Harm reduction: What is it, and how does it help the Clinic’s patients?

August 8, 2023

You may have heard of the term “harm reduction,” and you might know that it includes strategies such as syringe services or Narcan distribution. But do you know the philosophy behind harm reduction and why we use it at Venice Family Clinic?

Hear from our experts below on why they take a harm reduction approach with their patients who use substances, how they implement harm reduction in their work and how they’ve seen it help people.

Dr. Gilmore Chung, director of addiction services at Venice Family Clinic
Yasmin Safdie, LCSW, director of Venice Family Clinic’s SUMMIT behavioral health services
Arron Barba, director of Venice Family Clinic’s Common Ground prevention program

What is harm reduction?

At its core, harm reduction uses practical strategies and ideas to reduce negative consequences that stem from substance use. Those negative consequences include infectious disease transmission, isolation from family and friends, overdose, and sadly, death. To avoid these detrimental effects, harm reduction recognizes the actual experience of people who use substances to meet them where they are, finding realistic ways to reduce harm to themselves, their families and their communities, and over time working to improve physical, mental and social well-being.

How do we use harm reduction at Venice Family Clinic?

At Venice Family Clinic, we have two programs that serve people who use substances: Substance Use, Motivation and Medication Integrated Treatment (SUMMIT) and Common Ground. SUMMIT offers medical and behavioral health services in the treatment of substance use disorders, and Common Ground provides services aimed at preventing overdoses and the spread of HIV and hepatitis C. Both programs offer their services in welcoming, non-judgmental environments that focus on realistic approaches to prevention and care.

At Common Ground, we provide naloxone (generic for Narcan) for overdose reversals and safe-use materials to reduce the chances of getting HIV or hepatitis C.

“We provide preventive care to make sure people are not acquiring diseases or dying from an overdose,” said Barba, director of Common Ground. “Our staff focus on connection and seeing the client as a human who adds value to the world. They connect clients to therapists and case managers for additional support, such as housing, food or even just a phone to call a parent. And if a client is interested in stopping their substance use or they want additional support related to their use, our staff connect them to the Clinic’s SUMMIT program. Our goal is to support the client’s health goals.”

At SUMMIT, our clinicians work closely with patients with substance use disorders to fully understand their realities – how they live their lives, what challenges they face, and what supports they may or may not have – before developing a treatment plan together that feels realistic and achievable for the patient.

SUMMIT offers multiple services so patients are free choose what works best for them. There are group medical and behavioral health visits led by a therapist and medical clinician where people offer support to each other and have their prescriptions for opioid and alcohol use disorders refilled. This group visit model allows for people who use substances to share experiences and information with each other, receive mental health help and ask medical questions all at the same time. SUMMIT also offers individual and group substance use counseling, individual mental health therapy and medication for substance use disorders separately.

“People who use substances often experience alienation from society and their loved ones. My goal when working with clients is to make them feel welcome and safe to be who they are – to be received, accepted, respected and valued for just being themselves,” said Safdie, director of SUMMIT behavioral health services. “I want to help them understand how and why they make the choices they make, so we can figure out together how they can reduce some of the negative consequences that may come from making certain choices.”

Why do we take a harm reduction approach with our patients?

“We understand this population is stigmatized and that they carry their own shame about their substance use,” Barba said. “Studies have shown that people who are engaged in harm reduction services are more likely to seek treatment for their substance use and engage in medical care and other supportive services.”

Our clinicians, therapists, counselors, case managers and staff have found that using harm reduction principles generally leads to better outcomes, such as patients using fewer substances or using less overall, than an abstinence-focused approach.

“There are many people who are not ready or don’t have an interest in adhering to a life of abstinence,” Safdie said. “If it weren’t for harm reduction programs, those individuals wouldn’t have access to any kind of care or support. And just because they don’t have an interest in abstinence, it doesn’t mean that they don’t have an interest in understanding what their substance use means to them or exploring how it or their lives could be different.”

Providing a non-judgmental space for someone to examine their substance use makes it easier to establish an understanding between patient and clinician.

“As a doctor, it would be really uncomfortable for me to say to a patient who is asking for help, ‘I won’t do anything for you until you stop using.’ Putting those conditions on a patient is not realistic,” said Dr. Chung, director of addiction services. “When you make sure patients feel safe and taken care of, they don’t feel judged and are more likely to come back. The lack of judgement is seen as an open door. And over time, you can build a relationship and offer other care options that can make a difference in their overall health. But when you call someone out, it just pushes that person away.”

How has harm reduction helped Venice Family Clinic’s patients?

“The most wonderful thing that I have seen through harm reduction is that individuals who have been rejected, ignored, dehumanized and patronized have found a space at Venice Family Clinic where they can reconnect with their humanity,” Safdie said. “Where they have a voice. Where they can let go of the shame and feel valuable as humans. And when you add respect and empowerment to that, it creates space for people to start the process of making healthier and safer choices on their own terms.”

Dr. Chung, who has previously worked in environments that required abstinence in order to receive care, has found that the absence of such requirements benefits his current patients.

“No matter how unstable patients are medically, if they are in care and keep coming back, they have a much lower chance of overdosing than people who have been discharged because they tested positive on a substance test,” he said.

For example, one of Dr. Chung’s patients, a man in his late 50s who had been using various substances for most of his life, came to the Clinic because of chronic ulcers on his legs. Treatment for his condition required him to come in several times a week to have his dressings changed, which gave Dr. Chung the opportunity to speak with his patient on a regular basis about his substance use. After several months of these conversations, the patient decided he was ready to start taking buprenorphine, which helps decrease illicit opioid use. Today, the patient continues taking his medication, has stopped using illicit substances and his legs have healed. Dr. Chung believes that this patient wouldn’t have gotten the care he needed for his ulcers or his substance use if we hadn’t taken a harm reduction approach.

“Substance use is a medical condition that stems from other conditions, such as trauma, and we recognize that and care for people accordingly – without judgment or restrictions. The wins for the patient across many aspects of their lives, from the physical to the mental, are more significant if we approach them this way.”