How Can Pediatricians Become Harm Reductionists?

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Draconian drug policies have often been made in the name of the health of youth, yet harm reduction centers, like syringe exchanges, don’t tend to target people under 18. Physicians who come in regular contact with this demographic are perfectly positioned to stage harm reduction interventions, a Boston pediatrician suggests, seemingly departing from the position that the profession’s association take.

“Addiction is a pediatric onset condition—we’ve all got a role to play!” tweeted Dr. Scott Hadland, a pediatrician and addiction research at Boston University and Boston Medical Center, on January 15.

For him, that consists of two tangible actions, and a broader societal shift. On a visit to the Children’s Hospital of Philadelphia, Hadland “highlight[ed] what pediatricians can do to address the national overdose crisis.” Screening for substance use and making treatment referrals is “critical” but a “heavier lift,” reads a slide that he shared in his post.

One Twitter user agreed that it’s a”great thought” but pointed out that it could “be a little bit of a slippery slope,” suggesting that it could be “violating their privacy.” The American Association of Pediatricians (AAP) noted in their guide on screening and intervening that “unless the adolescent is in danger, the details of your conversations will remain private.”

Additionally, Hadland suggested that discussing harm reduction and overdose prevention could be a “lighter lift” and “not a controversial one” for pediatricians. Principles signed by AAP support naloxone education and distribution. But that might be the limit of the professional association’s support for harm reduction; the guide generally seems to take a staunch abstinence position, encouraging doctors to offer “clear advice to stop using, brief information on the negative effects of using, discussion of a plan to stop using, and recognition and encouragement of other strengths and positive behaviors of the patient that can support abstinence.”

Beyond the purview of adolescent medicine, there has been a recent push to bring harm reduction to teens. In May 2019, the Drug Policy Alliance* released a resource that could potentially assist pediatricians in having those conversations. Designed for high schoolers. DPA’s “Safety First: A Reality-Based Approach to Teens and Drugs” curriculum is a tool for parents and educators to facilitate discussions with teens about the health effects of drugs, according to the best available evidence, and how teens can make rational decisions for themselves.

Changing how drug use is discussed on a larger societal level will be key for empowering pediatricians to become successful harm reductionists, Hadland suggests. Specifically, “changing the language of addiction to reduce stigma” is what’s needed, state his slides. Harm reductionists working in media, like Filter contributors Maia Salavitz and Zachary Siegel, have created a resource called “Changing the Narrative” that unpacks stigmatizing language, like the word “crackhead,” and offers alternatives.

In contrast, AAP re-affirms, through their stated principles, that the dominant narrative of addiction as “a chronic brain disease,” which some harm reductionists have contested, must be reaffirmed and disseminated across the public and health care providers.

*The Drug Policy Alliance has provided a restricted grant to The Influence Foundation, which operates Filter, to support a Drug War Journalism Diversity Fellowship.

Photograph of The Children’s Hospital of Philadelphia by Jeffrey M. Vinocur via Wikimedia Commons/Creative Commons

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