Harm Reduction Enables Life
Hello! Welcome to Overdosed a weekly newsletter on drug policy and people who use drugs by me, Diane Roznowski.
The first thing I do every time I get in a car is put on my seatbelt. I do this because cars can be dangerous. Accidents happen, and seatbelts are proven to save lives. In 1968, the Motor Vehicle Safety Standard went into effect and required all vehicles (except buses) to be equipped with seat belts. The government recognized the importance of requiring manufacturers to include them and many state governments require passengers to wear seatbelts. Seatbelts and these laws are forms of harm reduction.
In many aspects of our lives, harm reduction isn’t controversial. We like that there are people who make sure our food is safe to eat. We don’t complain about safety seals on medications or drinks we buy at the grocery store. We like that our prescriptions come with descriptions of the medication, allowing us to know we got the right medication. That’s because harm reduction makes sense and prevents harmful things from happening.
Unfortunately, when harm reduction is talked about in the context of people who use drugs, it suddenly becomes controversial. It shouldn’t be.
People are always going to use drugs. Ending drug use completely can not and should not be our goal.
Harm reduction acknowledges that there will always be people who use drugs and attempts to make their drug use safer. It is often said that harm reduction is meeting people “where they’re at” in their journey with drug use and keeps them alive until if and when they’re ready to stop using.
There isn’t one definition of what harm reduction is because harm reduction is a set of ideas and strategies for reducing negative consequences associated with drug use and conditions that cause people to use drugs in the first place. You can learn more about these principles from the Harm Reduction Coalition.
Opponents of harm reduction will often say that harm reduction enables drug use. It doesn’t. People use drugs for various reasons but simply put they use drugs to feel something or to not feel something. Harm reduction does not cause people to start using drugs. Harm reduction enables drug users to continue living.
Harm reduction is the moral thing to do. It recognizes the humanity of people who use drugs and sees them as worthy of happy, healthy lives.
Harm reduction can include many different things but a lot of it centers around education. Harm reductionists frequently talk to drug users about how to most safely use their drugs, teach them how to spot and reverse overdoses, and teach them other best practices including wound care.
Many harm reductionists agree that harm reduction should also include direct provision of services including giving out sterile equipment and fentanyl test strips. Unfortunately, many times these services are prohibited by state and local governments and/or are extremely difficult to fund.
One form of harm reduction that has proven to be successful in other countries is the creation of overdose prevention sites or OPS (also called supervised consumption sites, safe injection sites, or many other names, I use overdose prevention site as it’s the least stigmatizing). OPS are currently considered to be illegal in the United States, but that is hopefully changing. I’ll cover these sites in more depth in a future newsletter but to summarize for now they are medical-like facilities where people would bring their own drugs to use under medical supervision. The sites provide sterile equipment, medical supervision, overdose reversal (if needed), referrals to primary care, and connection to various services. There are no documented cases of people dying in overdose prevention sites.
Currently, there is at least one underground overdose prevention site operating in the United States, but there are also a few trying to open legally. Safehouse is a non-profit that is determined to open the first legal overdose prevention site in the US in Philadelphia. Again, we’ll go into this more in the newsletter on these sites but Safehouse is currently being sued by the federal government to prevent them from opening. On Wednesday, the first (of likely many) court decision was made about this case. U.S. District Judge Gerald McHugh wrote in his decision, “The ultimate goal of Safehouse’s proposed operation is to reduce drug use, not facilitate it,” which is a big deal. This is a huge first step towards Safehouse being able to open which would advance public health not only in Philadelphia but also across the country. It is a rebuke to the Trump Administration who is trying to prevent these lifesaving sites from opening.
I get asked frequently what we need to do to end the drug epidemics we’re seeing. My answer always includes harm reduction first. We need to keep people alive. Period. If keeping them alive leads to them wanting to stop using drugs down the line, that’s great. If not we’ve at least kept them alive.
I wish I knew more about harm reduction before my sister Emily died. I genuinely believe it’s one of the only things that could have saved her life.
Further Reading
Filter - Alcohol Must Be Part of the Harm Reduction Conversation
Vox - One way cities can reduce overdose deaths: open safe spaces for injecting heroin
Vox - Cities are considering safe injection sites. A federal judge just said they’re legal.
OPB - Judge Rules Planned Supervised Injection Site Does Not Violate Federal Drug Laws
Harm Reduction International - What is harm reduction?
Current Reading
Fentanyl, Inc. by Ben Westhoff - I just finished reading this book last night. I attended Ben’s event at Politics and Prose and was really interested in learning more about the international politics behind the drug that took my sister’s life. I didn’t expect to learn a lot about drugs when reading this, but I did. I had never heard of novel psychoactive substances (NPS) before this book and was truly fascinated by how much harm they can cause. This book really opened my eyes to the politics and business behind China manufacturing and selling the fentanyl that is taking so many lives here in the US.
I’ve read a bunch of the highly talked about books on drugs and opioids and most leave me at least a little bit irritated at the author for their representation of people who use drugs or for their views on the solutions. Ben didn’t leave me feeling that way. While there were some issues with language choice (mainly using the stigmatized term “abuse” when use would have sufficed), his takeaways were spot on. Ben talked both at the event and in the book about how harm reduction needs to be embraced instead of arresting our way out of these issues or trying to stop drugs from coming here in the first place. I highly recommend reading the book.
States split by party on accepting Purdue Pharma settlement - I’m still paying close attention to the potential opioid settlements and found this map AP created to be really interesting. As you can see, state Attorneys General are split almost completely down party lines in deciding whether or not to settle with Purdue Pharma. Only four are not siding with the rest of their party.
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Until next time,
You can find all past newsletters archived here.