EP.8 OPEN ACCESS, OPEN MIC WITH DR JUDITH FEINBERGEP.8 OPEN ACCESS, OPEN MIC WITH DR JUDITH FEINBERG
Open Access, Open Mic
Lynn Madden talks with Dr Judith Feinberg about harm reduction, HIV, and the opioid crisis, focusing on syringe services, integrated care, and stigma. Their discussion highlights practical system changes and personal stories that show how treating substance use as a disease can restore health and hope.
44:04•29 Apr 2026
Harm Reduction, Hope, and Hard Truths with Dr Judith Feinberg
Episode Overview
- Substance use disorder is described as a chronic relapsing brain disease, not a moral failing, and criminalising it is questioned as illogical.
- A spike in endocarditis among people who inject drugs signalled serious risk for HIV and hepatitis, prompting a long campaign to start a syringe services programme.
- Mobile harm reduction services can offer sterile equipment, sexual health supplies, benefits enrolment, and direct support into treatment, including transport and accompaniment.
- Integrated care for addiction, HIV and hepatitis in primary care settings encourages people to engage with broader health needs and reinforces their sense of worth.
- Reducing structural barriers, such as long waits for appointments, and routine screening for HIV and hepatitis are highlighted as simple but powerful system changes.
“Substance use disorder is a chronic relapsing brain disease… I didn’t take the just let them die oath.”
How do people find hope in the darkest times? This conversation between APT Foundation CEO Lynn Madden and infectious disease specialist Dr Judith Feinberg gives a grounded, no-nonsense answer. Aimed at people interested in substance use, harm reduction, and public health – from those in recovery to clinicians and policy nerds – this episode blends big-picture systems talk with very human stories.
Dr Feinberg explains how her love of “solving a mystery” pulled her into infectious diseases and HIV at the very start of the AIDS epidemic, and how that same mindset later pushed her into harm reduction.
You’ll hear how a spike in endocarditis cases signalled a new injection drug use crisis in Cincinnati, and how that led to a nine-year fight to launch Ohio’s first syringe services programme, complete with a refitted RV, sterile equipment, condoms, Medicaid sign-ups, and staff literally driving people to treatment and sitting in the waiting room with them.
As she says, “I didn’t take the just let them die oath.” The episode spends serious time on stigma: why substance use disorder is “a chronic relapsing brain disease” yet still treated as a moral failure, why criminalising it “just seems strange”, and how structural barriers like 30-day waiting lists send the message that people don’t matter.
Lynn and Judith break down how the BIRCH project in rural West Virginia helps primary care clinics integrate addiction care with HIV and hepatitis testing and treatment, and why simple changes like same-day appointments can dramatically increase engagement. Anyone wrestling with shame, working in services, or just trying to understand why harm reduction matters will find candid, practical ideas here – and a lot of hard-earned hope.
It might leave you asking: what would change if every clinic treated people who use drugs as worthy from the moment they walked through the door?
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