Opioid epidemic: Preventing overdose deaths

KOB.com - Erica Zucco

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ALBUQUERQUE, N.M. — As an overdose prevention coordinator, Bernie Lieving works to prevent drug overdoses and train first responders, families, community members and anyone else who might encounter drug use on how to recognize the signs of an overdose and reverse a drug’s effects to prevent overdose deaths.

“This isn’t just overdose prevention education and naloxone distribution to stereotyped people who you would think are injection drug users,” Lieving said. “Anybody who has a prescription for an opioid and a prescription for a benzodiazepine and/or has a cocktail at dinner is at risk for a possible overdose. We go to senior centers,­­­­ do patient education.

“Lots of people don’t know they’re at risk for a possible overdose, so some of the education I’ve given to older adults has taught them things they didn’t know.”

Lieving said training and education are approached with a “harm reduction” perspective.

“Driving a car can be dangerous, so when we get in a car you put your seatbelt on, don’t text while you’re driving, generally follow traffic laws and speed limits,” Lieving said. “We apply that to other kinds of behaviors, specifically around drug and alcohol use in acknowledging that there are healthier ways of using drugs and alcohol than others, and drug and alcohol use exists on a continuum, from abstinence to chaos, but there’s a lot in between.

“We understand that not everyone is going to be abstinent and not everyone is going to be in chaos so we work with people where they are and talk to them about healthier ways of using drugs and alcohol that don’t put them at risk for infectious diseases and blood-borne pathogens like hepatitis C or endocarditis. We also talk with people when it relates to overdose, about how to use drugs and alcohol in a way that doesn’t put them at risk for an opioid overdose or an overdose on other substances.”

Lieving said he believes New Mexico has for years been a leader in terms of harm reduction, starting with the Harm Reduction Act in 1998. It granted safe needle exchange through the Department of Health and other proxies, distribution of naloxone since 2001, and now more complex education and training.

“It’s really about meeting people where they are, engaging them with dignity and respect and acknowledging that people who use drugs are members of our community and they deserve to be as healthy as safe as they can and want to be,” he said.

But Lieving said there’s still work to do, especially in reaching the root causes that also lead to people experiencing addiction.

“As a leader in the nation on harm reduction, people are understanding that it works and we cannot arrest our way out of this, we can’t imprison our way out of it, we can’t mandate abstinence out of this,” Lieving said. “I’m hoping that we’re going to continue making progress and looking at this as a public health issue and not criminalizing people that are living with substance use disorders.

I think one of the major things we don’t do in addressing this epidemic is looking at the antecedents to problematic drug and alcohol use– addressing issues of trauma and racism and poverty and sexism and homophobia and all of the social pollutions that affect people and marginalize them.”

He said addressing those root causes requires a holistic, intersectional approach.

“(We need) long-term evidence-based prevention initiatives that start in elementary school and to look at providing people opportunities for education and jobs and to address all of the social stressors that impact a vulnerable family related to drug and alcohol use,” Lieving said. “We’re doing a lot of work at keeping people alive and meeting people where they are and providing them with education and naloxone and hopefully increased access to treatment, but we’re not looking at the social determinants, or addressing the social determinants.”