Two weeks ago, I started a series of sit-downs with licensed health care providers on the topic of harm reduction, that either I currently work with, or in some cases have worked with. Since I started last week with the most difficult of the interviews, I will post this week about the easiest and most encouraging.
This person is a Board Certified Family Nurse Practitioner that has been licensed for 9 years. In those 9 years, she has worked in Women’s Health and a non-profit specializing in care for people with HIV/AIDS. I asked the same questions of her about harm reduction in general, as well as how it could be applied to tobacco harm reduction that I did with the Physician that I interviewed the week before:
I started with the questions about harm reduction with HIV/AIDS and gave her the statistics(which I think she is more familiar with than I) about the huge reduction in the numbers of deaths and new cases currently as opposed to the numbers at the height of the epidemic. If you didn’t catch it last week, at the height of the epidemic in the 80’s and early 90’s, about 50,000 people a year died from HIV/AIDS-related illnesses. Currently, the number is about 12,000 per year. My first question was, “What thing or things do you think got us to the reduction in numbers?”. She answered, “Education, testing, prevention, better medications, harm reduction services like condoms and needle exchanges, and most importantly, normalizing the conversations and getting rid of the social stigma, particularly among healthcare providers.” (This is already so much easier than the doctor last week whose first answer was “abstinence”).
I asked her if it surprised her that the number of deaths in people who identify as LGBTQ alone from tobacco-related illnesses is currently at about 30,000 per year, more than double that of HIV/AIDS in all the population in the US. She said that she wasn’t surprised. That LGBTQ identifying people have huge and disproportionate rates of smoking and substance abuse. I asked in her opinion, why she thought might be. She answered, “Social stigma, family/social issues, perception of lack of care and resources, and often housing issues.”
Now the good stuff…First, I showed her the report from the Royal College of Physicians that concluded that vaping is at least 95% less harmful than combustible cigarettes. I asked her if she thought the same principles of harm reduction could be applied to smoking with less harmful alternatives such as vapor products, smokeless tobacco, SNUS, etc., and what that would mean for public health. This is her entire answer:
“I would have absolutely no problem talking to patients about switching to vaping if they want to quit smoking. I would like to be more educated about it, and what the barriers might be to someone looking to switch, for example, ease of use, cost, etc. When I was in school, the only options we had to give to people were patches, gum, and Wellbutrin. It is not my job, nor is it ethical to refuse people something based on my opinion or social ‘morals’. It is my job to help someone who asks to lead a healthier lifestyle if they choose. I have a feeling that the new generation of healthcare providers in schools right now may become better educated on the subject, just like every new generation becomes more educated on the topic of the time. Social change and change in medicine come gradually, with each new generation of providers. What I learned in school is radically different from what someone 20 years ago learned. I suspect it will always be evolving.”
Needless to say, I could not have been happier with the way the conversation went. I happen to work in healthcare, so these are easy conversations for me to have. But EVERYONE can talk to their neighbors, family, friends, etc. The more the opinions of society change, the more opinions in all areas, including healthcare will change. It takes time and patience, but it WILL happen. Change always does. Go have a conversation with a non-smoker.
Don’t ever give up.
CASAA Director of Community Outreach