Through The Lens of Harm Reduction
The last two months I’ve been fortunate to have been given the opportunity to see the world through new eyes – through the eyes of former and current IV drug users and their community. Their professional framework is harm reduction; a distinctively different lens than Free To Grow, whose focus was less on the user, and more on the impact of use and abuse on families and communities. While Free To Grow’s work certainly included strategies to provide support to those experiencing the negative consequences of addiction, its bias was undeniably towards abstinence, at least in the case of drugs. After all, as many in the community reminded us, the sub-title was, “Head Start Partnerships to Promote Substance-free Communities.”
The community in which I have been living would argue that use, whether it be alcohol or drugs, has been part of society since its beginnings, and that abstinence is an unrealistic, and not necessarily legitimate goal. That people can make informed choices about their use, and should be encouraged to use in a way that doesn’t harm themselves or others. That the line between legal and illegal drugs is often fuzzy and arbitrary – that marijuana is no more dangerous used in moderation than alcohol or legal amphetamines and anti-depressants. That drugs like opium, heroin and cocaine have historically been used responsibly, and, like alcohol, are only problematic when misused or abused – and subsequently bring harm to individuals, their families and their communities.
As a field, harm reduction is committed to putting in place strategies that are open and accepting of all persons – that don’t demonize or stigmatize people for their drug use, and meet people where they are. In a world where the transmission of HIV through infected needles is one of the most significant sources of new HIV cases and AIDS deaths, it’s easy to feel the discrimination and punitive nature of policies that don’t permit clean needle exchanges. People shouldn’t die just because they’re drug users. We don’t put policies in place that are life-threatening to people who smoke or drink to excess. Yes, these behaviors are legal. But the fact that prostitution is illegal in Thailand didn’t stop the government from launching a broad-based pragmatic condom distribution campaign for sex workers, reducing the prevalence of HIV in sex workers and their partners dramatically. (Of course, the cynical take on the decision to distribute condoms to sex workers could argue that the government was worried less about the sex workers than their clients, who represented all walks of Thai society, to say nothing of the Western men who have for years flocked to Thailand to find the girls of their dreams.)
Some aspects of harm reduction have been easy to embrace: that all people deserve to be treated with respect, that all deserve equal access to preventative measures that can reduce the harm of their risky behaviors, and all should have equal access to ARV and other health treatments if they are sick. It’s easy to see a world that is filled with double standards regarding use and abuse, with wealthy people able to check themselves in to Betty Ford if their use becomes out of control, while poor people more likely to land in jail, without access to humane treatment options. Harm reduction, at its core, demands equity.
Yet, the little time I’ve spent in the harm reduction world has also raised many questions for me. How much use is too much? And who decides? If it is up to the individual, how does one deal with the denial that is often part of addiction? These are not only my questions, but questions that come up day after day in my work here. If an organization is committed to hiring former and current IV drug users, what happens when people begin coming to work too high to function? What is the appropriate intervention? And what of the impact on families and communities, particularly of drugs like methamphetamine or yabaa (or “crazy drug”, as it is called here) which destroy brain cells and increase violent behavior? How effectively does the harm reduction community speak to the crime that is sometimes related to securing money to purchase drugs?
These are not easy questions, and I have engaged in many discussions with those with much greater expertise and background in the approach than me. They, too, acknowledge the complex nature of the issues – that accountability and responsibility are just as much a part of the equation as compassion and acceptance. There is a danger of romanticizing “responsible use”, and turning away from some of the more difficult consequences of any life that includes a reliance on intoxicants – legal or otherwise. But it is a complexity that is, I think, too often neglected, and whose perspective brings a more nuanced framework that could bring greater honesty to our broader prevention work on the ground.
The community in which I have been living would argue that use, whether it be alcohol or drugs, has been part of society since its beginnings, and that abstinence is an unrealistic, and not necessarily legitimate goal. That people can make informed choices about their use, and should be encouraged to use in a way that doesn’t harm themselves or others. That the line between legal and illegal drugs is often fuzzy and arbitrary – that marijuana is no more dangerous used in moderation than alcohol or legal amphetamines and anti-depressants. That drugs like opium, heroin and cocaine have historically been used responsibly, and, like alcohol, are only problematic when misused or abused – and subsequently bring harm to individuals, their families and their communities.
As a field, harm reduction is committed to putting in place strategies that are open and accepting of all persons – that don’t demonize or stigmatize people for their drug use, and meet people where they are. In a world where the transmission of HIV through infected needles is one of the most significant sources of new HIV cases and AIDS deaths, it’s easy to feel the discrimination and punitive nature of policies that don’t permit clean needle exchanges. People shouldn’t die just because they’re drug users. We don’t put policies in place that are life-threatening to people who smoke or drink to excess. Yes, these behaviors are legal. But the fact that prostitution is illegal in Thailand didn’t stop the government from launching a broad-based pragmatic condom distribution campaign for sex workers, reducing the prevalence of HIV in sex workers and their partners dramatically. (Of course, the cynical take on the decision to distribute condoms to sex workers could argue that the government was worried less about the sex workers than their clients, who represented all walks of Thai society, to say nothing of the Western men who have for years flocked to Thailand to find the girls of their dreams.)
Some aspects of harm reduction have been easy to embrace: that all people deserve to be treated with respect, that all deserve equal access to preventative measures that can reduce the harm of their risky behaviors, and all should have equal access to ARV and other health treatments if they are sick. It’s easy to see a world that is filled with double standards regarding use and abuse, with wealthy people able to check themselves in to Betty Ford if their use becomes out of control, while poor people more likely to land in jail, without access to humane treatment options. Harm reduction, at its core, demands equity.
Yet, the little time I’ve spent in the harm reduction world has also raised many questions for me. How much use is too much? And who decides? If it is up to the individual, how does one deal with the denial that is often part of addiction? These are not only my questions, but questions that come up day after day in my work here. If an organization is committed to hiring former and current IV drug users, what happens when people begin coming to work too high to function? What is the appropriate intervention? And what of the impact on families and communities, particularly of drugs like methamphetamine or yabaa (or “crazy drug”, as it is called here) which destroy brain cells and increase violent behavior? How effectively does the harm reduction community speak to the crime that is sometimes related to securing money to purchase drugs?
These are not easy questions, and I have engaged in many discussions with those with much greater expertise and background in the approach than me. They, too, acknowledge the complex nature of the issues – that accountability and responsibility are just as much a part of the equation as compassion and acceptance. There is a danger of romanticizing “responsible use”, and turning away from some of the more difficult consequences of any life that includes a reliance on intoxicants – legal or otherwise. But it is a complexity that is, I think, too often neglected, and whose perspective brings a more nuanced framework that could bring greater honesty to our broader prevention work on the ground.
posted by Lori at 7:51 PM
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