Michael Powell, reporting at the Atlantic under the heading, “Policies that gave addicts clean needles and places to use drugs were intended to reduce harm. They created a “zombie apocalypse.”:
Harm reduction took root in the 1970s in the Netherlands, where addicts formed unions—the Junkiebond in Rotterdam, for instance—that distributed needles and pushed back against official insistence on abstinence from hard drugs. Not long afterward, this philosophy gained support in some American and Canadian cities. I first encountered it when I reported on a heroin-shooting gallery in Bushwick, Brooklyn, in 1991. The work of harm-reduction advocates at the time undoubtedly saved lives. HIV-infection rates for drug users in Bushwick had reached 50 percent or higher, at a time when that diagnosis was close to a death sentence. Activists risked arrest to distribute clean needles and bleach to disinfect used ones. But some began to argue for a more radical step: There would be less death, they said, if addicts could inject drugs without fear of arrest.
That momentous step came about not in New York but in Vancouver, a city whose political culture was left-wing and libertarian, celebrating the rights of the individual. In 2003, as overdose deaths surged, the Liberal Party of Canada carved out an exemption to federal drug laws and established North America’s first sanctioned injection site, in Vancouver’s Downtown Eastside, a troubled dockside neighborhood. Addicts could bring their heroin and cocaine to a 13-seat center where staff dispensed needles, swabs, and sterile water to cook the drugs and offered advice on vein maintenance. Clinic staff were trained to reverse overdoses, and if that failed, to call a hospital for help.
The whole piece is worth a read, and the photos certainly tell a story. Victims overdosing on the sidewalks, entire parks left vacant because they’re being used for drugs, and other images that look like something out of a Cold War-era documentary on an attack on the homeland.
Powell reports on Seattle and Burlington, Vermont. Two cities with similar approaches to Canadian and European experiments in drug legalization and what most Americans would term “full acceptance”.
Reducing demand, supply, and harm
Harm reduction policies work to reduce three things: Demand, supply, and harm. Reducing demand means supporting treatment and recovery, as well as education. Supply reduction means regulating and restricting access to substances, either through legal interdiction or law enforcement. And harm reduction is about reducing negative risks for people who do continue to use substances.
What’s alarming to me is how public health policies, at all levels nearly everywhere, shifted in the last ten years to a more positive outlook. They’re not “addicts”, they’re “people who use drugs.” People “use” rather than “abuse” drugs. People don’t “fail a drug test”, they “test positive for a drug.”
When we were filming The Addict’s Wake, we ran into a debate whether we should use the word “addict” in the film title. Ultimately, we opted to use the word because it provided clarity on precisely what the film was about and used the language many of us commonly default to, for better or worse.
Now, four years on from the film, most states aren’t better or worse off, just in different positions. Coastal cities and states are still debating how to handle their harm reduction policies. Those of us in places like here in Indiana and the Midwest are picking up the pieces of the opioid epidemic. The fall of the Purdue Pharma company hasn’t hurt, but the sort of drugs most people identify as severe and problematic are still problems.
Marijuana legalization continues to amble along in several states. Illinois, Michigan, Ohio, and Kentucky all have some variation of legal or medical use on the books. Indiana remains the island there with no signs of change. It is likely, however, that legalizing marijuana or any drug in Indiana would not end well. Indiana and its cities have poor coverage for treatment for people who do want to stop using drugs. We see alcohol abuse on the decline, which is worth celebrating, but the inverse is an increase in drug use. Similar scenarios have played out of over generations. When seemingly everyone stopped smoking cigarettes, other products fill the void. For many, that was alcohol. For others, it was sugary foods that prove to be as engineered for addictiveness as anything available on a dark street corner.
Culturally, Indiana and, indeed, most places, just are not in a place to consider harm reduction to the extent necessary to do them properly or well. Indiana briefly flirted with this during then-Governor Mike Pence’s term when rural Scott County suffered a massive HIV outbreak due to dirty needles. The obvious, “easy”, immediate solution was to just supply clean needles. Pence’s administration ultimately did after a few weeks, but at significant political cost from their own party and many others.
But that is only one part of overall harm reduction policies. The other two pillars received much less coverage outside Scott County. Dr. William Cooke led a harm reduction team in the area to support recovery and reduce demand from users. Scott County’s location between Indianapolis, Cincinnati, and Louisville means its hard to spot every car or truckload of drugs into the county.
Still, no one doubts law enforcement’s efforts before, during, and since to reduce supply. Now, many years later, the low income and small population of the county makes it challenging to run effective treatment centers, but significant efforts from grassroots organizations like the Scott County Partnership and others persist. Still, that is a heavy, large lift after a highly-publicized outbreak that garnered worldwide media attention. Most communities would struggle to pull together the kind of resources necessary to dramatically shift the culture under the best of circumstances and intentions.
Culture and economy
One lesser-discussed aspect of marijuana legalization is Indiana’s high density of logistic and warehouse jobs. Indiana is one of the most manufacturing-reliant states, and about a third of the state’s workforce is employed in a manufacturing, logistics, or warehouse job. So, too, is Michigan (where marijuana is legal), so the merits of the debate are open to perception. But Indiana leaders have largely followed the lead of groups like the Indiana Chamber, which has resisted legalized marijuana because so many of the state’s employers would have to shoulder the burden of workplace safety. No one wants to increase accidental injuries and death because someone was high on a forklift, driving a truck, or while operating a large machine.
Some states have navigated the policy side of employer issues, like Nevada, where drug testing is permitted but with thresholds for active agents in a user’s body, nullifying the notion that a person can smoke marijuana on a Saturday and come to work Monday and be punished for it. There is also a parallel with alcohol, but alcohol testing is easier since it’s a single, well-known compound with a known metabolism rate. Drug panels need to screen for many different substances that persist anywhere from hours to days layer with more complexity and less predictable detection windows.
We said in The Addict’s Wake that no one wants to be addicted. But the forces that we found that push people into addiction and keep them there are many. Job losses, grief, trauma, injury, even just recovering from a surgery, can addict even the most ardent, tough-minded conservative or the most sincere and open liberal to a pattern of drug use they never invited, wanted, or intended. And when people find themselves addicted to anything, getting off it frequently requires an immense change in both that person and their community’s attitudes toward a substance. Those are often slow, hard to change, and even harder to identify.
