The first time I ever heard the phrase "harm reduction" I was sprawled across my living room couch watching the news with my husband. The feature story covered a nonprofit handing out sterile syringes to heroin users on the US-Mexican border in an effort to prevent disease transmission from shared needles.
"Why the hell would they do that?" I barked, incredulous, before switching the channel. At the time it seemed obvious that supplying paraphernalia to an active drug user meant condoning drug use, if not enabling it. Like most people who've never used illicit drugs outside dabbling in high school, I believed that the best way to prevent drug use was to put addicts through so much misery that they would realize the error of their ways and want to change - either that or lock them up so they wouldn't bother the rest of us.
Ironically, I began working for a harm reduction agency less than a year later. At the time I didn't make the connection between the syringe program and my employer, as I was not hired to pass out hypodermic needles, but to educate migrant farm workers about HIV and hepatitis C from unprotected sex. Later I moved into outreach to active drug users and sex workers and was trained on how to talk to them about the importance of using sterile syringes to reduce disease transmission. I balked at this at first, fighting the urge to add, "but you shouldn't be using drugs anyways." But slowly I started to see how other factors, including poverty, lack of resources, stigma, and the criminal justice system, contribute to drug use.
One user I met, Louise, framed the issue in a new way for me. "Non-drug users think that if they put drug users down as much as possible, constantly remind us what horrible people we are, and create an environment in which we are hunted by police and caught up in a de-humanizing criminal justice system, then we'll stop using drugs," she said. "In fact, it does the opposite. Stress, low self-esteem and unhappiness increase drug use."
I realized with some embarrassment that she was describing my attitude towards drug use almost exactly. What she said made a lot of sense. Since when had making a person feel awful about him or herself led to positive change? As I began to question my long-held opinions on drug users, I thought about my own family. My grandmother was an alcoholic. Though she struggled with addiction and depression for years, she became sober in her late 30s when my father was still a boy and dedicated the next 50 years of her life to helping others overcome alcoholism. At her funeral earlier this year, I was struck by how many people she had touched with her message of hope and redemption, how she drew from her own pain to heal others.
I started thinking, what if alcohol were illegal? What if my grandmother had served prison time for drinking? Undoubtedly my father's life, and therefore mine, would be very different if alcohol were treated the same as heroin, and if my grandmother had faced courts, incarceration, perhaps even the loss of her children as punishment for her addiction. Would the added stress and criminal repercussions have made her more or less likely to achieve sobriety? Probably less. Much less. But alcohol, for all the potential harms it can cause, is not illegal. My grandmother was free to fight her own demons without having to battle the criminal justice system as well. And she won.
This is what harm reduction is about to me. It's about allowing adults to make choices about what we put into our bodies and to assume the consequences of those choices. It's about enabling us to fight our personal battles without involving the state. It's about recognizing that more punishment, more prison, more stigma, doesn't necessarily create better outcomes.
Regarding syringes, I have realized that denying needles to an injection drug user no more decreases drug use than withholding cups would render an alcoholic unable to drink. Still, it is easier to jump to those conclusions than to contemplate the true complexity of problematic drug use. It's easier to say, "If they would just stop, they wouldn't have all these other problems." But part of maturing is the recognition that life is not made up of neat, black and white categories, especially with regards to decision-making. Ultimately, addiction is a private struggle that some will win and others will lose. But for most people, de-humanizing treatment and a prison record tip the scales in favor of losing.