Bioethical Considerations of Harm Reduction. Co-sponsored by ACLP's Addiction & Toxicology, and Bioethics SIGs

The workshop will be moderated by Dr. James Levenson with an emphasis on audience participation to discuss application of the concepts presented. Dr. Levenson will facilitate audience

Dr. Nicholas Kontos will introduce harm reduction as a treatment approach and offer historical context for today’s harm reduction landscape.

Dr. Brent Schnipke will demonstrate how harm reduction is fundamentally an ethical, patient-centered practice. Harm reduction implies that a physician's moral culpability extends to the inaction taken in preventing foreseeable harm. The C-L psychiatrist can act as an advocate for the patient in promulgating harm reduction as a treatment approach, and help other providers reconcile the moral imperative of reducing harm from substance use with sometimes feeling complicit in a patient’s substance use.

Dr. Miyuki Fukui will present practical guidance on implementing harm reduction measures for the management of in-hospital substance use. In-hospital use presents a unique challenge to providers because this harmful activity will occur regardless of whether the patient is hospitalized and receiving medical treatment or not; many patients leave the hospital and suffer severe medical consequences rather than achieve hospital-imposed abstinence. Hospital staff often look to the C-L psychiatrist to navigate these challenging scenarios and direct management.

Dr. Samantha Zwiebel will examine how the management of substance use disorders compares to other psychiatric presentations of self-harm, such as factitious disorder, with respect to harm reduction. While the C-L psychiatrist can feel overwhelmed navigating ethical dilemmas in harm reduction, such territory is not without psychiatric precedent. Dr. Zwiebel will analyze how ethical principles are inconsistently applied across different disorders, and offer practical guidance on how to streamline decision-making.

Dr. Nicholas Kontos will critique the prevalent dichotomization of providers as either “stigmatizers or supporters” and offer a broader interpretation of the ethics of harm reduction. The C-L psychiatrist can help providers reframe harm reduction not as an argument of extremes, but as a carefully considered treatment approach that requires ongoing assessment of how to best serve the patient.