Harm Reduction

One of the very worst public policy mistakes of the 20th Century,  one which is still with us, was the criminalization of what we now like to call Substance Use Disorder (SUD). The laws were enforced with literally grotesque inequity, filling the jails and prisons with Black and Latino people for "offenses" that white people committed at the same or even higher rates but were seldom prosecuted for. Imprisoning people is ineffective at treating SUD, but even so it is wrong to imprison people for falling victim to misfortune. It is extremely expensive, and it makes it nearly impossible for people to build a successful life once they are released. If anything, it creates more crime, not less.

Fortunately, we are beginning to make some political inroads with the idea that treating SUD as a criminal justice problem is a total failure, both practically and morally. Here a few facts that seem to surprise many people. 

 

• The vast majority of people who use criminalized potentially addictive drugs one or more times never develop dependency and it's never a problem -- unless of course they should have the misfortune to be arrested. 
• Much of the harm that is caused by dependent illicit drug use is caused by its illegality. Illegality makes drug dependence very expensive, causing people to commit petty crimes to pay for it. This is not a moral failing: addiction creates powerful compulsions that drive people to behavior that is inconsistent with their values, and punishment won't stop them. 
• Illicit drug use is stigmatized even by many health care providers, driving people away from basic health care and from potential treatment. 
•  Because the supply of drugs is illegal and unregulated, buyers can't know what's really in them, leading to the epidemic of overdoses and overdose death, a problem exacerbated by the need to use the drugs surreptitiously.  
• Because access to paraphernalia such as sterile injection equipment is restricted, SUD risks transmission of infectious disease including acute infections, and chronic infection with HIV and HCV.

More enlightened countries such as Portugal have decriminalized SUD, with dramatically successful results.  We are finally making some inroads in the U.S. with the harm reduction philosophy, which rather than criminalizing SUD, seeks to provide people with resources and support to be safer and cause fewer problems for others while they are using; and to reduce or eliminate harmful drug use. 

But of course "conservative" politicians are screaming about "enabling" drug use. Paul Waldman in a series of tweets presents a succinct case study, beginning with "A case study in how mainstream outlets like the New York Times launder Republican disinformation: Step 1: Far-right "news" site invents race-baiting lie about govt program ("Biden is giving away crack pipes!") Step 2: Republican politicians repeat lie, claim to be outraged . . ."

Of course there's a powerful vested interest in the prison industry.