December 6th, 2016
You know how it is. You say you work in harm reduction to somebody outside of the echo chamber and they look at you funny. You patiently give a basic sketch of what it means, omitting as much jargon as possible, and you can tell the person isn’t really listening.
Then they interrupt to ask some questions that prove they weren’t listening.
Now, you’re all about meeting people, even this person, where they’re at, but where you’re at is you didn’t eat lunch yet and this is starting to feel futile.
So here are some suggested answers that should shut them… I mean, educate them. And maybe make the conversation a little more enjoyable.
Q: But doesn’t everyone want to reduce harm? What’s so special about what you do?
A: Yes, you’re quite right. I hadn’t thought of that! Maybe it’s just that we all want to reduce harm in different ways.
For example, some people who work under the mainstream addiction treatment model want to reduce the harm for people who have decided to quit using drugs—by increasing the harm for people who haven’t yet decided to quit! (Some stuff called leaving them to “hit bottom,” and “high-threshold treatment,” also not wanting to let them to switch out their riskier street drugs for much safer medical drugs, even though it’s less likely to kill you than attempting to do no drugs—I’ll explain all that after lunch).
Other people in the criminal justice system work to reduce the harm for people who use drugs by arresting them and locking them up. They also get to the root of the problem by locking up people who sell drugs (never the same people who use them); you can see for yourself how successful they’ve been at making sure there are no drugs in our society. Sure, their approach means that people live in horrible conditions, are separated from their families for years, and are stigmatized and denied opportunities once they’re released… But their main point is, there are absolutely no opportunities for “drug abuse” in the appallingly inhumane conditions of a prison. Oh wait.
But yes, everyone is a harm reductionist!
Q: But only addicts use drugs. And people always have to quit before they can be productive, right?
A: Huh, that’s an interesting point you make. I guess I do struggle, now I think of it, to name anyone who drinks alcohol and is happy. Nor can I put my finger on a single tech entrepreneur or musician who has thrived after using LSD—and of course, the titans of Wall Street are a resolutely cocaine-free bunch.
Yup, you’re right: Everybody who uses drugs is addicted and therefore unproductive, and recovery is only ever possible if you never use any drug ever again! Let’s face it: None of the 150 million-plus Americans who have used marijuana has ever amounted to much.
Q: But what about heroin!? That’s the most evil thing in the world.
A: I hear you, buddy, I hear you. That’s why we need to take away just some of those desperate harms somehow (remember my previous answers?). So look, even if you’re right that heroin is the worst of the worst, and that people who use it are doomed, how about we try to not add to their problems? Ok? Go with me on this.
So we’ll give them love and support. We’ll give them sterile syringes so they don’t contract blood-borne diseases. We’ll make sure there’s naloxone all around, and people trained to use it. And, I know! Let’s make those medical drugs available if people want them. And why stop there? Let’s make heroin legally available—not because we promote it, you understand, but so people aren’t killed by the adulterants in street heroin (those combinations do most of the killing, you know). Oh and one more thing—we’ll set up welcoming, professional facilities where people can use their heroin under medical supervision.
Because you know how many people have died from an overdose in one of those facilities, my friend…?
Nope, not 4 million. It’s actually zero.
So, whad’ya know? Maybe people who use heroin aren’t inevitably doomed. And maybe, just maybe, people who use it—even those who are addicted—are inherently valuable human beings who already contribute amazing things to society all around you.
Ever think of that?
Q: Not really. It sounds like this harm reduction thing is just an excuse to drink and use drugs?
A: Now there, I think you got me.
Yes indeed: We all work for nothing; we risk arrest handing out lifesaving supplies in jurisdictions where they’re considered a threat to public order; we put our careers at risk; we spend time trying to explain things to delightful people like you; we do all of this in order to have the opportunity to do something that frat boys are doing for free at the local state college. Precisely.
Actually (and now, you really are going to have to follow me as I start walking very fast towards the place where I’m going to eat my lunch, on my own), harm reduction means believing that every human being, including you, has value, regardless of their relationship to substances. Harm reduction is about loving unconditionally. Harm Reduction is about improving public health, for people who use drugs and for everyone. It’s about saving lives. It’s about social and racial justice, and fighting to change the laws that make those things impossible. It’s about believing, my friend, that every person should have the chance to live a happy, healthy and fulfilling life—no matter which drugs they may use.
April Wilson Smith is an epidemiologist who lives in Philadelphia. She was previously a union organizer for 18 years. Her last piece for The Influence was: “How I Went to Rehab for Alcohol and Found Out I Was a ‘Heroin Girl.'”