Harm Reduction in Drug Addiction
August 4, 2017 § Leave a comment
The opioid crisis that has taken root across North America exposes several ugly truths. The first is racial. The use of drugs is treated differently in the United States, depending on the race of the victims of addiction. When they are African American and/or Latinx, they are criminalized. But when it is white people using drugs, it becomes a crisis. To a degree. The important disclaimer here is class. When poor white people are using, it remains a criminal issue. But when middle- or upper- class white people are using, it becomes a public health issue. Thus, this is the second truth: class.
I think of all the jokes I have heard about ‘white trash’ and meth labs in trailer homes since I moved to the South. But, on the flip side, there is the criminalization and demonization of poor white people, and nearly all African American and Latinx drug addicts. Addiction, I remind, is a public health issue. Addiction is a question of psychology. It is not a matter of criminality.
Addiction is something very real in my world. It is something I grew up with in my family. When I was a university student in Vancouver in the early-to-mid-90s, the city was in the midst of a heroin epidemic. Walking through the fringes of the Downtown Eastside one afternoon, I passed the back alley on Carrall St., between East Hastings and East Pender, and saw a young woman, around my age, with a needle in her arm, foaming at the mouth and her fingertips going blue. There was no one around. And she was dying. I went into the alley, she was unresponsive, and her pulse was very faint. There was no one around. No police, no other pedestrians on Carrall St. All the doors in the back alley were closed, some of them barred from the outside. There was no one looking out the windows onto the alley. She was completely alone. And then she died. I don’t know how many people died in Vancouver of heroin overdoses in 1997. But I know she was someone’s daughter, sister, grand-daughter, girlfriend. I did find a police patrol on East Pender about two blocks away, and I told them. I told them everything I saw. I was very shaken, of course. I went home, they went to the back alley to deal with her body.
Vancouver is the site of a long-term heroin crisis. This crisis has been made worse by the addition of fetanyl to nearly every drug on the market on the West Coast. My mother is an addictions counsellor in Vancouver. Every time I talk to her, she says that her recovery centre has lost 2, 3, 4, 5, or more, guys in the past week or however long it has been since I last talked to her. Nonetheless, at least Vancouver has engaged in harm-reduction, which at the very least, makes it safer for heroin addicts, in terms of needle exchanges and safe-places for injection.
Vancouver is home to the only heroin-injection clinic in North America. It has been in operation for eight years now, operates at capacity (130 people, only a fraction of the addicts on the streets of the Downtown Eastside of the city), and is controversial, not surprisingly. In 2013, the then-Health Minister, Rona Ambrose, tried to shut it down, claiming that it enabled addicts. But it survived.
In Gloucester, Massachusetts, a sea-side town about an hour north of Boston, police there decided to begin treating the opioid crisis as a public health issue in May 2015. Police Chief Leonard Campanello notes, as many others have, that there has been a failure to stem the flow of illegal drugs into the country (be it Canada or the US), and that, ultimately, we have lost the war on drugs. Campanello thinks, rather, that it’s a war on addiction.
The important thing to note in both Vancouver and Gloucester is that the police and other agencies there treat addicts as human beings in crisis. And they treat all addicts as such, class and race are not part of the calculus. And Vancouver and Gloucester are just two examples of many across both the United States and Canada where jurisdictions have sought to treat addiction as a public health issue in order to engage in harm reduction.
Last month, in Philadelphia, news broke that the staff at the public library branch on McPherson Square in the Kensington neighbourhood had become first-line responders to heroin overdoses in the park. Several times a day, librarians were rushing out to administer Narcan to people overdosing. Volunteers scoured the park daily for used needles and other paraphernalia of addiction. Librarians referred to the addicts out in the park as ‘drug tourists,’ as Philadelphia, as a port city, has a particularly pure form of heroin on its streets.
But, within a couple of weeks, McPherson Square was nearly devoid of addicts. The police had descended onto the park and pushed them away. Thus, the addicts were back in the shadows, living and shooting up in abandoned homes, in back alleys, hiding in the dark corners of the city. And while some community organizations continued their work of trying to help the addicts, it appears that the police in Philadelphia have not turned to a new model, but, rather, to the old model of scaring off drug addicts, criminalizing them and sending them into the shadows.
I don’t think there is anything new or revelatory in what I’ve said here. Drug addiction is a public health crisis, first and foremost. Harm reduction in locations like Vancouver and Gloucester have made a difference, they have made positive changes in addicts’ lives, including saving lives and getting people off the streets. And harm reduction programmes have got addicts into rehab and off drugs entirely. The criminalization of drug addicts does not have such results.
More to the point, society’s response to drug addiction amongst marginal populations (poor white people) and ethnic and racial minorities (marginalized in their own ways) speaks to how we see some people as disposable. The morality of such a view is beyond my comprehension, it is something I just fundamentally do not understand.