Isn’t this just moderation? And moderation never seems to work.
We’re constantly seeking to reduce harm in our daily lives, from air bags, to nuke helmets, to condoms. Moderating could certainly be a form of harm reduction but there are many ways to reduce harm. I once pitched an app to some Stanford kids who were looking for a project where drug users could find each other and act as spotters. Like, “Hey we’re gonna shoot up at 9 p.m. tonight at my house is anyone available to stay clean and bring NARCAN® tonight?” Anyway, nobody liked the app idea, they thought it was an insane legal risk, but I’m not in the business of worrying about what cops might think. My point was that drug use is prevalent so how can we help keep people alive. Is it any different than the designated driver campaigns? Harm reduction could be just committing to injecting safely or using safer substances. There aren’t really hard and fast rules about it.
Who’s a good candidate?
Anyone who’s ready. Some people haven’t had great success with abstinence so it might make sense to start with more obtainable goals. Some people want to look at their drug use, but don’t want cessation of all drug use. The idea of “you’re not ready” is flawed. They are ready, maybe they aren’t ready to be abstinent, but that doesn’t mean small changes can’t be made.
Who’s a bad candidate?
The social worker in me says there aren’t any bad candidates for harm reduction. But, look, I still believe sustained abstinence is the best approach to breaking your drug habit. I’m also a realist. When I hear from young guys who are abstinence resistant, I still encourage them to give it a shot. I have a deep commitment to meeting people where they are, but truth be told, young people are likely better served by seeking abstinence.
When did harm reduction become so popular in recovery?
It’s not! Harm reduction isn’t big in recovery. 99% or more of rehabs are steeped in abstinence. The failure rate is forcing the conversation but there is still strong opposition to harm reduction. It’s viewed as enabling. San Francisco was slated to be the first city with safe injection facilities but Governor Brown rejected it. Even in a city as progressive as San Francisco, there is still strong opposition to harm reduction. But it’s catching on, especially on the community level, like the Harm Reduction Coalition.
Isn’t your version of harm reduction just all a shady marketing ploy by the cannabis industry?
Not at all. The growing cannabis industry doesn’t need people in recovery. I’m one of very few people who promote the possibility of cannabis use in recovery. Cannabis is inherently a harm reduction measure since there isn’t a lethal dose of it that exists. If someone is opiate dependent and injects, becoming a cannabis user is a triumph. The cannabis industry is way more focused on rebranding the lies that have been told about weed than trying to swindle people in recovery.
But are there certain drugs/booze that fall outside of the scope of harm reduction? I mean, could people reduce their daily cocaine usage by smoking crack twice a month? What’s the line here?
Harm reduction is loosely defined as “any positive change” so, while it sounds absurd, and it is, but “less crack” is still reducing harm. If the goal is to “moderate crack use,” that’s a start. If someone says “I’ll only use sterile injection rigs,” that’s great, let’s take HIV and Hep C off the table. The window is open, but we can open it wider. We can also accept the inherent worth and value of all humans, that includes drug users who are unwilling to be abstinent. Few things poll at 100%. “Do you like pizza?” is likely in the high 90’s. “Would you bring your son back to life if it meant he were still a drug user?” That definitely polls at 100%.
If someone fails at harm reduction, is it back to abstinence? What’s plan C.?
Most people fail at harm reduction when they give up. How many attempts does it take for people to stop smoking? Same thing here. It will likely take many attempts to reach a goal, reevaluate and keep going. I really think it’s a matter of sticking to it.
Joe Schrank is Executive Editor of The Small Bow. If you’ve got a suggestion for “I’ll Ask Joe” please email us here.