Such tragic occurrences are commonplace in recovery. Many patients impacted by addictive disorders are driven by a passion to give back to society by going back to school to become social workers. Others become peer support specialists, helping patients in recovery; Still other work tirelessly in the harm reduction movement as was the case with Jesse Harvey. The don’t realize how hazardous it is to work with subjects who are actively using drugs; bringing drug paraphernalia to the clinics; drug dealers hovering around the clinics etc.
Patients in recovery are reminded over and over – don’t try to outmuscle the addiction; be smarter. The smartest and most commonsensical thing to do is stay on one of the three anti craving medications – methadone, buprenorphine, or naltrexone. Some patients are reluctant to stay on an opioid indefinitely. In that case, daily ingestion of naltrexone or taking the monthly injection of naltrexone is a choice. Working in a clinic without any protection is way too dangerous and could be lethal. It is like a firefighter fighting a fire without protective gear; a physician or nurse not using gloves; a police officer not wearing a bullet proof vest. Nobody chides the first responders for being ‘weak’. I fail to understand the reluctance of people in recovery not being on the appropriate anti craving medication.
We must learn from history. When methadone clinics were first established in the mid-1970’s way too many staff were recruited to work in methadone clinics from people in early recovery with tragic consequences. At our clinics we have almost 20 peer support specialists working with patients. They are the ‘secret sauce’ of the organization. Their secret weapon – being on Vivitrol. We don’t mandate it, but most of them stay on Vivitrol voluntarily.
I am even advocating the widespread distribution of naltrexone tablets to high-risk patients. Not too long ago, it was considered inappropriate to distribute naloxone. Naloxone has reversed tens of thousands of opioid overdoses and kept patients alive. Why are we so bullish on naloxone? Because of naloxone unique pharmacology. It is a non-opioid, has no street value, it cannot be abused. But let us also be cognizant of naloxone’s limitation. It can only be administered after an overdose and by a person other than the patient. Naltrexone, the oral opioid antagonist was developed to prevent relapse to opioid use in high-risk patients. If Jesse Harvey was on naltrexone tablets or on the Vivitrol injection he would have been alive.
Drug overdoses have climbed every single year for the last twenty years. Clearly, the present strategy has not worked. It is time we look at bold prevention measures that take harm reduction to harm avoidance. It is time we open safe prevention facilities where people are educated on prevention measures, and they walk out with naltrexone tablets and naloxone. The new slogan: I AM ON NALTREXONE. I CARRY NALOXONE.