Let Junkies Be Junkies

AlterNet has an article on harm reduction in Vancouver.

Vancouver has essentially become a gigantic field test, a 2 million-person laboratory for a set of tactics derived from a school of thought known as “harm reduction.” It’s based on a simple premise: No matter how many scare tactics are tried, laws passed or punishments imposed, people are going to get high. From winemaking monks to coca-leaf-chewing Bolivian peasants to peyote-chomping Navajos to caffeine-fueled office workers to the junkies of Vansterdam, human beings have never been willing to settle for our inherently limited palette of states of consciousness.

If you accept the notion that people aren’t going to stop abusing drugs [emphasis mine], it makes sense to try to minimize the damage they inflict on themselves and the rest of us while they’re at it. Harm reduction is less about compassion than it is about enlightened self-interest. The idea is to give addicts clean needles and mouthpieces not to be nice but so they don’t get HIV or pneumonia from sharing equipment and then become a burden on the public health system. Give them a medically supervised place to shoot up so they don’t overdose and clog up emergency rooms, leaving their infected needles behind on the sidewalk.

Give them methadone — or even heroin — for free so they don’t break into cars and homes to get money for the next fix.

It clearly is trying to offer some balance, with this wise observation from the AMA…

But it doesn’t have to be an either/or choice. As the American Medical Association states in its official position on the issue, “Harm reduction can coexist, and is not incompatible, with a goal of abstinence for a drug-dependent person, or a policy of ‘zero-tolerance’ for society.”

…and a quote from Neil McKeganey that’s prefaced with a slap at people with questions about harm reduction.

The critique of harm reduction best supported by actual evidence is that it doesn’t do enough.

“The harm reduction approach within the UK appears to have had only modest success in reducing the breadth of drug-related harms,” University of Glasgow researcher Neil McKeganey wrote in a recent overview published in the journal Addiction Research & Theory. “Despite a plethora of initiatives aimed at increasing drug (injectors’) awareness of the risks of needle and syringe sharing, and of providing drug users with access to sterile injecting equipment, around a third of injectors are still sharing injecting equipment.”

Overall, the article provides a good introduction to harm reduction from the point of view of a harm reduction advocate. (Catch that students?) However, I have a few problems with it:

  • It uncritically advances the notion that addicts won’t get well and don’t want to get well. A few subpoints. First, clearly some people don’t want to recover and some people will never recover, but we don’t know who will and who won’t, so the humane thing to do is treat them all as though they can recover.Second, motivation is not static. Those who don’t want help today, may want it tomorrow.Third, it’s important to ask why some people don’t want to recover. How many of these people aren’t interested in recovery due to a lack of hope? How can hope be fostered in these people? (We know something about this.) Can people who doubt addicts interest and ability to recover offer this hope?
  • It advances the tired meme that most objections/concerns about harm reduction are irrational and anti-science.
  • The writer fails to acknowledge the suffering caused by addiction and that harm reduction addresses only a few, secondary causes of that suffering.
  • The writer fails to acknowledge the context of limited access to treatment. Vancouver might be much less controversial if their harm reduction efforts were in the context of a system that was also putting significant energy into getting people well.
  • Finally, the focus of the argument is infection and crime control. What about compassion? What about health care (treatment) as a right?