The words “harm reduction” tend to illicit a polarized reaction, and we’ve been hearing these words more and more these days. Is it because there’s more need for a harm reduction model today than ever before? Or is it because there’s more fear now that Canada’s collective substance abuse issue has spun wildly out of control, and anything less than abstinence would seem to be enabling?
Debates regarding safe injection or safe consumption sites dance across comment threads daily, as controversy around the Housing First initiative picks up steam on the West Coast. There are those who support the idea, and there are those who do not. Of course, there are also those who are either ambivalent or apathetic, depending on the day of the week, the month of the year, or the specific case to which they’re referring. “Are we talking harm reduction for the ambiguous Them, or harm reduction for my son, who I love, who cannot seem to stop shooting heroin, though I desperately want him to, and who will die if he doesn’t stop completely?”
Personally, harm reduction was a model that would not have worked for me when I was actively using. And believe me… I tried.
I tried “reducing” my “harm” by only harming myself on weekends; or only harming myself in public; or only harming myself with the harm that this particular harm dealer sold because his harm seemed purer; or only harming myself using certain harmful things, because when I harmed myself with other harmful things, I’d have a harm-over that lasted for days. For me, abstinence was the only way, and I had the supports in place to pursue that avenue. But everyone’s different. That was my journey, and we’re all working with our own maps.
Not everyone will respond well to the idea of “never again”. It was only when I realized that “never again” pertained more to the forgiveness of my loved ones, and the number of times I’d be able walk out of an emergency room on my own two feet like I had so many times before, that I decided I had no choice but to apply it to my using as well. “Never again” is an abstract concept to a person in pain. To an addict, it’s as complex as wrapping one’s head around the idea of infinity, the irony being that the implication is finite.
Sometimes it’s because the user is too stubborn, or the user is too sentimental, or worse, the user is too stubbornly sentimental. Sometimes there are socioeconomic barriers that prevent serious substance users from accessing the kind of round-the-clock support they might need in order to stop for an hour safely, let alone a lifetime. Sometimes there’s a co-occurring diagnosis, stacking the odds against the user doubly. Sometimes there are waitlists months long for the kind of intense psychosocial rehabilitation suggested for individuals battling addiction along with trauma, whether it’s generational, childhood, or of the acute variety. There are so many things to consider when allowing the word abstinence to stumble clumsily off the tongue, and for that reason (as well as, you know, THE HUMAN RIGHT TO CHOOSE) we have harm reduction.
To say there is decreased value in the practice of harm reduction is to say there is no value in the treatment of mental illness. And, after all, aren’t addiction and mental illness grown of the same soil? We certainly do not tell a schizophrenic to simply stop hearing voices, nor do we tell an individual with clinical depression to just “cheer up”. We ask that doctors and mental health clinicians work with them, taking a person-centered approach, with consideration for the patient’s desire to get well, and hopefully, the patient’s own definition of wellness.
Some people think safe injection sites — despite the very clinical moniker — sound like government-funded crack dens. Some people picture a dirty old basement that’s somehow staffed by workers in white uniforms who run around pouring tropical beverages and offering foot rubs to junkies while they get high. But also… some people still buy and wear Crocs; proof that some people can get it wrong sometimes too.
The “safe” in “safe injection”, no matter where the site is or what the staff may be wearing, refers in large part to the skillful administration of Naloxone, or Narcan, an opiate antidote. When overdose occurs, quick and informed dispensing of Naloxone by trained staff can save lives. And it does.
To say that drugs are bad seems obvious and silly. Drugs are bad, but especially so today. Fentanyl, a highly potent opiate analgesic, is shrewdly creeping its way into product across the country. The death toll due to overdose is higher than ever before, and the people dying deserve a chance at life, no matter what that life may look like, just as much as anyone else. Addiction is dangerous, but so is having a peanut allergy. We don’t tell people that are allergic to peanuts to NEVER cross the threshold of a Thai restaurant. We give them Epi-pens to be safe and suggest they always order with caution. If they want to chance it, and nibble on plain satay at a table with others eating saucy noodles, we don’t then deny them their medicine in the event of a reaction because, hey, we told them Thai restaurants were a gamble.
Though there are many schools of thought around it, I believe addiction is a disease. It can take many years of persistent drug use to work oneself into a state of total dependence, yes. But further to this, a calculated and devastating cocktail of genetics, experiences, and memories, both explicit and implicit, get the addict sick in the first place. We don’t punish the peanut-anaphylactic for being a peanut-anaphylactic. We reduce the potential harm to them by offering medicine and advice.
If there is anywhere to insist upon abstinence, it would be in the arena of judgment. Harm reduction was not my solution, but I don’t dare cast a stone at any agency or individual who wishes to ensure that no more lives are lost to this potentially fatal disease. So before you take a side, consider this: It doesn’t matter if it’s the ambiguous Them, or the son that you raised and love. All lives are precious. And I’m pretty sure that’s a stance that everyone can take together.
About Carli Stephens-Rothman
With a BA in Journalism from Ryerson University, Carli has been writing professionally for seven years. Today she can admit that six of those were mostly a blur. Reaching a year clean and sober in December of 2015 -- after privately (and then not so privately) battling addiction for much of her twenties -- Carli has refocused her personal and professional lives in order to nurture a new path. From her home on Vancouver Island, she continues to freelance for a number of Toronto-based publications, including The Toronto Star and SheDoesTheCity, while setting out upon a new academic journey in the field of addictions and mental health. When not writing or studying, or exploring the brilliant world of recovery, she teaches yoga with a focus on healing and confidence-building.