UNDOING DRUGS

An overview of—and advocacy for—“harm reduction” in addressing drug addiction.

Journalist Szalavitz opens with a grim moment of autobiography: “I had no intention of quitting. I’d only just been introduced to the glories of shooting speedballs, a seemingly divine mixture of cocaine and heroin. I wanted more.” Like most addicts, she wasn’t interested in anything but chasing the high. Thankfully, someone in the room advised her, in those years of the raging AIDS epidemic, not to share needles but, if she had to do so, to run bleach through the syringe and wash the injection point. That, Szalavitz writes, was her introduction to “harm reduction,” a variation on the Hippocratic oath that “works to minimize the damage that may be associated with substance use.” Forms of that damage are many—not just the physical effects of addiction and the danger of numerous diseases, but also social stigma, poverty, and imprisonment. “A big form of harm reduction is keeping people out of jail,” notes one activist, “because jail is really harmful.” Urging that harm reduction is a form of “radical empathy,” the author offers numerous case studies in its practical application over the years—the working-class addicts who educated British doctors in how to treat the illness. One positive outcome was the widespread availability of naloxone, the overdose-fighting drug; ironically, one of its key proponents died of a fentanyl overdose with a strong element of PTSD attached. “Policies to change risky behavior cannot be more harmful than the behavior they seek to alter,” Szalavitz sensibly remarks, noting that efforts to contain drugs such as opioids have driven users to more dangerous street drugs such as heroin and fentanyl.

A controversial but empathetic argument for humanizing the treatment of those locked in substance abuse.