Discovery Recovery introduces harm reduction to drug conversation
BUTLER TWP — First responders and doctors treating addiction patients have one requirement: believe everyone deserves safety and dignity.
“In order to understand and embrace harm reduction in the substance use community, there is one fundamental requirement, and it is that you believe all people deserve safety and dignity,” said Dr. C Thomas Brophy, medical director of The Ellen O’Brien Gaiser Center.
Harm reduction was the theme of the third annual Discovery Recovery Symposium presented by the Gaiser Center and hosted by Butler County Community College. The center aims to create through the symposium a community dialogue regarding addiction treatment with the belief that anyone can stop a fatal overdose.
Brophy, a double-board-certified doctor in addiction and emergency medicine who has worked for UPMC and Allegheny Health Network, began by explaining harm reduction isn’t a taboo practice that occurs only in the addiction field. He said items like seat belts, sunscreen, helmets, vaccines and contraception are considered harm-reduction techniques.
Brophy said from 2020 to 2025, drug overdoses have slightly risen year over year peaking just over 120,000 per year. Despite not seeing the most recent reports, he said he’s heard from reliable sources overdose deaths are beginning to plateau.
“I think it lends so much to the fact that people are not only embracing, but are actively engaging with harm reduction and making sure (we’re doing) whatever it takes to keep people alive,” Brophy said.
Brophy explained the neuroscience behind addiction and phases of change a person experiences when trying to cut a habit create the largest barriers to addiction treatment. He concentrated primarily on the pre-contemplation state, meaning when a patient is in denial there is a problem.
“That’s the main phase that we need to embrace harm reduction, because they’re not quite ready, from a psychological standpoint, to make steps toward treatment and improvement,” Brophy said.
When studying the effect of substances on the brain, he said doctors tag the substance with microscopic radioactive isotopes that illuminate the particles in an MRI. He said the substance goes to the limbic system, which tells the body its basic needs like food, water and safety. He said when substances are involved, they take over the limbic system so the patient chooses the substance over essential needs, which is why a patient cannot be talked out of their dependence.
“Their limbic system has now been hijacked by the dopamine it’s getting from that drug use,” he said.
Applying harm reduction to addiction medicine provides a more stable recovery path for a patient, Brophy said, and can include practices like providing safe injection sites so diseases aren’t transmitted via needles, fentanyl testing strips to ensure substances aren’t laced and helping to ensure patients not dependent on opioids do not become dependent.
“The fentanyl test strips are for your kid who’s going to college next year, who’s probably going to experiment at some point, and they don’t want to die,” Brophy said.
When tackling needle exchange programs, Brophy compared exchanging a dirty needle with a clean one to stopping the spread of blood-borne pathogens. He said one of these sites has operated in the neighborhood of Oakland in Pittsburgh for about 20 years, which he remembered from his brother’s experience with heroin addiction.
“Because of the way the brain works, they’re not using that prefrontal cortex in that moment,” Brophy said. “They’re not looking at that needle and thinking what are the pros and cons.”
When discussing safe injection sites, Brophy pointed to a site in Vancouver, British Columbia in Canada, which has seen more than 4 million visits and 50,000 overdoses but no fatalities. He said about 15-20% of those users ask for help with their addiction — once they feel safe.
Brophy added a safe injection site briefly operated in Manhattan, and one almost opened in Philadelphia.
“I understand that people don’t want a safe injection site next to their kids’ school or something along those lines, but there is still use and utility in having these facilities,” he said.
Staff from the Gaiser Center also led a breakout session regarding how to identify burnout and prioritize self care. Anna Shuster, the center’s clinical director, said the part of the brain taken over by addiction is the same part responsible for the fight, flight, freeze or fawn response.
She said burnout is essentially the nervous system going into overdrive, and each person has a different response to this. It starts with an increased heart rate after a person perceives a threat, muscles constrict, and the digestive system starts to shut down.
“All while that’s happening, our frontal cortex, the smart part of our brain, can go offline because we need our flight, flight or freeze (response) to activate,” Shuster said.
She said when someone is asked to take a deep breath in a stressful situation, it’s because getting more oxygen to their brain will help.
Center director Joe Mahoney said first responders and doctors curb this response by training themselves to stay calm undergoing repeated stressful situations.
“Their training has effectively shut down their ability to recognize the emotional aspects,” Mahoney said.
Alyssa Vorel, the center’s supervisor of outpatient and ancillary programming, said a person can help themselves avoid burnout by learning to recognize and treat the signs in themselves. Mahoney added paid time off should always be utilized to avoid burnout, and attempting to push through burnout makes people less productive.
