by Eddie Einbinder, LMSW.
For any Philip Seymour Hoffman (PSH) fan or drug reformer the recent piece in Vogue by his widow, Mimi O’Donnell, is a must-read. I wept…for Philip, his wife, the kids, the public, the current danger that similar variables have my high-risk patients in, my frustration over our addiction treatment reform proposal that Trump’s team will likely never read, and everything else…
Jumping ahead… supervised injection facilities! syringe exchanges, heroin or other opioid assisted treatment, legalization and regulation of drugs (dose and delivery) – the more dangerous it inherently is, the more important that it be controlled by government and not dealers. SMART recovery meetings (instead of NA), in-house field coaches, sober (ish) living houses, doctors and counselors who will treat addiction without abstinence as a prerequisite, taking away the stigma! The stigma is the social factor that is one contributing variable, which prevents all of the above practices or laws from becoming mainstream and reality. A safer reality. In which PSH could have not only asked for support every day while outside rehab, but in which he could have been employing tactics to use in the safest way possible, to almost entirely ensure survival. Nothing to enable use, nothing to encourage it. But to the extent that (he or his wife knew that) he was going to use again anyway, I would have signed up for every safety precaution possible.
Life does not have to be only the extreme roller coaster from inside and outside inpatient rehabilitation facilities. In one place, if structured correctly, you literally cannot use. And the next day you have access to every substance. I’ve never fully understood how the former environment is realistically supposed to prepare one for the latter, even with the appropriate supports in place. Please don’t misunderstand, if I have a patient in immediate or near future risk of grave physical or mental harm, I strongly recommend that they have 24/7 supervision as soon as possible and help facilitate the process. But it’s not the same prescription for the development of long term sustainability in the outside world.
Back to stigma, not only is it what pulls the weight behind real social and political change, but it is also, at its seed, what prevents one from asking their friend for help in the frame of an embarrassing or taboo moment. For example, asking a friend, or hiring a professional, to watch over you while you do your heroin, maybe that friend has a naloxone kit they’ve been trained to use. Maybe that friend gathered the cleanest materials for you to use. Maybe that friend knows the Good Samaritan policy in New York, and that neither they nor you can get in trouble for calling 911 to bring you to the hospital if you are on illegal drugs and need medical attention. I call this, most simple of tactics, the “buddy system.” From when you needed to pair off with a friend while swimming in the lake at camp. Why? Because it is quite hard to save yourself from drowning! Just like it is pretty hard to inject yourself with naloxone when you are already overdosing. Just like it is pretty hard to drive yourself home while drunk. The term for that ideal buddy is “designated driver.”
Society has accepted that people are going to get drunk and should not drive. So we prevent a lot of deaths by identifying “designated drivers.” Imagine if kids were taught about drugs, the potential statistical reality of their use, and how to decrease the dangers of them as much as possible, in the same way we were taught about decreasing the dangers of swimming, or driving, or sex (depending on how progressive your town was in your teenage years). We’d have far fewer deaths. The list of pressing topics and logistical solutions goes on and on.
Reducing the harms via Education, de-stigmatization, decriminalization, regulation, taxation… I’ve been in this field long enough to know that the moral argument, while the important one, is not the one that will win this debate. It is the monetary argument that will win this debate. I believe Marijuana hit its tipping point (finally) largely as a response to the great recession in 2008. It was not a response to too many poor young black men being charged with possession in the Bronx. So, for you people who do not care about the personal and cultural loss of PSH, and the millions of others, and the violence resulting from illegal drug trade, please know that the U.S. government will profit from the legalization of all drugs.
In my professional opinion, if there had been a socially and legally accepted harm reduction psychotherapy center and a supervised injection facility in the West Village of Manhattan, PSH would still be alive, and likely making gradual progress in his functioning and working towards safer and decreased use over the long term.
Eddie Einbinder is an internationally recognized educator of harm reduction within drug use. His work in this field is presented through lectures, literature and film, and is targeted towards youth and young adults. Acceptance and understanding of meaning and purpose behind one’s drug use, and working with patients to identify and succeed with realistic strategies towards achieving their goals, is integral to his work at The Center For Optimal Living. firstname.lastname@example.org, 212-213-8905 x108