Prosocial Harm Reduction – Pro COMMUNITY Drug Consumption Sites

We face a crossroads in harm reduction. The concept has been widely deployed. Yet many object to it — including progressives who should be our biggest backers. Here’s the solution.

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The Biden Administration’s Harm Reduction Background

Joe Biden is confused, or ambivalent, about drugs. His administration has publicly endorsed harm reduction. But he dislikes drugs (he has never had a sip of alcohol). He has always been down on marijuana, and had people entering his administration drug tested and barred from employment. He is a great disease backer. And, it is worth considering, his two surviving children have had many rehab stints between them.

So will he support progressive drug reforms? What about his selection for drug czar, head of the office of National Drug Control policy, Rahul Gupta? Progressives were dubious. As a West Virginia public health official Gupta supported shutting down his state’s largest needle exchange in the midst of an HIV upsurge. How could a Democrat possibly take such a position in this day and age? (We have to allow that this was West Virginia and Gupta is a good friend of Senator Joe Manchin’s.)

Progressives Who Dislike Harm Reduction

Nonetheless, when Gupta testified before a congressional committee, Republicans rejected the reforms Gupta endorses. And not only Republicans.

Democrat Stephen Lynch joined Republicans in their harm reduction objections. He decried the use of medication-assisted treatment (MAT) for those with substance use disorders.

We allow doctors to have hundreds of patients and just give them Suboxone and not really deliver any behavioral health services that would get at the underlying addictive activity. We’ve got a couple of clinics that hand out Suboxone — the patients go out the door and then they either trade that or they buy fentanyl or methamphetamines, which is even a worse problem. They can’t get high with the Suboxone, so they’re going to harder drugs, which leads to more stabbings and other violence. . . .

Lynch went further. “It’s not working where I am,” he said. “I’ve got tent cities, hundreds and hundreds and hundreds of people all together, right next to a methadone clinic, that are shooting up … I think we’re pushing more of this stuff out, and it’s not helping.”

Lynch represents the southern part of Boston, known for its relative conservatism. But he’s not a conservative by national standards. He calls himself a proud cosponsor of the Women’s Health Protection Act who will work to codify Roe v. Wade as federal law. He is good on Democratic economic issues.  Moreover he gets elected by connecting with low- and moderate-income constituents. His MAT comments express his blunt, practical, hands-on approach.

So we can ignore Lynch’s “nonprogressive” anti-HR message on the way to being totally out of touch with America.

Or we can absorb it.

Chasing Out the Good— The Vermont Example

One of us (ZR) lives and works in Vermont, perhaps the most progressive small state in the US (Bernie Sanders, the longest-serving independent in US congressional history, is its Senator), and is involved in efforts to create safe drug consumption sites in the state. 

That Vermont is actively considering such sites is a strong positive message. Then again, Vermont’s governor recently vetoed a bill that would have created a working group tasked with crafting a plan to open safe consumption sites.

The Governor, Phil Scott, albeit a Republican, is not a reactionary. He supports a wide panoply of HR services, including syringe programs, distribution of Narcan, and fentanyl test strips. The governor signed a bill last year to decriminalize buprenorphine. But Scott is clearly drawing a boundary indicating his limits.

And drug consumption sites are his limits.

One progressive we know objected to the opening of DCSs in New York by recalling  “shooting galleries” — unorganized locations of yore that encouraged destructive behavior. Others, like Governor Scott, worry that they’re simply ineffective long-term. What, afterall, is to be done once people find a safe-haven to do their illegal drugs; use drugs at these sites forever? Is that a burden that a community should bear on behalf of people’s antisocial life choices? 

But drug consumption sites can be more than negative-seeming shooting galleries. Indeed,they can lead to greater and more positive community involvement. Proponents of these sites — and the organizations that endorse and fund them—  can readily communicate and demonstrate this to opponents, if only they don’t get in their own way. 

Our Vermont resident author has been involved with the exceedingly progressive Howard Center — an organization combining several mental health programs, including Burlington’s Safe Recovery program. “Safe” practices an alternative drug recovery approach. It is a syringe exchange that has been a boon for public health since opening in 2001. It reduced much of the harm associated with intravenous drug use, including HIV and Hepatitis C. It provides sterile drug injection equipment, medical assistance, and naloxone (an overdose antidote). It also provides support with housing, insurance, and legal problems based on the understanding that people must have stable lives before they can make positive long-term changes, including drug use.

In other words, Safe emphasizes on-the-ground, pragmatic programs connecting clients to themselves and their settings utilizing skills training and community support. This resembles our own approach in our online Life Process Program.

However, the Howard Center as a whole has turned away from this grassroots approach as it increasingly relies on MOUD (medicine for opioid use disorders). Perversely, Howard Center’s Chittenden Clinic — a MOUD dispensary — is lauded, (relatively) well-funded, and now available statewide, while the Safe Recovery approach is debated, poorly funded, and only has a single site. Why has the Howard Center’s cutting-edge HR technique been so self-limited?  As the other author (SP) describes in his memoir, MOUD is actually an outcropping of the prevailing American brain disease approach. It expresses the vision that addiction is a unitary biological process that can be chemically nipped in the bud without examining and changing the warp and weft of people’s lives. 

And, let’s face it, as MOUD, Suboxone, and buprenorphine programs have expanded and even become commercialized ventures, we have not staunched the drug deaths epidemic in America. Drug deaths are instead accelerating. They mark and mar the entire American experience and approach to addiction.

DCSs as a Community Resource

The US is not on a path to developing a unified drug or harm reduction policy. But we might at least formulate a policy that could conceivably appeal to a majority of Americans — including Democrats. Drug consumption sites (DCSs) offer us a chance to do so.

DCSs pride themselves on their nondescript, sterile settings. Their purpose is to allow people to safely administer their (tested on site) drugs, and to deal medically with any adverse reactions they have. That’s certainly good as it goes. But, as the Howard Center example demonstrates, this conception is treated as an entity entirely separate from standard mental health services.

One DSC skeptic emailed us for a hot take: “Why should we go through such effort to preserve people’s worst habits— especially when they do not give back to the community?”

We believe the answer is that people have a natural yearning to contribute to a community and tend to do so when they have the option, as Safe Recovery has intuited.  

Thus, the goal should be to incorporate harm reduction into a larger framework of constructive community involvement. Helping people— including those using drugs harmfully— to develop the resources and opportunities to regain footing as productive and helpful citizens is the most therapeutic technique of all.