Harm reduction is something we all practice whenever we take risks, which happens on a moment to moment basis in life. We are almost constantly going through the process of assessing risk, deciding what level or risk we’re willing to take, and doing things to minimize the risks we don’t want to take.
A great example of this is wearing a life jacket when you’re on a boat and don’t know how to swim. By being on the boat, you’ve taken a risk that you may fall out and drown. Wearing a life jacket is a harm reduction strategy to preventing the risk of drowning. In the same way, wearing a condom is a harm reduction strategy to mitigate risks involved in having sex like pregnancy and STDs.
There are also a number of harm reduction strategies that can be implemented for reducing the risk around using opioids and IV drugs, specifically. We can provide people who use drugs with sterile equipment and syringes. We can make sure they have the overdose-reversal drug naloxone (name brand: Narcan) and encourage people to never use alone. We can supply people who use heroin purchased on the prohibition market with fentanyl test strips to make sure they don’t ingest super-powerful opioids like fentanyl unknowingly.
By implementing these measures, we humanize the person or people we know who uses these substances. The most recent stats say that 44% of Americans know someone who is or has been addicted to opioids. If 44% of us are using these drugs, and the rest of us are using other chemicals and destructive behaviors to deal with the disconnectedness of modern life, we need to start talking about good safety measures for addiction in the same way we would talk about using life jackets or eating healthy food.
The goal of harm reduction is not to get people into an addiction treatment center, or to get them to commit to a certain type of capital-R Recovery journey by going to meetings and doing what has worked for other people. The goal is to inform people about the risks they’re taking with their substance use, and help them identify the best way to manage that risk while still achieving their goals.
Every human being deserves the right to form their own risk assessments and choose the strategy that will work best for them, especially when it comes to the way we deal with emotional pain. Heroin, meth, and other drugs are simply strategies for dealing with hardship and pain. We hear a lot of stories about these drugs in our culture and media that make them seem scarier than they actually are. The truth is, they have risks associated with their use just like there are with driving a car or drinking alcohol recreationally. The biggest and scariest risk with using heroin these days is overdose, and that has less to do with the chemical nature of the drug than it does the market in which the drug is being sold.
If a person’s emotional pain is so intense that they are willing to risk overdose in order to get relief, they deserve to make that choice for themselves. The reason why harm reduction works is because it begins with this first-order respect for individual autonomy and decision-making. It begins with compassion. It acknowledges that people take drugs for a reason, and that reason isn’t just going to disappear or seem suddenly irrational in light of another person’s experience.
The difference between healing and recovery is having frank conversations with each other about the risks we’re taking. We make sure we have accurate information about the risks we’re taking and have what we need to stay safe. We give each other permission to do exactly what we need to do to get our needs met and also mitigate any associated risk, whether that’s risk associated with driving a car or using IV drugs.
A great question to ask when you’re not sure of how to counsel someone, or yourself, as you navigate your relationship with a certain chemical or behavior is:
Another way to think about this is, what parts of this habit do I like? What parts do I not like?
The key to engaging in the process of recovery and healing from addiction is being able to identify both the positives and negatives of your relationship with any given chemical or behavior at any given time. It’s important to acknowledge the good with the bad: for example, “heroin helps me not feel feelings that are hard to feel. It also drains my bank account and keeps me in a shitty living situation that doesn’t feel good.”
Once all this is out on the table, awkwardness and shame and all, then we suddenly have the space to make more intentional decisions about what we really want and need.
This means that medical treatment and detox may be part of a person’s recovery process, and it may not. This means some people may need total abstinence from all mind-altering chemicals forever or for a while, and some may not. It means some people might choose to substitute one chemical bond for a less dangerous one, like switching from heroin to methadone, or from meth to Adderall, or from liquor to beer. It also gives that same person the space to eventually renegotiate their relationship with the safer substance.
The process of healing from addiction is inherently non-linear and multi-layered. Harm reduction and recovery are often considered opposites: either you’re supporting drug users, or you’re telling them that their behavior is categorically wrong and they have to change. At the end of the day, we’re all humans, and we all need to be supported with compassion, connection, and non-judgment. We are all on a healing or recovery journey of some kind.