Harm Reduction and the Opioid Crisis: Clinical, Policy, and Ethical Perspectives

The opioid crisis requires a multilevel response, incorporating law and policy with evidence-based treatment for those with opioid use disorder. Policymakers often aim to reduce the use of opioids nationwide. As we pursue this long-term goal, however, many people are currently suffering serious harms caused by or subsequent to opioid use. In order to prevent or mitigate these harms, clinicians and others operating at the ground-level implement various harm reduction strategies such as needle exchanges, safe injection sites, and the provision of both preventative and emergency medical care. But these harm reduction strategies are sometimes in tension with policies designed to reduce opioid use because long-term population level goals may conflict with immediate patient-centered goals.

This paper explores this tension at three different levels of analysis. First, at the clinical level, health care providers may experience ethical distress about decision-making regarding complex treatments for conditions that arise from intravenous drug use. How, if at all, should clinicians evaluate the drug use of patients in clinical contexts? Second, at the policy level, laws designed to limit opioid use often evidence a punitive and prohibitionist attitude towards those with opioid use disorder, undercutting the ability of physicians to care for their patients. Third, at the level of ethical theory, the tension between harm reduction and long-term policy goals suggests the need for a clearer articulation of the ethical principles at stake. Drawing on these multiple perspectives, this paper aims to better understand the complexities of opioid use disorder and the opioid crisis.

Brian Hutler – Philosophy – Temple University