Harm Reduction Splits the Recovery Community

Maya Hambright, MD

My work partner and I started a mindfulness-based recovery center and it tore us apart.

I grew my family medicine practice in upstate New York into a recovery-based practice as heroin overdoses devastated the community.

In the early days, a mother of one of my patients told me that paramedics walked (rather than ran) into her house the last time they were called (it was the fourth time) and didn't give her son Narcan. He died that night. The stigma has decreased since then, and I now hear many stories of paramedics who have bonded with families and are checking in on those whose lives they've saved.

We have options now that were unheard of just a few years ago: Narcan infusion like insulin in a pump, intravenous injection sites in New York City, police partnering with community organizations and driving people to recovery centers.

Heavily I think of the lives we have lost to stigma. (And I cannot even begin to discuss the stigma and racism and criminalization of the crack user in the 1980s — a topic for another essay.)

We created our center as a free walk-in outreach program rooted in mindfulness — a Buddhist approach to recovery grounded in trauma-informed care, meditation, acceptance forgiveness, and compassion — with yoga, Refuge Recovery meetings, tai chi, and recovery coach training offered daily. I have worked in inpatient treatment for years and watched people come in and out and back in again. Traditional treatment had been missing something, and this was it.

When COVID-19 closed our local hospital's inpatient and outpatient detox programs and shut down its step meetings, we stayed open. The workers and the center provided a lifeline as overdoses and isolation increased.

Soon I started hearing from my private patients that they could no longer attend meetings at the outreach center because they felt the environment was longer safe. It had become known as an "injection site." People would close themselves in the bathrooms with the expectation of being given Narcan if needed. They did not have to go to meetings or groups but instead could use and spend days crashed on the couches.

I raised these concerns but was rebuffed by the director. He said that our clients would live after their overdoses, whereas when they used in the gas station, they would die. He told me we could not mandate people to meetings because we were not a traditional recovery center, where treatment is forced and retraumatizing.

We had opened in a non-White neighborhood and had promised the neighbors that we were not importing trouble. But their kids were now unable to walk past our building: Clients would smoke in groups and snatch their bikes, hide their stuff in bushes, sleep in backyards, and use in plain sight.

I could no longer remain identified with the program and I resigned. I was shamed and told that I did not believe in harm reduction. I felt that I was the "them" in the "us vs them." I had become somehow grown-up and part of the establishment. (I was seeing this as a negative.)

A few weeks ago, MG came to see me in my office. I had last seen him 9 months earlier at the center, when he and his girlfriend were locked in the bathroom and I was banging on the door and they refused to come out. He called the director from the bathroom, and on speaker, I was instructed to leave them alone.

I had heard that MG overdosed a few times at the center. Six months ago, he was arrested and drug court sent him to an inpatient program and subsequently a halfway house. He came into my office for hepatitis C treatment, and we talked for a long time. I had known him since he was young; he grew up with my kids, which is how I got so involved in recovery.

He told me that in the past half-year, he has not used when given the opportunity, he does not think about using, he never wants to use again, and he has never felt this way. He is 29, and he said he just wants to learn how to be a person.

I asked him how he thinks he came to this new place and what the role of the center was.

Did he feel supported or enabled? He was thoughtful in his response. He felt that he was not judged, and that may have helped him believe that he deserved recovery and a new start in life. But even so, he was not sure that it is okay to allow people to use — though he does want people to live.

We could not decide whether the center was harmful or reducing harm. Lives were saved, but the mission of the recovery center was lost as only people in active use felt comfortable there.

 He then smiled at me and told me he hoped that the director and I would make up.

Maya Hambright, MD, is a family physician who specializes in addiction medicine.

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Cite this: Harm Reduction Splits the Recovery Community - Medscape - Feb 14, 2022.