The National Family Support Technical Assistance Center (NFSTAC) has curated a “Family & Caregiver Toolkit,” aimed at those whose children (of any age) are impacted by issues related to mental health and/or substance use. Rolled out October 6, on the whole it does a decent job of explaining harm reduction to what it presumes is an abstinence-oriented audience.
NFSTAC is the Substance Abuse and Mental Health Services Administration-funded arm of advocacy organization The National Federation of Families. Its new toolkit comprises eight modules that each serve as a resource hub for a different aspect of mental health and substance use, including one dedicated to harm reduction. The resources collected within that module are a mix of external links (including a Healthline article from former Filter staff writer Sessi Kuwabara Blanchard) and material previously produced by NFSTAC.
A few places where the “Understanding Harm Reduction” module briefly misses the mark include a characterization of fentanyl as something that “can be found in methamphetamine and coke and counterfeit pills that look like Xanax, Adderall and various pain pills.” Most of this is technically accurate, but misrepresents the risk by framing opioids as almost an afterthought, and as far as we know it’s not true that fentanyl is in counterfeit Adderall.
Also a bit of a miss is the overemphasis on cannabis use disorder (more fully expressed elsewhere in the toolkit). It does a fair job when advising families and caregivers to adopt principles of nonjudgement and not demand abstinence. But though some people do experience a psychological addiction to marijuana, there aren’t really any physical harms that practicing harm reduction can reduce. Strategies advised in the toolkit include staying away from “synthetic products instead of the real thing,” and an interesting moment midway through a training course when it suggests a form of marijuana harm reduction is to grow your own.
The toolkit endorses “using vapes or smokeless tobacco instead of cigarettes.”
NFSTAC also suggests using a marijuana vape pen instead of smoking. Given the national panic that the administration has helped to stoke around youth vaping, it’s a relief that NFSTAC doesn’t appear to buy into the idea. The three tobacco harm reduction measures that are (briefly) endorsed in the toolkit are designated smoking areas, enforcing age restrictions around purchase of tobacco products and “using vapes or smokeless tobacco instead of cigarettes.”
Arguably one the biggest missed opportunities, however, is in NFSTAC’s advice to “consider restating any limits you have around substances, including not using them in your home”—meaning reaffirm that boundary, rather than reconsider it, which would be easily one of the most lifesaving harm reduction measures to get families and caregivers on board with. Most opioid-involved overdose deaths happen because the person was using alone.
Pre-Exposure prophylaxis (PrEP) is briefly referenced, with no accompanying context, as a form of opioid harm reduction—right after a slide about stimulant harm reduction where it’d have been a natural fit. But nowhere in the harm reduction module are there any references to condoms.
“In short, there is so much we could include in a toolkit that our thinking was we needed to limit what we put in the toolkit to not overwhelm families who may be using this product with lots of information that is available elsewhere,” NFSTAC Project Director Gail M. Cormier told Filter.
There are a number of openings where you’d expect condoms to be mentioned even without additional context about safer sex, such as among the examples of everyday harm reduction (designated drivers; seatbelts; helmets; sunscreen; COVID-19 face masks) that families and caregivers might already practice. Overall, the toolkit explains harm reduction as a principle that already exists in our daily lives for activities such as drinking alcohol, and which has simply been extended to drug use. Which does get the job done in terms of introducing the concept in a relatable way, but is an ahistorical version of events when it wouldn’t have cost anything to briefly acknowledge how the movement originated during the AIDS crisis.
That said, this is a well-above average introduction to harm reduction for abstinence-minded families and caregivers—or at least, those who aren’t familiar with harm reduction as an option. To the organization’s credit, the toolkit never describes getting someone to stop using as the ultimate goal. To families that may be wondering whether harm reduction is simply enabling substance use, NFSTAC explains that it’s “moving a person in the direction of wellbeing,” rather than in the direction of abstinence.
Image (cropped) via City of Hamilton, Ohio