The soul of harm reduction

Several experts were asked “what harm reduction means to me.

Highlights below:

I regard harm reduction as a subversive way of performing medicine: doing outreach work, sharing knowledge with users, empowering them, care and cure in a more human, respectful and humble way, inventing a model which not only concerns drug use, but also transforms my whole practice

The magnificent work people who injected drugs in New York in the late 1970s and early 1980s did to figure out that they were under attack by an insidious disease – long before science figured it out.

Their success, in spite of continual assaults on their dignity and autonomy by media, politicians and police, in figuring out how to reduce their risk of acquiring or passing on this new disease – long before public health or others did much of anything.

The creativity of users (and their saying “We Are Human”) as they organised activist groups to pressure service providers and governments to help them when they need it and to respect their dignity and autonomy at all times.

To me, harm reduction means love, passion and care to all human beings who live with us … I have graduated from university twice – once from a medical university in Shiraz (my home town) and once from the street university with all the people who use drugs and live with drugs. To me, the most efficient and noble experience was having the chance to be with people on the streets – to live with them and learn from them. Now they are my best friends and my best teachers whenever I need. I feel for the first time in my life that now I have a meaningful dream to live with

I had to smile when I was asked to write this short piece of what harm reduction means to me. Harm reduction for me has become more than something I do at work. It is a philosophy that I have adopted to guide how I deal with many sides of my life and I practice it not only professionally but maybe more importantly in my home. I am a single parent with three teenage children – two girls (11 and 15 years old) and a son of 13….

I have created a non-judgmental environment in my home where my children are comfortable sharing with me what is going on in their lives. HIV and drugs have been a regular topic of discussion in my kitchen for years! Condoms have always been around our house and are not seen as something weird or external – my children know what they are for. I have educated them to be peer educators in terms of drugs, sexual health, and HIV – so that when they hear misinformation from their friends they are able to provide the correct information. They know that I would rather that they did not use any substances, but we have also discussed each substance (including tobacco, ganja, crack and alcohol) and they know the harms associated with each. Instead of preaching sexual abstinence with my children, I have discussed with them the physical and mental health benefits of postponing intercourse to a later age and we have discussed other strategies for satisfying a partner through ‘outer-course’ (politically correct word for ‘mutual masturbation’ or ‘heavy petting’ – as it was called when I was 14!). If they chose penetrative sex, then they know that any boy who refuses to use a condom is not worth having sex with.

The age of sexual consent is 16 in Saint Lucia. As they turn 16, I will let them use the guest apartment under the house for their conjugal visits rather than have them go out to a car or beach where rape is a possibility.

For most drug users, harm reduction – not abstinence – is the only chance to survive. Harm reduction relieves them from the humiliating consequences of prohibition (at least those who have not been deterred). Harm reduction enables them to save their lives and live them free of contempt and humiliation. Harm reduction means to lead a constant fight against people’s need to reassure themselves of their superiority by stigmatising those who deviate from normality. Harm reduction forms a lively counterbalance to the exaggerated sense of duty and hostility to pleasure originating from puritan ideology. Harm reduction supports people who do not want to suffocate in a puritan corset but who strive for a life with intense experiences, even if their attempts often ended in failure.

One thought on “The soul of harm reduction

  1. Harm Reduction I disagree with Harm Reduction.First off, what is harm reduction really? In the raw bass form, Harm Reduction is simply trading one addiction for another. For example a Treatment Center that utilizes Harm Reduction in Drug Addiction patients the person that enters with an addiction to heron will be provided methadone as a form of Harm Reduction. The purpose of methadone is to ease the withdrawal symptoms. A treatment center will have a doctor prescribe their patience in the treatment center marijuana as a trade off for pain killer addiction. For what reason? One Doctor I spoke with stated that is was less harmful and that they could then wean the patient off marijuana with alcohol and then off alcohol with yet another harm reduction procedure of prescription medicine“Oh Really!?” I questioned, “…and how effective is that?” His response, “There is not substantial data available yet because the harm reduction procedure was still in it’s infancy of research at his facility. I then asked a doctor of psychology to enlighten me on this harm reduction theory. The doctor explained that he has seen this Harm Reduction procedure applied to several patients. He came to the realization that it was merely an overt liberality of addressing the subject of people with drug addition, not the addiction itself. He went on to inform me that he no longer believes that harm reduction is the answer. I presented the following portion of the article that spurred me quest. Since the doctor I was speaking with was someone who has had first hand experience with harm reduction and the article was written by another doctor who practices harm reduction, I thought I might get a comparison of intellectual ideas flowing. The Author of the article wrote:. “I regard harm reduction as a subversive way of performing medicine: doing outreach work, sharing knowledge with users, empowering them, care and cure in a more human, respectful and humble way, inventing a model which not only concerns drug use, but also transforms my whole practice” How does he do this? I imagine him going up to someone using a Smoking Crack and hands hand them marijuana and say, “hey, put that bad thing down and use the herbal instead, it’s less harmful.” Using, if you will, a metaphoric example of how I see Harm Reduction. Imagine someone holding a 45 caliber and ready to shoot it. The “Harm Reduction” process would be to trade the person holding a 45 caliber pistol with a 38 caliber pistol. Reason: It does less damage?! Then after a brief time, trade the 38 caliber pistol with a 22 caliber pistol. The concept is to slowly wean the person holding a potentially deadly weapon (In this case Drugs) to eventually have the person holding a mere rubber band. The Author concluded his article with:”For most drug users, harm reduction – not abstinence – is the only chance to survive. Harm reduction relieves them from the humiliating consequences of prohibition (at least those who have not been deterred). Harm reduction enables them to save their lives and live them free of contempt and humiliation. Harm reduction means to lead a constant fight against people’s need to reassure themselves of their superiority by stigmatising those who deviate from normality. Harm reduction forms a lively counterbalance to the exaggerated sense of duty and hostility to pleasure originating from puritan ideology. Harm reduction supports people who do not want to suffocate in a puritan corset but who strive for a life with intense experiences, even if their attempts often ended in failure.”A persuasive argument, however I disagree. Harm Reduction does not work with someone with the disease of addiction. There are other tools available and are much more effective than Harm Reduction. Bottom line, harm reduction is failure not success. You have to treat BOTH the person AND the disease of addiction. Harm Reduction only focuses on one and like a battery it needs BOTH terminals to be connected in order to work effectively.

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