The Controversy Over Harm Reduction

By all measures so far, 2020 set records for the number of people who died from drug overdoses. Lat week, the New York Times reported that the Biden administration has begun to support “harm reduction” approaches in order to reduce the death toll from addiction. These include controversial programs like needle exchanges, Narcan availability, and support groups. The controversial methadone and Suboxone maintenance approaches, which replace illicit drugs with a long-acting, legal (but hard-to-kick) opioid, are also considered harm reduction, though the article does not specifically say the Biden administration supports these.

The article saddens my heart. It does so not because harm reduction is a bad thing– it is absolutely a good thing. Rather, much of what we call “harm reduction” most western nations call basic decency. Why shouldn’t addicts have access to Narcan in case of overdose, and clean needles so they don’t get hepatitis or HIV? Why shouldn’t there be testing to ensure that the drugs an addict uses aren’t contaminated with deadly chemicals?

The answer lies in our antiquated approach to addiction. Science tells us addiction is a disease. But our society, from politicians to law enforcement to the justice system, treats drug addiction as a moral problem. In essence, we say, “They chose to become an addict, they get to live with the consequences not only of their addiction but of choosing a life that gets them cast out of society.” We won’t help them. We won’t even treat them as human anymore. Nothing that could possibly enable that addiction will be provided, whether that’s a clean needle or a decent-paying job. (Many drug violations are felonies, and you can’t get a decent job with a felony on your record.) Instead, we lock them up until they’ve learned their lesson.

Imagine for a moment saying to someone who has cancer, “We’re going to lock you up until you decide to get better.” Let the absurdity of that sink in for a moment. Sure, addiction creates behaviors we don’t approve of. But if it is biological in nature, we don’t get to blame the sufferer for having it any more than we get to blame the diabetic for having diabetes. (If the diabetic robs a candy store, that’s another story. I would never say that an addict is not responsible for the behaviors they engage in to support their addiction, but they are surely not responsible for having the disease of addiction that compels them to use drugs.)

A couple of weeks ago, I went to court to testify on someone’s behalf at their sentencing. He was last on the docket, so I got to see eight other men and women sentenced. All but one were being sentenced for committing a drug- or alcohol-related offense while on probation. Every one of these struggling addicts received at least a year in jail. One man, who pleaded that he’d never been to rehab and had no idea how to stop using drugs, received six years in prison.

This is our answer to addiction: lock them up. It’s absurd, like locking up a heart attack patient. It’s cruel, dehumanizing, and alienating those who so desperately need help. And it doesn’t work. Which may be why judges are so frustrated that they’re locking repeat offenders up and throwing away the key. Some 68% of those incarcerated for drug offenses are rearrested within 2 years, so why let them out?

The most successful approaches to addiction, including the Twelve Step programs, all recognize one simple truth: someone struggling with addiction can’t quit without help. If we accept that as true, then our societal approach to addiction, which expects a person to just decide to quit and then do so, basically says, “An addict is not worth helping.” Our approach is a death sentence, because addiction is a fatal disease.

So long as harm reduction remains controversial, we are a nation that kills its sick rather than curing them. And that should be offensive to all of us. But harm reduction is just the beginning. Abstinence is the ultimate goal for anyone who has passed into the realm of addiction. My next post will explore what is needed for an effective abstinence-oriented approach, and why it is so difficult for addicts to get the help they need.

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