The Limits of Harm Reduction

Have we created a system which lacks intervention and creates risks to our communities?

by Katya Kowalski

Harm reduction and drug policy reform go hand in hand. We hear the two terms used interchangeably, which makes sense as most drug policy reforms are grounded and associated with principles of harm reduction. 

Often harm reduction is seen as the gold standard – but has this gone too far? Have we created a system which lacks intervention and creates risks to our communities?

To start, we ought to define what is meant by harm reduction. In a drug policy sense, it refers to policies, programmes and practices which aim to minimise the negative health, social and legal implications associated with drug use. The movement is grounded in justice and human rights. Harm reduction interventions are most typically associated with things like: information on safer drug use, drug consumption rooms, overdose prevention and drug checking.  

Over the last few years, there have been steps toward implementing more progressive drug policies rooted in harm reduction and veering away from classing drug use as a criminal issue (and rightfully so), particularly on the West Coast of the United States.

However, does harm reduction work solely on its own?

In 2020 Oregon decriminalised drugs for personal use to curb soaring rates of addiction and overdose deaths. This was a welcome step to address this crisis as a public health emergency, rather than criminal justice one, particularly as the first US state to decriminalise possession of hard drugs. However, since the implementation of this measure, Oregon’s overdose rates have grown. Residents are seeing open air drug use on the streets, tents set up with unhoused people on the streets of Portland and month long waits for treatment.  

We’ve seen a similar situation unfold in San Francisco with soaring rates of homelessness and drug abuse, notably portrayed in Michael Shellenberger’s book San Fransicko.

Alongside decriminalisation a more ‘hands off’ approach is being used with regards to crime and theft. In San Francisco and Oregon any theft under $950 is viewed as a ‘misdemeanour’ under Proposition 47 and therefore rarely sees any intervention from the police. 

Although decriminalisation and a lack of enforcement for theft are two separate policing decisions – a great deal of the public and media see this as one big problem, and it is those who live, work and shop in such areas see the direct consequences.

There is a valid case to be made that in avoiding the persistent harmful criminalisation and persecution of drug users, you prevent such scenes being pushed out of sight – as drug users avoid being seen publicly using in fear of criminalisation. Yet, without any policing of such behaviour or proactive scheme to prevent it, the chaotic nature of such drug use can become even more chaotic.

To help those who are experiencing problematic relationships with drugs, the answer is not just to leave them to their own devices, just in the same way it is not to simply throw them in custody. The answer is to provide them with support services and help. I strongly believe there is a middle ground policy for this in which drug use is treated as a public health issue, with strict and appropriate intervention depending on the individual.

To be clear – I do not oppose harm reduction or drug decriminalisation, I am strongly supportive of both. However, it is important to acknowledge that if someone is on a destructive path, being radically compassionate can in fact cause harm – something which progressives don’t seem to register. 

Sensible and effective harm reduction measures need to be proactive in order to reduce the problem and benefit the individual. That’s why things like diversion schemes are great, rather than simply and only decriminalising drugs. 

Andre Gomes in his recent Talking Drugs piece rightfully highlights that ways to minimise drug related harm is through treatment and intervention. I agree that harm reduction interventions should focus on addressing littering, homelessness and drug consumption rooms to reduce the lawlessness and chaos of drug taking behaviour. But that’s not what’s been happening in the US with decriminalisation. 

I’ve found that in drug policy, matters are often discussed in absolute terms, being either 0 or 100; you’re either pro or against reform and we don’t leave much room for nuance. I personally think the most sensible and realistic approaches sit in the middle. 

What we are seeing with harm reduction is a symptom of a wider socio-political symptom of polarisation and a lack of a nuanced understanding for sensible solutions. Policy makers are doing what they think they should do in order to appease the public. Just because something looks and sounds good on the surface, doesn’t mean that it works in practice. But we live in an era where there is this social fear of not wanting to go against the crowd – and as ironic as it seems, this is happening in the US. Policy makers want to please their base and look to be taking action – despite the consequences.

Jonathan Haidt’s work on the moral foundations theory demonstrates that progressive moral values care deeply about people not being harmed and fairness. However, caring so much means that other, important values are left sidelined and aren’t addressed – which is what we’ve been seeing in the US. 

Progressives hold values of caring, fairness and liberty – but will reject values of sanctity, authority and loyalty as ‘wrong’ or unimportant. This shows why progressives and conservatives struggle to see eye to eye, but it also shows why progressive policies around drug policy are being poorly implemented – because they are only focusing on and addressing half of the moral principles. 

Haidt’s work also explains the repulsion and outcry from social conservatives over the situations in Oregon and San Francisco. No matter what you think we should do about drug policy in society, the reality is that the majority of social conservatives see drug use as immoral and the only way to get them on board with progressive policies is if they satisfy those other moral pillars. 

I also think it is a fair point to state that we need to protect the public from crime and dangerous behaviour. It is wrong to stigmatise drug users for being criminals, but it is ignorant to assume there isn’t a link between drug use and crime. In the case of Portland and San Francisco, there are areas in these cities which are becoming dangerous for the public. These areas are not policed and are becoming exceptionally dangerous places to inhabit.

In order to have sensible drug reform, compassion cannot go too far, otherwise we enter a realm of destruction – something which we can see in Oregon and San Francisco. Policies need to be all encompassing to be a solution.

The precise problem with radical harm reduction policies in the States is that there is no middle ground. Whether you like it or not, the vast majority of the population doesn’t want to see people openly consuming drugs in the streets. And if groups of people that are engaging in destructive behaviours are left to their own devices, then will create more chaos.

Decriminalisation is important, but it has to be backed with other sensible drug policies, like a robust public health infrastructure, strong treatment and rehabilitation support. I also think it’s fair to ask for a police intervention if someone is persistently offending or posing as a risk to the public. 

To solve the drugs crisis in a compassionate and sensible way, we should have:

  • Personalised treatment and rehabilitation plans that suit the individual but are engaging and proactive to actually provide benefit
  • Professional, assertive case managers, along with more and better trained up police officers, treatment workers and psychiatrists to ensure plans are being adhered to
  • Specific goals with are tracked for recovery with a certain amount of pressure that is applied to the drug user to adhere to the goals that are set
  • High likelihood of intervention, rather than severity of action. The lack of intervention from police and public health institutions is what creates chaos, there needs to be reasoned intervention from police to enforce sensible policies so that destructive behaviour doesn’t spiral.

You can’t expect to solely decriminalise, making drugs more freely available without appropriate treatment and rehabilitation facilities, expecting usage rates to go away – they’ll understandably skyrocket. Decriminalisation on its own is not a silver bullet to solving the crisis. 

If we continue to feed into this coddling mindset which the left are persistently nurturing, we will not get out of this victimhood attitude which is being created with the openair drug scenes in the US. The way the drugs crisis has been tackled in the US has been grossly inefficient, going from one extreme with the war on drugs to another. 

This is yet another example of how the incredibly complex issue of drug policy is simplified with acknowledgement of the fact that chaos and destruction will breed more chaos if these policies are not paired with appropriate intervention. 

So, does harm reduction work solely on its own? I would argue no. 

Katya Kowalski is Head of Operations at Volteface. Tweets @KowalskiKatya

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