew that the stranger's words had impacted her life greatly.

 

Szalavitz would later identify — and contact — the woman as Maureen Gammon in 2020 after a great deal of searching. Gammon worked to spread the gospel of harm reduction on the West Coast in the 1980s.

 

That simple gesture of compassion lead Szalavitz to take care of herself until she recovered and then go on to cover American harm reduction from its roots.

 

Szalavitz highlighted the origins of modern harm reduction, which originated during the AIDS (acquired immunodeficiency syndrome) crisis, and the activists who helped shape the movement.  

 

These include a Puerto Rica activist who incited hunger strikes in the Riker's Island jail's AIDS ward and got ACT UP NY to get involved with a needle exchange, a group of individuals from San Franciso who promoted the idea of cleaning needles with bleach to save lives, and working-class drug users in Liverpool, England, who publicized the principals of harm reduction.

 

She also asserted that cutting the medical opiod supply — which has been reportedly reduced by 60 percent since 2011 — to reduce overdose deaths has actually done the opposite and risen the prevalence of fentanyl.

 

"Harm reductionist had predicted that this approach would backfire. For one, it drives people with addiction to street drugs, not recovery; taking away a drug does not cause somebody to recover; secondly, because smaller drugs are easier to smuggle, crackdowns tend to push dealers toward more potent and therefore more risky products," Szalavitz said.

 

"Our policy also increases disability and suicide among pain patients because cutting off medical opioids doesn't cure pain either, studies now show that forcibly tapering or ending opioid prescriptions can be deadly."

 

An assistant district attorney asked Szalavitz if there is anything that prosecutors can do in the courtroom to reduce the stigma and shame for addicts, expressing a feeling of having her hands tied.

 

"We're already dismissing the simple possessions and when we do that the case gets called, and obviously the commonwealth is not going to go forward, and then when the person turns around to leave, I always say 'Good luck, Mr. or Miss so and so,'" she said.

 

"Sometimes they say thank you, and sometimes they don't and it is frustrating because it is still a crime and there's not a public health treatment, and so it feels a little frustrating and not very helpful. l can dismiss them over and over again but the other thing that's hard is sometimes I dismiss their case, they walk out the door, and I don't see them again because they overdose."

 

Szalavitz suggested having outreach available in the courts or non-mandated support options for people whose cases are dismissed.

 

"People often don't stop because they fear that treatment is going to be horrible, and oftentimes, they're correct and they fear that they are basically going to give up the only thing that makes life worth living for them, and then have nothing," she had said earlier in the presentation.

 

"You're talking about population, at least 50 percent mental illness, at least 50 percent severe histories of childhood trauma, massive amounts of despair, this is not a population of people who are like, 'I need extra pleasure, and I'm really lazy,' So sort of recognizing that itself helps destigmatize, recognizing the pain that people are trying to deal with, however, ineptly."