harm reduction

July 11, 2024 9:00 AM

I LIVE DOWN THE STREET from what I call Car Corner — an intersection anchored by a tire shop, a car dealership, an auto-parts store, and a mechanic. On the other end of the block is a bike path that cuts through the city, a converted railroad track. In the warmer months it buzzes with cyclists, skateboarders, police cars, boom boxes, firecrackers [n+1, content note: On Delivery: the overdose crisis] previously
posted by HearHere (18 comments total)

Jesus that was good
posted by Uncle at 9:37 AM on July 11 [8 favorites]

This was excellent! I was quite struck by the following line:

Drug use has no inherent moral value, and this can make harm reduction a controversial political project, even on the left, because we like to build movements around the virtuous.

I am pro-harm reduction, but it's wild to see how many folks who would consider themselves liberal/left vehemently oppose them. If they aren't opposing transitional housing being built near them, that is.
posted by Kitteh at 9:41 AM on July 11 [11 favorites]

around the virtuous
Nature offers “advocating for drug users’ health, not their rights, figures as a morally and politically palatable stance for stakeholders.” content note: Haidt, yet also Lakoff [wiki]
posted by HearHere at 11:24 AM on July 11

This is some of the best writing I’ve read in 2024
posted by Jon_Evil at 11:43 AM on July 11 [7 favorites]

That was incredible. I have been doing harm reduction work for about 19 years in various capacities: community-based orgs, underground orgs, government, as a volunteer and for pay. So much of the last couple of years I feel like I have been needing more people to lean into the nuance and the contradictions. This is one of the better articles I have seen that encapsulates some of the *feelings* of this work. It is lovely and hard and messy and gorgeous and it is community. When done well it is the difference between being in community together and not just doing services at someone. And so much is logistics and supply chain management and filling orders and also sharing space and holding grief and joy. I also really appreciate the very clear acknowledgment that people who use drugs are the ones who are and should continue to be the ones who do and lead this work. It was a really well done version of show, don’t tell. This is one of the hardest pieces to hold onto as the mainstreaming of harm reductions continues but it is fundamentally crucial to its effectiveness on decreasing morbidity and mortality as well as the community building aspects.

There were a few bits in there I very slightly bristled at, but that’s the point, we can be together knowing “stuff gets more complicated”. And I will be holding onto the phrase “doesn’t demand shame as the price of care.”
posted by Hopeful and Cynical at 12:48 PM on July 11 [10 favorites]

Thank you, that was powerful. And a reminder that not only do we need to get these people out of the river, we need to go upstream and find out who's throwing them in. And that involves so much housing policy, and public space design, and mobility, and...
posted by straw at 3:29 PM on July 11 [2 favorites]

I have a friend—she's my wife's friend, but I went to her wedding, so, sure—who is a passionate advocate for Naloxone: she's a nurse, and she does presentations about it and how to use it to community centers and the like. I respect that she's passionate about something she believes is doing good. Personally, I think it's really swimming against a strong current to try to save people who are that intent on nullifying their lives.
posted by outgrown_hobnail at 3:41 PM on July 11 [1 favorite]

Personally, I think it's really swimming against a strong current to try to save people who are that intent on nullifying their lives.

The article itself is a strong counterpoint to that position. Like half of it is devoted to not being able to get people naloxone that they were asking for due to a shortage.
posted by hoyland at 4:39 PM on July 11 [9 favorites]

i used to work in this industry. the line i found had the most success with normies complaining about harm reduction was "do you think the punishment for using these substances should be mutilation and death?" because if you're not on board with harm reduction (amongst other things) that's what will be inflicted on many who would otherwise live.
posted by LegallyBread at 4:50 PM on July 11 [8 favorites]

...swimming against a strong current to try to save people who are that intent on nullifying their lives.

I mean, I get it, there's the argument that without Naloxene some of these folks wouldn't use, and if I wear the "pulled myself up by my own bootstraps" "hard work will get you everywhere" "poor people need to apply themselves" hat I grew up with, i can see that, but I'm gonna put on another hat.

And that hat is: I have some friends. A bit younger than me, but definitely adults. College educated upper middle class white people. Some of those friends have thrown tens of thousands, if not more, down the standard psychology and psychiatry rathole. Some of those friends have trauma that is impacting their lives. Sure, it's not living rough on the street trauma, some of it is abusive workplace induced trauma, but it is very strongly negatively impacting them. So they're augmenting their alternative therapy with some of the alphanumeric drugs, probably from sketchy suppliers.

Is it doing them good? I don't know. They seem to think that it's moving them forward in ways that the money they shoveled down the conventional psych treatments didn't. How do we judge outcomes from that, anyway? Ability to grind a 60+ hour week? Self-reported happiness? Something in between?

It's not my jam, these days I'm off alcohol and using cannabis sparingly, but we all self-medicate as we can, and, hell yeah I hope they have access to whatever they need to deal with the shit they're dealing with. And Naloxene because they can't trust the supply chain.

And these are the people with loving families and medical plans who haven't suffered the trauma of living rough. In terms of what they're trying to heal, it's far less, and my impression is that, yeah, they're finding what they need and moving on from the substances.

But until there's a better answer for them within the system, I have no problems with supporting their progress outside the system.
posted by straw at 5:48 PM on July 11 [7 favorites]

there's the argument that without Naloxene some of these folks wouldn't use

it’s a really, really bad argument but I suppose it’s an argument
posted by atoxyl at 5:57 PM on July 11 [4 favorites]

Personally, I think it's really swimming against a strong current to try to save people who are that intent on nullifying their lives.

One could certainly characterize trying to help people with intractable addictions broadly as “swimming upstream” but it makes little sense to frame naloxone distribution this way, since it’s ultimately just giving ordinary citizens the means to administer treatment that would otherwise be administered by medical professionals. And for medical professionals “we’re not going to give you this $40 drug that will immediately save your life because you might do dangerous things again in the future” is not really the ethos.
posted by atoxyl at 6:13 PM on July 11 [5 favorites]

I certainly wasn't trying to "nullify my life" when I was in my addiction, even though it may have seemed like that to an outside observer. (I have no doubt that I came closer to doing so than I will ever know, because I was drinking to blackout and beyond pretty frequently near the end.) I support harm reduction, although I don't quite trust myself to handle drug-administering paraphernalia or spend much time around people who are actively using. It took me more than one try to get and stay sober, so I'm willing to give people as much Narcan as they need; I hope that they do get clean, but having a disease shouldn't be punished by death by neglect.
posted by Halloween Jack at 9:12 PM on July 11 [12 favorites]

Great essay. Inspired me to volunteer for harm reduction orgs out here, if they’ll have me.
posted by infinitewindow at 9:20 PM on July 11 [3 favorites]

> and not just doing services at someone

"doing services at" is a brilliant phrase and i'm going to steal it
posted by bombastic lowercase pronouncements at 8:15 AM on July 12 [2 favorites]

This is ‘there is no ethical consumption under capitalism’ but with the good and the bad consequences pushed to the ultimate extreme. Unless you’ve saved someone’s life this week I wouldn’t judge.
posted by bq at 8:20 AM on July 12

America is the land without second chances. Many people would like anyone not middle-class to be eliminated, executed, banished. Get the kids who can't read out of my kids school, punish staff who have attendance issues, close the castle and pull up the drawbridge.

I suspect this is a fundamental human perspective. Overcoming this is how humanity itself evolves.
posted by rebent at 2:39 PM on July 12 [1 favorite]

Personally, I think it's really swimming against a strong current to try to save people who are that intent on nullifying their lives.

For the record, this is incredibly offensive.
posted by adrienneleigh at 3:41 PM on July 12 [6 favorites]