Yesterday was an interesting news day.
First, in Michigan, there were a couple of stories (here and here) about kratom and a legislative push to ban leaf-based and synthetic kratom products.
Later in the day, I began to see coverage of a UK smoking ban for people born after 2008.
I expect that this will provoke intense debate about the effectiveness of bans.
For me, that’s the wrong place for our attention. Even if we were to take a “safe supply” approach, that would require some form of law enforcement, right? How do you maintain a “safe supply” in the context of innovations that are driven by market forces, the desire for a better drug effect, or something else? For example, kratom has been totally legal, with very low thresholds for access, yet we have had innovations like 7-OH emerge. “Safe supply” approaches might impact the pace of innovation, but they won’t stop it.
So… the question on my mind is not whether to ban some substances but rather what a ban should look like. Does this look like a ban on a food additive, pesticide, or very large sugary drinks? Or, does it look like a war-on-drugs ban on cocaine and prohibition-era alcohol?
The legal status of a substance doesn’t dictate a repeat of mass incarceration or abandoning users of the substance. It also doesn’t dictate that ownership of the issue be delegated to law enforcement.
I don’t have a blueprint, but there are a lot of decisions to be made once a bill becomes law, and we shouldn’t assume that the law predetermines all of these matters.
I’ve posted before that every approach is incomplete. I’ll reshare that below.
Over the last decade, as faith in the effectiveness of drug policy, addiction treatment, and drug enforcement diminished, interest and hope in harm reduction grew. Harm reduction was once a last resort response to drug problems and in recent years has become the first line response to drug problems. Harm reduction is now receiving the kind of scrutiny and doubt that other responses have received in the past.
This post challenges that skepticism and seeks to reset expectations for what harm reduction can deliver:
We also must remember that harm reduction programs are often plugging holes in broken healthcare, treatment, and social services systems. Much like how a hospital treats people who come in with ailments exacerbated by poverty, lack of housing, and so on, harm reduction programs attempt to keep people alive in an extraordinarily challenging time, against the backdrop of a potent and changing drug supply. We don’t blame the hospital for society’s failures, and we shouldn’t put the onus on harm reduction programs either.
The overdose crisis is a tragic and complex problem that will not be solved overnight; it necessitates a broader and deliberate vision of our drug policy and requires deep, empathetic care for our most vulnerable. Addressing broader structural issues that contribute to homelessness, addiction, and overdose will not be easy and will take some time. In the meantime, we should empower harm reduction programs to continue saving lives, rather than place unrealistic expectations upon them.How to Judge Harm Reduction’s Success. (2023). Retrieved October 15, 2023, from Psychology Today website: https://www.psychologytoday.com/intl/blog/fighting-a-crisis/202310/how-to-judge-harm-reductions-success
I agree with the author that people are expecting too much from harm reduction, but I’d add that we also expected too much of treatment, policy, and law enforcement.
The truth is that there are no silver bullets. However, the scale and severity of the crisis intensify the desperation for silver bullets. Worse, the search for a silver bullet leads us astray and encourages each player to pretend to be THE solution to alcohol and drug problems.
- Harm reduction is essential and an incomplete response.
- Specialty treatment (addiction counseling and nonmedical treatment) is essential and an incomplete response.
- Medical treatment is essential and an incomplete response.
- Law enforcement is essential and an incomplete response.
- Recovery communities are essential and an incomplete response.
- Community action is essential and an incomplete response.
- Family responses are essential and an incomplete response.
- Public policy is essential and an incomplete response.
I’m sure I missed several things that are also essential and incomplete.
Does treatment need to do better? Yes. Same for harm reduction, public policy, medicine, law enforcement, and communities.
Who should take the lead? I don’t know. I’m not sure it matters if every system recognizes that it is essential and incomplete.
Note: Some readers have questioned whether law enforcement should be considered an essential element. Here are a few things to consider:
- Imagine that law enforcement was eliminated from the response to alcohol-related problems that occur at the individual, family, and community levels. Would that be a good thing?
- Alcohol and other drug use, whether legal or criminalized, is associated with all sorts of negative externalities. Law enforcement will probably always have a role in responding to those problems. Some of those roles might be shifted to other systems or shared with other systems, but it’s hard to imagine law enforcement not playing some essential role.
- Advocates of legalization want regulated drug markets. Who would enforce those regulations at the local, state, and federal levels? (Everything from selling to minors to regulatory corruption.)
