Is harm reduction for drug use the best practice? 

Pragmatism or surrender?

The term "harm reduction" has recently come into the social lexicon as a sort of shorthand for the practice of facilitating a person's self-destructive behavior in an effort to prevent or minimize a graver danger. This is a truly depressing practice.

Perhaps the most depressing example was described in the Oct. 13, 2023, edition of The Week magazine, adapted from a piece by Aymann Ismail describing the organization Never Use Alone. This group operates a "safe use" phone hotline for drug users to call when they are about to use drugs and are concerned that they might overdose. The group's volunteers stand by and talk to the user as they take drugs to make sure that they remain conscious. If they lose consciousness, the volunteer will then contact emergency medical responders. Their business card advertises "No Preaching. No Shaming. No Judgment."

One of the phone volunteers recounted a first-time caller, Kimber, who called after just getting out of rehab and who was about to inject heroin, which she suspected was actually fentanyl. The volunteer obtained Kimber's address and the directions, advised her to have her door unlocked, to lock up her dog, and to leave any Narcan (an opioid antidote) in sight on her coffee table. She advises Kimber that she has to be especially careful due to her stint in rehab, as she may have lost her tolerance. She then kept Kimber on the line, ultimately calling emergency medical services when she became unresponsive.

The volunteer, a nurse, described her own daughter's addiction, her 11 overdoses, and how she buys needles for her, allowing her to inject at the dining room table. Her mantra is a desperate, plaintive "just don't die."

There are similar services operating on the same principle. Needle exchange programs provide new needles to protect against the spread of pathogens like HIV. Safe injection sites allow users to inject under supervision and to receive Narcan if they overdose. Some organizations distribute condoms to schoolchildren in an effort to prevent STDs like AIDS, and pregnancy, even though most agree that children should not have sex. In Switzerland, addicts are actually furnished heroin in clinics, under the reasoning that it will reduce thefts.

The approach is not new. For generations, there have been parents who allow their children to serve alcohol at parties in their home, reasoning that they are "going to drink anyway," and that it is preferable that they do it in a supposedly safer environment.

All of these practices share a common thread: Accept and enable the dangerous or self-destructive activity in order to serve the greater good or preserve life.

Some philosophically object to harm reduction as a sort of general moral hazard, in that it treats the self-destructive behavior as socially acceptable, thus encouraging others to try it. In earlier times, many social pathologies were discouraged by social approbation and stigma. Before the 1960s, drug use was typically seen as low class and the source of shame and embarrassment, which tended to discourage use. It has since become fashionable in many circles, drawing in some who want to follow the crowd, as has the condemnation of those who are seen as judgmental. Characterizing addiction as a "disease" that you somehow "catch," instead of the result of bad choices, has also done a lot to reduce the social judgment that once discouraged use.

The assumption is that they're going to do it anyway, but is that always the case? For example, the safe use program might draw cautious people who want to try injecting drugs or consuming pills of unknown origin but have been previously deterred because they are worried about overdosing. It might encourage an addict to experiment with a higher dose or a dose of unknown potency. Drug users are often aware of the risk of AIDS, and clean needles might encourage them to inject when they might have found a safer way to ingest their drugs.

A safety mechanism in the event that things go badly would seem to lower a user's innate caution, just as using a safety line might tempt a rock climber to try a riskier route.

Harm reduction feels a lot like surrender in our fight to prevent self-destruction, especially since it seems to lower the influence of shame and stigma in discouraging drug use. But it does appear to reduce deaths, at least in the near term, and we conservatives pride ourselves on our pragmatism and ability to make the "least bad" choice.

I also can understand how a parent could be so desperate to save their child's life that they will do virtually anything that will at least keep them alive a while longer, and perhaps long enough to possibly recover from addiction. Hope endures.

I suppose it comes down to a choice between what is best for an individual, versus what is best for the broader society. Δ

John Donegan is a retired attorney in Pismo Beach, who is grateful he doesn't have to make decisions like this. Respond with a commentary of your own by emailing it to [email protected].