The only goal should be keeping people alive
Would Kevin be alive if our country had a better drug policy?
It’s possible. It’s also impossible to know. The only thing we know is what happened. My brother-inlaw, after dealing with various addictions his entire adult life, bought drugs on the street in November 2020. The pills included fentanyl, and he overdosed and died at age 45 alone in his Manhattan apartment.
His story is unique, but also devastating in how common it has become. He was one of more than 78,000 people who died in this country of opioid-related overdoses in a 12-month period. And it didn’t have to happen. We’d all like a world where people who are addicted to harmful substances are able to be free of them. Rehab, sober homes, 12-step programs and other treatment options work well for some people. They don’t work for everyone, and that doesn’t even get into affordability or availability, both of which are major problems.
The strategy of harm reduction recognizes that getting people off drugs isn’t the goal. It’s merely a goal. The goal is keeping people alive.
Dr. Benjamin A. Howell, of the Yale School of Medicine, who treats addiction and researches ways to address the opioid crisis, said harm reduction is about meeting people where they are.
“It’s an approach to addiction that says everyone deserves efforts to decrease their harm, and that includes people actively using drugs,” he said. “It’s a spectrum. We shouldn’t force people to say the only option is abstinence or to get into treatment if they’re not ready.”
Harm reduction goes against many people’s instincts. Anything other than abstinence is in many quarters considered a failure. It’s hard to believe we’ve been having these same discussions for my entire life, but when I was a child in the 1980s, we had Just Say No, a national campaign straight from the White House that said the real answer to drugs was denial.
It worked as well then as it does now — hardly at all. But despite everything we’ve learned in the past 40 years, our national outlook has not changed nearly enough. The nation’s prisons, to name one example, are filled with people who are addicted to harmful substances, and, as thousands of deaths a year will attest, scaring them into submission has not proven an effective strategy.
For some people, there may not be an effective strategy.
“The stigma is real,” Howell said. “Even people who are active users, who know they need help, will self-stigmatize, and that leads to people not accessing treatment.”
Kevin, by contrast, had tried many different treatments, even if he wasn’t always a willing participant at first. It sometimes worked, for a while. But the physical reality of addiction — it’s not enough to want to stop — proved impossible to overcome, time after time.
When he was in remission, we got to see who he really was — a good son, someone who loved living in New York and, not least, a beloved uncle to my children. Too often, those parts of him were harder to see. But even in the depths of his addiction, the person he was never went away.
That’s why harm reduction has to be an option. His family found it incredibly stressful trying to keep tabs on him in his last years as his situation worsened. But my wife would give anything in exchange for what she’s lived with for the past year and a half.
Even as public opinion slowly shifts toward a better way forward on drug policy, the obstacles remain severe. The Biden White House, for example, came into office pledging to make harm reduction central to its drug enforcement strategy. Last month, though, a viral story in conservative media that the president was proposing to hand out “crack pipes” put the entire initiative at risk.
Making available clean drug paraphernalia has been proven to promote public health. Needle exchange programs slow the spread of disease while recognizing the reality that getting people sober isn’t always an available option (they also do not increase drug use ). If keeping people alive is the goal, it’s the kind of strategy we need to pursue. But watching the president bow to the pressure of a blatantly racist fake outrage campaign is enough to make you lose hope.
Still, there has been progress, and the state of Connecticut this year is considering a bill that would put a greater emphasis on harm reduction. That would include decriminalizing fentanyl test strips, a means of determining whether drugs bought on the street contain the synthetic opioid. Had such a method been available, it’s possible Kevin would not have died that day. There’s no way to know.
Other proposed changes would increase access for life-saving methadone, make anti-overdose measures more available and push state government toward a greater focus on harm reduction in general.
Fighting the opioid epidemic requires a variety of strategies on multiple fronts. Law enforcement is not going to get us out of this; we can’t arrest our way to a drugfree future.
Keeping people alive is the only goal. Harm reduction must be a part of that.