Lessons in Destigmatizing Harm-Reduction Efforts

I grew up in an extremely religious household. I’m talking the charismatic, speaking in tongues, healing through prayer, church every Sunday, youth group during the week, Jesus camp over the summer, a few years as a missionary kid in Kenya: the whole-works kind of religious.

So, it’s safe to say that a rather moralistic approach to human behavior—this idea that there is a specific “right” way to act in order to be considered a good or deserving person—was pretty ingrained in me.

However, just as my religious upbringing never fully jibed with my lived experience and worldview, neither did the moralistic, abstinence-only approach that is often utilized in treating substance-use disorders.

The first time I heard about the harm-reduction approach felt like a cartoon “light bulb” moment. Harm reduction rejects the stigmatization and criminalization of substance use and replaces it with a more holistic and humanistic approach to meeting people who use drugs “where they’re at” instead of judging or punishing them. It acknowledges that some ways of using drugs are safer than others and prioritizes minimizing harm related to drug use and providing non-judgmental, non-coercive resources and support.

People who use drugs don’t have some kind of moral failing, as so much of society would have you believe. They are human beings who exhibit a full spectrum of human behavior that cannot be taken out of the context of their lives , their unmet needs, and the systemic structures that influence them.

Like many in our society, I had been raised with a rather binary good versus bad, all or nothing, sin versus salvation type of mindset that often leads to unhelpful judgment and even destructive punitive measures.

Harm reduction, on the other hand, offers compassionate and supportive methods that not only resonate with me on a personal and professional level, but also have the strength of evidence behind them.

The desire to pass along that framework and highlight the importance of treating substance use disorders, especially within primary care, is what motivated me to educate current medical students interested in Family Medicine in opioid overdose response training.

I, myself, am a medical student interested in pursuing a career in Family and Community Medicine. I’m currently completing a dual degree DO/MPH program through the Jefferson College of Population Health and my medical school, the Philadelphia College of Osteopathic Medicine (PCOM).

In the Substance Use course taught by Drs. Megan Reed and Jeffrey Hom through my Master of Public Health program, I was trained—in a class project—to reverse an opioid overdose using Naloxone nasal spray. An opioid overdose (of heroin, fentanyl, or prescription opioid pain medications) can become fatal when it slows or stops normal breathing.

Naloxone, an opioid antagonist, binds to opioid receptors and blocks the effects of opioids, thereby reversing the overdose. As part of the curriculum, Drs. Reed and Hom encouraged us to then provide three additional trainings to people outside of our classes.

In February, I first virtually trained my husband, Royce, and then later my best friend, Emily, in order to run through and work out any kinks, timing or technology issues before the larger virtual training session of medical students.

Neither my husband nor my best friend have any science or medical education beyond what they took in high school, so it was excellent practice in ensuring I was communicating understandably and not using too much medical jargon. (It was honestly pretty fun to share what I have been learning over the last few months—and a topic I feel quite passionately about—with the two most important people in my life!)

For my main training session, I reached out to the Student Association of the American College of Osteopathic Family Physicians (SAACOFP) to ask if they would be interested in hosting the event. I thought that maybe 10 students tops might attend. Much to my surprise, over 50 students signed up (with an estimated 40 actually attending the virtual Google Meet session).

The vast majority were first year medical students,  with some other years represented.

I encouraged the SAACOFP president to invite a representative of PCOM’s Addiction Medicine Club to join the session. It ended up being a wonderful opportunity for collaboration.

The virtual training went quite well. I supplemented the slides given to us during my class with about 10 slides of my own (mostly pulled from class lecture slides) to help make the presentation more interactive and applicable to medical students, to give greater context to the opioid epidemic across the U.S. and here in Philadelphia specifically, and to introduce the concept of harm reduction.

I started with the broader context and then moved into the more specific overdose response training followed with an interactive exercise.

I borrowed the 9-1-1 call center idea from class to also have a volunteer “practice” the overdose response training while I pretended to be a flustered granddaughter whose grandmother took too many of her painkillers post-hip surgery.

I wrapped up the training with questions from the group, where a question about the possibility of absorbing fentanyl through physical contact created an opportunity for another student, who was a former EMT, to share some of her experiences responding to opioid overdoses.

This experience was the perfect synthesis and sharing of everything I have been learning about harm reduction, the opioid epidemic and overdose response using Naloxone.

After the training, a group of medical students stayed on the call to ask about dual-degree training, addiction medicine rotations, and for general medical school advice.

The response (and number of attendees alone!) demonstrated the real interest around substance use disorders and opioid overdose response training. I felt grateful to play a small role in advancing that education.

It was an empowering experience to realize that I reached a point in my training where I can start teaching others, a realization which left me potentially interested in pursuing teaching opportunities down the road.