What’s the Harm in Harm Reduction?
It sounds nice. Who wouldn’t want to reduce harm? After all, harm is bad, right?
“Harm reduction” is the term used in the field of substance abuse to describe methods employed to lessen the risk factors that come along with using illicit drugs. Things like an overdose, disease, and crime fall under the umbrella of what’s considered “harm.” The thing is that if people are getting bad heroin and dying, we don’t want that. So…. Give them good heroin?
Forms of Treatment
Of course, the above is an oversimplification. But, then again, this approach is actually underway. A study published in 2018 suggests prescribing pharmaceutical-grade heroin to current heroin addicts as a valid form of treatment. Yes, you read that right. And, it’s being seriously considered. Many people are working to mitigate the fallout of addiction and the new school has adopted an approach of accepting it and trying to make it less harmful. The push to make this a virtual policy for how to deal with this epidemic is gaining traction in many places.
War on Drugs
There are several other ways in which the harm-reduction approach also manifests itself. Free needles, safe injection sites, and replacement drugs such as Suboxone and Methadone are the bread-and-butter of harm reduction. Most of the “stigma-free” campaigns you’ve likely heard about contain, as a core element, the normalization of mental health conditions which includes addiction. But why did a nation with a strict “War on Drugs” attitude evolve into a place where acceptance, tolerance, and assistance of safe drug use exists and is promoted?
The answer probably lies within the stark fact that the war on drugs has become a lengthy set of lost battles. It’s clear that filling up prisons with drug offenders and giving stiff sentences, penalties and fines haven’t really discouraged people from using drugs, especially once they’ve started. Treating people like the scum of the earth tends to further a sense of separation and a worsening of behavior, both in and outside of addiction.
So, does the solution lie in a complete 180-degree approach? Let’s look to San Francisco for this answer. The city has been employing the harm-reduction approach quite heavily in recent years, giving out over 4.4 million needles annually to its growing population of 22,000 intravenous drug users. There’s a Drug User’s Union, which is pushing for a safe place where people can “use and enjoy drugs”. Non-profits make and distribute safe-snorting and crack-smoking “kits”, which are given to at-risk and homeless youth. The idea seems to be; they’re going to do it anyway so… let’s make it safer to use drugs. This has resulted in a blurred line between harm reduction and drug advocacy.
But is it working? Citizens of the area seem to doubt it and voice complaints ranging from an increase in homeless population to public places no longer being safe and sightings of people shooting-up openly. The media has exposed the vastness of the biological hazard that comes along with millions of used needles being tossed in the street, and residents are moving out of town. Financially, the city has begun paying roughly $1.7 million per year to have “most” of these discarded needles cleaned up, and businesses are having trouble due to a decrease in tourism.
Adding fire to the flames is the trend that objecting to harm reduction is often viewed as a form of stigma towards drug users which is heavily frowned upon. Ending stigma towards mental health issues, which addiction is considered such, is a campaign that has gained much momentum in the last decade. Stigma is a mark of shame or disgrace. The purpose in pushing for stigma-free attitudes is that if people are scorned for their illnesses, they’ll be less likely to be open about them and thus seek help. It’s a noble cause that can create much impact but, like anything, can be taken to extremes. If you can’t point out a problem anymore due to harsh backlash, something’s wrong.
And something is very, very wrong. Addiction is worse than ever, and the nation’s apparent dilemma is: Should drug addiction be punished, and substance use disorders just ignored in hopes that it wipes itself out like a plague? Or, should drug use instead be accepted, and made “less dangerous” by giving the drug user more freedom and protection? Notice that both approaches contain an element of defeat and apathy toward the root problem. This is the basis for quite a division of ideologies. A stroll through social media posts about harm reduction reveals argumentative commentary polarized between “just let them kill themselves” and “just normalize and accept drug use.”
But, like most things, the answer likely doesn’t lie with either extreme.
If we look at it honestly, it’s hard to argue that there’s any upside to drug addiction and the harm that comes along with it. Families are destroyed, people die, and crimes against the innocent are committed every day as a result. It’s an issue that needs solving; it needs help. So, what does that help look like?
Perhaps, exploring a microcosm of society can shed some light. Rather than look at the whole, national problem, think what you’d do if a member of your family was struggling with substance abuse. Would you estrange and belittle them in hopes they’d overdose and the whole thing would just be over with? Would you provide them with needles, drugs, and a place to use and live while insisting this was all normal? Unfortunately, society’s dilemma is reflected on this smaller-scale daily, as many families try both approaches before either wising-up or losing their loved one.
If you consult a real professional in the field of addiction, they’ll tell you bluntly that neither of those methods works in treating an individual with substance use disorder. They definitely need help. They don’t respond well to punishment. Enabling makes the situation worse. And an aloof apathy surely doesn’t change anything. But the help they need is difficult to muster. It’s caring but tough. Do not give them money. Do not aid in their drug habit by giving them a place to endlessly crash and use drugs. Support them in the direction of getting treatment.
Applying this approach to the national crisis could be effective, as we’re essentially dealing with many individuals. It’s unlikely that addiction will be completely “eradicated” so long as there are drugs on this planet. But it could be significantly reduced. Rather than aiming to reduce the harm, which is the consequence of addiction, a far better target would be the source. To do otherwise is to surrender to the idea that nothing can be done about it, and either ignore it or to try and make it more palatable. Imagine such an approach were taken in the field of medicine whenever disease struck. We wouldn’t be here right now.
Drugs aren’t an “enemy.” They’re an inanimate substance. Perhaps that’s why the war on drugs never got us anywhere. Similarly, fighting the harm that addiction causes are another way of dancing around the issue. Treatment, education, and prevention are approaches aimed at the source, and they work, when done well. Perhaps the funding and efforts being given to both harm reduction and imprisonment would be more sensibly invested in these areas.
After examination, harm reduction brings to mind the term “band-aid” solution. But band-aids don’t solve addiction any more than they cure or prevent diseases. Before things get any worse, let’s popularize a different model… addiction reduction. The reality is, the people who die every day from substance abuse have a face and a name. They were someone’s family. Perhaps it’s time we wise-up.