What a great question. Thank you. I could go on for three hours.
First, it's important to make some things clear. Treating people with addictions involves a continuum of care. Harm reduction is part of that continuum, but it's not the be-all and end-all. It's one step.
Treating comorbidities is at the other end of the continuum. We know that 50% to 70% of people with an addiction also need treatment for a mental health issue. They could have bipolar disorder, ADHD, an anxiety disorder or something else. What's more, at least 50% of opiate-dependent individuals suffer from chronic pain. Therefore, when we treat existing comorbidities, whether physical or psychiatric, it's much less difficult—not to say that it's easy—for someone to get off the substance they are using.
I want to make another point. Earlier, the discussion touched on the criminal element and the criminalization of people with addictions. I spent four years working in federal penitentiaries, and I saw first-hand that 80% of the inmates had committed an offence directly or indirectly related to the use of drugs or alcohol. That finding has been studied. When it comes to decriminalization, I would say that exposure to drugs tends to lead to increased use. A few years ago, I thought it was a more realistic approach. Now, I'm not so sure we are ready for it.
Lastly, I want to point out how ironic it is that we are seeing so many opioid-related deaths. The only known addiction for which pharmacological treatment is successful nearly 100% of the time is, in fact, opioid addiction. Methadone and buprenorphine are used to treat opioid addiction and can help someone get off opioids completely when given at the right dose to the right person.
We need to tackle the root of the problem and focus on our capacity in psychiatry and general practice to treat chronic pain. As I see it, harm reduction is one step. Any alcoholic who wants to quit drinking initially tries to control themselves, before they end up quitting for good. Harm reduction is a way to get people to potentially quit using, total abstinence, or at least reduce their use through the treatment of comorbidities.
That's what I find, but harm reduction is not the gospel. It's one tool, and sometimes, it's not the right tool. It can work for all types of addictions, but it's not the be-all and end-all.