Is "Harm Reduction" Ultimately More Harmful Than Good?
I have yet to look at this side of the issue: been meaning to read a Mike Shellenberger piece on it but have yet to do that, and I saw this at City Journal.
Seth Barron's piece gives some arguments against "safe injection sites" that I think are worth considering (and reading more on):
Proponents say that safe injection sites are an obvious solution to the horrific problem of drug overdoses, which now kill more than 90,000 Americans annually. In 2020, the 30 percent leap in drug-overdose fatalities nearly matched the 40 percent increase in the nation's homicide rate. Opioids killed 69,000 people that year, most of whom died after either injecting or insufflating synthetic opioids, whose hyper-concentrated nature makes it nearly impossible to titrate.Establishing safe spaces for addicts to inject themselves, says city councilman Stephen Levin, "saves lives." He explains that "these centers keep people from dying. The medical data is very clear. Any public health expert says it is not a controversial issue at all. Of course you want supervised injection facilities." De Blasio echoes this premise. Taking issue with a reporter's nomenclature, the mayor explained, "I call it overdose prevention centers, because I think it gets to the heart of what this is. It's to save lives, stop people from overdosing, who could be saved and of course, to in every way, help them towards treatment and support. So, this is an idea that has worked in Canada. It's worked in Europe. It's an idea whose time has come."
Advocates of safe injection sites, whether in government, the media, or in the nonprofit sector, all point to the Canadian experience as positive proof that such programs are a life saver. Insite, which opened in Vancouver, British Columbia, in 2003 as North America's "first sanctioned supervised drug injection site," is considered the gold standard of care from the perspective of "harm reduction."
The principle of harm reduction is that society should ensure that all dangerous, dysfunctional behavior--drug abuse, unsafe sexual practices, failure to comply with psychiatric medical orders, living on the street--happens in as safe a manner as possible. People will not stop using drugs just because they are told not to, so the best way to manage the various side effects of drug abuse--overdose, festering wounds, poverty, crime, child neglect, despair--is to make using drugs as easy as possible. And in addition to preventing death or disease, harm-reduction programs create an opportunity for government social-service providers to conduct outreach, helping addicts or other people in need of services get in touch with care in a trusting, non-stigmatized environment.
It's not hard, though, to see that harm reduction can be a long, dark tunnel to the light of the prosocial day. At Vancouver's Insite, "when somebody's struggling with their injection, like we can see they're getting frustrated, agitated, poking or stabbing away at themselves, it's our responsibility to see if we can help make that safer for them, to find a safer vein," says Tim Gauthier, a nurse and the clinic's coordinator. The staff at Insite don't actively inject anyone, but it's hard philosophically to explain why not, if it would be safer to do so. Similarly, if it is dangerous for an addict to have to go buy impure drugs on the street, how is it not morally justifiable for a harm-reduction center to offer to sell pure drugs on site, at cost? Or to give them out for free?
Advocates would surely object that these thought experiments don't relate to the real-world work of saving lives. So how are Vancouver and Toronto doing in regard to overdoses? Not so well, it turns out. The British Columbia coroner reports at least 1,200 overdose deaths in the first half of 2021, "the highest ever recorded in the first seven months of a calendar year and . . . a 28% increase over the number of deaths recorded between January and July 2020 (941)." Toronto is doing no better: the Ontario coroner reported a record 521 opioid overdose deaths in the city in 2020, and the situation this year is much worse: one day in early May saw five deaths, the highest ever recorded. Even if, for the sake of argument, one wanted to concede the possibility that these numbers might be even higher in the absence of safe-injection sites, the difference made is on the margins. As Christopher Rufo wrote last year in a City Journal story on Vancouver's program: "It's not that addicts who use the safe-injection site are achieving sobriety; they're just not dying on the floor of the Insite injection room."
And none of this raises the other problems associated with "safe injection sites," which are necessarily located in the areas where the scourge is the most acute, and which essentially make the blight permanent by encouraging drug dealers to prey on the sites' users. Robbery of dealers and users will follow, as will street crime and associated dysfunctionality.
Well, here's another hard question: just what do YOU owe the addict?
Even absent the criminal assaults which accompany addiction - how many times is your police department to revive someone with Narcan - so they can go OD again?
There is no reward greater than being high for a very large number of people, and the bulk of these do nothing on their own, or on our behalf.
I suggest that the principle of common decency does NOT extend to relieving anyone of their responsibilities to others, family or not.
In fact, that principle suggests that promoting drug use, by any measure, is not a worthy goal.
Radwaste at November 8, 2021 4:52 AM
By the way - "safe spaces" for addicts?
Where the hell is MINE, so I can walk through a hundred or so American cities without being assaulted to get money for drugs?
Radwaste at November 8, 2021 4:54 AM
I don't know enough about the results in this case, but I'm for results over ideology.
Does giving out free heroin give good results? Less abused kids, less dead addicts, less people pooing on the street? I'm all for it.
Does it make things worse? Don't do it.
NicoleK at November 8, 2021 6:12 AM
Radwaste makes a good point about safe spaces for those of us who aren't addicts. Reminds me a bit of the Leeds prostitution experiment where they decided to make a neighborhood in England a safe space for the buying and selling of sex. It ended up becoming a hellacious space for women who weren't hookers, because every woman was assumed to be a hooker and treated as one.
How do these affect the people living in the neighborhoods?
NicoleK at November 8, 2021 6:14 AM
I don't know enough about the results in this case, but I'm for results over ideology.
Does giving out free heroin give good results? Less abused kids, less dead addicts, less people pooing on the street? I'm all for it.
Does it make things worse? Don't do it.
NicoleK at November 8, 2021 6:12 AM
Whatever the results, rest assured that the people getting paid for these programs will manipulate the numbers to ensure it is portrayed as a rousing success, regardless of the actual results and unintended consequences.
Personally I don’t think that most addicts are interested in safe injection centers anymore than the homeless are interested in free housing in the middle of the Mojave.
After all, getting there, and using it, requires a level of planning that most mentally ill drug addicts are incapable of. If they had a measure of personal responsibility to begin with, they wouldn’t be shooting up on the street.
Isab at November 8, 2021 6:24 AM
Results are racist, asking to test the effectiveness is racist and should never be allowed. Will a University test this? a government agency? of course not unless they can guarantee to get the answer that is acceptable. If not, it won't be published.
Intention is all that matters to the left anymore, they intend roses they get thorns.
Joe j at November 8, 2021 6:38 AM
Most addicts I've encountered have the amazing ability to create their own reality, and live in it. To them, they are smarter and funnier than the sober world. And the cause of their problems not themselves, but the world that has refused to recognize their genius.
Whether it is because they cannot face the reality of the world around them and the fact that they are not the people they wish themselves to be, or because the world as they've experienced it so far is too painful to face, I don't know; perhaps a little of both.
We all get cut from the team, get a bad grade, don't get the job, or get turned down for a date. Most of us learn from our bad experiences and move on in the real world. Addicts medicate themselves and move into a fantasy world.
I don't know if these safe spaces will help addicts transition to the real world, or make their fantasy worlds easier to inhabit. Like NicoleK, I'll support these programs if they can show real success at a reasonable cost. And, like Raddy, I wonder how much of our already-strained public finances we should dedicate to this cause.
Conan the Grammarian at November 8, 2021 7:12 AM
The drug problem is a classic wicked problem where complexity makes it almost impossible to solve it. Here we have a combination of mental illness, lack of discipline, an addictive drug, etc. It is so tempting to offer a single solution to a wicked problem and such will always fail or even make it worse. This is not to say there are never solutions, but simple solutions are not it. Legalizing heroin is not a solution because parents will not be happy that their 14 yr old is addicted. Safe sites don't help much.
cc at November 8, 2021 7:46 AM
1. AA and other 12-step programs have quite harsh rhetoric about "going back out there until you've hit bottom".
Many 12-steppers also have withering criticism for the Therapeutic Community which often lets addicts game the system without attaining any self insight.
Maybe because it's addicts talking to addicts in these programs.
2. These do-gooders have been around since the temperance movement and the Fabian Socialist concern for substance abuse in the early Industiral era.
Then as now they flip victim and perpetrator. That was part if their Prison Reform movement.
Gilbert and Sullivan parodied them in Pirates of Penzance, with a police force we now recognize as "woke"
When a felon's not engaged in his employment
Or maturing his felonious little plans
His capacity for innocent enjoyment
Is just as great as any honest man's
http://www.songlyrics.com/the-pirates-of-penzance/when-a-felon-s-not-engaged-in-his-employment-lyrics/
Ben David at November 8, 2021 8:56 AM
And of course, do they really expect addicts to open a door with a sign that says, "Do your smack here. We'll make sure you don't die!" Most addicts I know are always paranoid that they'll get arrested. And you know those who do participate are going to be asked how they got their supply, etc. Very few are going to use this service.
Fayd at November 8, 2021 9:02 AM
From what I've seen they do use the service... it's the neighbors who are unhappy about it.
NicoleK at November 9, 2021 5:56 AM
Like a bar with free beer, it may be an opportunity to hook up with other drug users. These centers,if they exist at all should be in business or warehouse districts
Isab at November 9, 2021 8:01 AM
"These centers,if they exist at all should be in business or warehouse districts"
Not gonna happen. As this blog and current California fecal flow has shown before, addicts want to be where they can steal from other people. It's part of demanding they be acknowledged without earning attention. While they are alive, they will burden others. They will not live out in an industrial park.
Radwaste at November 9, 2021 4:12 PM
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