When everything is harm reduction

“Icarry naloxone because overdose can happen to anyone.” It’s an odd sign, one you might’ve seen around Pittsburgh publicizing Allegheny County’s new harm reduction programs. I encountered it regularly at the Station Square T station for several months.

It’s the word “anyone” that stops me short, because it’s not true — that is, unless one subscribes to sensational accounts of accidental skin-contact fentanyl emergencies. Overdoses don’t happen to just anyone, like car accidents or jury duty. They’re more like a perverse, reverse lottery: You have to play to lose.

In the same way that lottery ads imagine that everyone is a potential lottery player, this sign seems to imagine that everyone is a potential drug user. And that is a grim thought indeed.

Remedial interventions

I don’t object to harm reduction as such. In the context of addiction, which overwhelms the essential human capacities of reason and will, policies and practices that minimize the danger of the addictive behavior — while also, ideally, advancing hope for a post-addiction life — only make sense.

And even outside the context of addiction, the logic of harm reduction can still hold. After-school centers like Brookline Teen Outreach, which I profiled last month, are essentially harm reduction organizations responding to the catastrophic failure of the traditional social structures of families and neighborhoods. The wisest leaders of such organizations see clearly that they can’t replace those essential institutions, but they can provide simulacra that remediate the damage caused by their loss.

This is noble and courageous work. But, truth be told, as BTO executive director Caitlin McNulty told me, it’s like bailing out a sinking ship with a teaspoon. It’s certainly better to reduce harm than not to — but if everything is harm reduction, we are fighting a losing war against the forces of chaos.

The progressive challenge

This reality poses a particular challenge for progressive political movements, which seem to have all themomentum in the Pittsburgh region, at least among the Democratic primary voters who decide elections. With its trend toward the maximization of toleration for disorder, and the minimization of personal moral blame for causing or participating in that disorder, modern progressivism is steeped in the logic of harm reduction.

This only emphasizes the question that has always dogged progressive ideology: progress toward what?

To give full credit to the movement, with the exception of permanent decriminalization of drugs, it generally doesn’t see harm reduction as an end in itself. Rather, this approach is meant to respond to the cruelty and injustice of a racist-sexist-capitalist society and buy time for the more perfect society the movement intends to build. On this view, society is so corrupt that very few individuals can be truly liable for antisocial behavior; the only moral and compassionate thing to do is to help people cope as best they can, while causing as little damage as possible.

There’s a true moral intuition behind this approach. The political problem for the movement is that today’s progressive goals are often so vague or distant — “climate justice,” affordable housing for all, universal just wages — that many of their own voters will lose patience in the meantime. And while I’m sympathetic to some of these long-term goals, especially the vision of a just economy, my own dim (and I think realistic) view of human nature teaches that even perfect social conditions will not produce perfect people. Social entropy will always be a threat.

Decline and fall

Progressives ignore this reality at their own political peril. The fact is, as it stands, everyday social dysfunction is getting worse. The ship is threatening to capsize, and bailing out isn’t keeping up. Anyone who tells you otherwise is gaslighting you.

A few anecdotes from my own daily experience: As my wife dropped me off at a suburban T station around 8 a.m., a man stumbled through the parking lot, and almost collided with our minivan. The entiretime he was meowing loudly.

As I climbed the steps from the North Side T station, a man changed courseso that we’d be forced to brush past one another. When we did so, he turned and shouted “boo!” into my ear, then cackled as he descended to theplatform.

It is increasingly common for small groups to board trolleys while conversing in profanitylaced shouts, heedless of children and the peace of all other people present. They aren’t necessarily intoxicated; they just don’t care.

And while picking up sundries at my neighborhood CVS, two women got into a barely coherent screaming match about whether one of them had filmed unruly teenagers outside. The staff could only look on helplessly.

Taken individually, each of these little stories — and I could tell many more — can be dismissed as the endemic messiness of urban life. In many if not all of them, personal culpability is lessened by mental health deficits, addiction or simply poor socialization. But that’s not the point: The point is that this dysfunction is undeniably getting worse. And as long as the best responses we can muster are remedial, hemmed in by thetrue but incomplete logic of harm reduction, rather than addressing the underlying collapse of civil society,it’s going to keep getting worse.

This poses a problem for any political movement that holds power during such a decline, but especially one whose entire brand and purpose is progress. At a certain point, even the most idealistic voters are going to say: enough.

For all the good intentions of today’s progressivism, when everyday people see public service advertisements that imply our society is so derelict that literally anyone is liable to overdose on drugs, they see despair, not progress. Harm reduction has its place, but when everything is harm reduction, there’s no room for the hope that all true progress depends on.

And fairly or not, whoever’s in charge when voters are fed up with the decline of social order will be left holding the bag.