11.10.2017 – JBC: A harm reduction conversation with a Family Practice Physician

Yesterday, I started having conversations and asking questions of healthcare providers that I see almost daily about harm reduction and smoke-free alternatives. I will be posting each story as I organize my notes…I thought I would start with the difficult one first. A Physician who wanted only to be identified as a Family Practice Physician in the Sacramento, CA area for 20 years sat down with me, and this is the conversation we had:

I talked to him first about HIV/AIDS-related deaths now (around 12,000 per year) as opposed to the number of deaths at the height of the epidemic (over 50,000 per year), as well as the current all-time low new infection rates. My question to him was, “What strategies do you think got us here to the reduction in numbers”? His first answer was “abstinence” (I warned you this was a difficult conversation). I had to really go at him to get better answers out of him, and the abbreviated version is me asking how realistic that is, and finally asking that if someone is hell-bent on having sex, what do you tell them or prescribe to them so that they are as safe as they possibly can be? He said he gives people condoms and will prescribe either PrEP(Pre Exposure Prophylaxis) or PEP(Post Exposure Prophylaxis). I said, so harm reduction?. He said yes, harm reduction. I asked what he tells people who are IV drug users that come in and say that they have tried to stop using but can’t. He said, “I tell them to get off of whatever they are using.” I said again, what if they have tried and can’t quit? He said “needle exchanges”. So again I said harm reduction? He said yes, harm reduction.

Now the big question: I asked, “Do you think the same harm reduction strategies would be effective for people who smoke and can’t quit; ie, far less harmful alternatives like vapor products or Snus”? He said he would have a hard time telling someone it was ok because of the small percentage of risk. I asked why it was different for him with smoking, as opposed to sex, and furthermore the impact that lower risk products would have from a public health standpoint. He said he didn’t know why he felt different about harm reduction with smoking. He said he was going to go home and think about it for the weekend and try to figure out where his reservations are coming from. My final question to him was, “Do you tell your patients to wear seatbelts when they drive”? He said “Every day”. I asked if he wears his seatbelt. He said of course. Me: “Even though the CDC says that seat belts reduce fatalities and serious injuries by only around 50% and that it is by no means a guarantee that you won’t be killed in a car accident”? He smiled a big smile and said, “Yes, because harm reduction”.

The whole point of this story is that even though he didn’t emphatically agree with me, he did agree to go home and think about it and I saw the light go on. Sometimes, these conversations don’t end in huge, burning bush moments where people fall at our feet and proclaim their belief in what we propose. But changes can happen gradually. It’s better to start these conversations now, than scramble for support when it comes down to the wire. Go out and have conversations with people you know. If we all did it with just one person, we would have double the number of us during important election times. That’s how change usually starts. Slow and small. Don’t ever give up.

Jennifer Berger-Coleman

CASAA Director of Community Outreach

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