Iranian Harm Reduction

A couple of articles in the NYT recently on harm reduction in Iran. I could write a lot about this, but I won’t.

A few points:

The Iranian H.I. V. problem, unlike the one in the U.S., is largely driven by intravenous drug use (IDU).

The author notes:

“By recent measures, 62 percent of H.I.V. infections in Russia came directly from a shared needle. In Malaysia it is 76 percent, in Iran 68 percent.”

In comparison, according to the CDC , in the U.S. the percentage of new H.I. V. infections related to IDU is around 12-16%. Not insignificant, but obviously a very different state of affairs.

Also, the author suggests that:

“Doctors could be particularly influential in opening up the last frontier for methadone and needle exchange in America: prisons. Prisons hold large numbers of drug users, at the peak of their motivation to change, who make up quite literally a captive audience.  They are not just the place where harm reduction is most needed, they are also the ideal place to offer help.  If only we could.”

“The peak of their motivation to change” and we should give them clean syringes and methadone? Ouch! What about recovery oriented treatment?

Looking at addiction solely through a public health lens leaves much to be desired. Nothing in the article about recovery and only a little about treatment, which I assume was not recovery oriented.

The impact of the Iranian policy is not all bad, it does sound like people suffering addiction in Iran are being treated more humanely than they were in the past and that move toward harm reduction has helped to shift the focus from one that is criminal/moral to a more health oriented model. Addicts are also being engaged and offered services that they may never have had access to in the past. Yet, harm reduction without an emphasis on recovery is so hopeless.

I really like this paragraph from one of Jason’s past posts:

“Ideas like this are rooted in despair, rather than hope.  We get overwhelmed by the problem. We’re too cheap to offer adequate help. We don’t believe that these people can recover. We think they have no chance. We’re scared that they’ll hurt us and get us sick. So, we offer them these kinds of interventions. Often, these programs represented in the name of choice, when, the addicts themselves, want better from us. They actually want to get well, but often lose hope that it’s possible for them. The system starts patting them on the head an encouraging them to be more realistic. What they need from professional helpers is for us to lend them our hope to cultivate some of their own. They need a system that stops talking about if they recover and starts talking about when they recover.”

It has been said that “the good can be the enemy of the best” The following quote from the article says a lot:

“‘There is a rule in Islam that between bad and worse, you have to accept bad,’ said one Iranian drug expert, ‘Having needle and syringe programs is bad, but having H.I.V. is worse. There is no third option.'”

Yes there is, and many more …

2 thoughts on “Iranian Harm Reduction

  1. I would think that a county like Iran with almost no infrastructure recovery as we know it would be difficult to provide. This is a step in the right direction.

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  2. Thanks for the comment.

    It’s definitely a step in the right direction or, at least, a step away from a terrible direction.

    The problem I have with these stories is that the work recovery is used exactly zero times. One mention’s treatment zero times, the other uses the word a few times but seems to refer only to methadone.

    In spite of this better but still minimalist response, the language of the articles is very congratulatory and enthusiastic.

    Why such enthusiasm for such a minimal response to addiction and its harms? Despair and stigma.

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