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A Perspective from the Field: Five Interventions to Combat the Opioid Epidemic and Ending the Dichotomy of Harm-reduction versus Abstinence-Based Programs

ABSTRACT In this perspective article, the authors share our knowledge, expertise, and experiences in responding to the opioid epidemic in St. Joseph County (Indiana). The authors discuss five interventions we have used in the county to minimize the devastating effects of the opioid epidemic. Their hope is that the knowledge gained from this article will be transferred to other states and counties to further promote recovery and well-being for individuals who have opioid use disorders. The authors recommend that naltrexone (injectable extended-release) be offered in county jails, drug courts incorporate medication-assisted treatments (MATs) into their programming, recovery coaches be used in emergency rooms, harm-reduction recovery groups be accessible to individuals, and naloxone be readily available to communities. We also propose paradigm shifts in how some professionals approach treatment and conceptualize recovery. The authors challenge the agency-driven dichotomy of being either a harm-reduction or an abstinence-based program. Recovery is best understood on a spectrum and should be defined by the individuals we serve, not the projection of professional values or agency agendas of what they think ones recovery should look like.