If the Government Wants Harm Reduction, It Must Resist the Backlash

    In what can only be described as racist dog whistles, conservatives recently accused the Biden administration of spending millions on glass pipes to be distributed to people who smoke stimulant drugs. 

    The claim was based on $30 million in funding from the Substance Abuse and Mental Health Services Administration (SAMHSA), which allows organizations on the ground to decide which harm reduction interventions are needed for their community. 

    Even though it’s not clear how much—if any—of this money would go toward safer smoking kits with pipes, conservatives still screamed, “$30 million for crack pipes?!” 

    My response? Yeah, if only

    If only we lived in a world where policy was rooted in science and compassion. If only we lived in a world where the government saw 100,000 of its citizens dying in a year and invested in the interventions that are proven to save lives. If only we adopted a harm reduction approach to ending the overdose epidemic.

    When faced with pushback rooted in conservative lies, the “key pillar” snapped.

    To its credit, the Biden administration has tried more than any other. It rightfully added harm reduction as a key pillar in the national overdose response plan. And as part of that, SAMHSA created this grant program. This is a start, which we badly need to bring to scale.

    But when faced with pushback rooted in conservative lies, the “key pillar” snapped.

     

    Ignoring science comes at a high cost. Every life lost is a tragedy, and there have been more than 100,000 tragedies in the last 12 months. We see Black and Indigenous men hit the hardest. The fact that these deaths were overwhelmingly preventable compounds the devastation. 

    The evidence is unequivocal. Safer smoking kits—including pipes—save lives. The kits increase safety and reduce the risk of diseases and injuries. Providing them creates a window to build trust, establish relationships, and connect people to other services and education. The kits also offer alternatives to injection, a route of administration that increases risks of disease, overdose and death. And providing safe and sterile equipment to those of us who use drugs does not encourage the use of drugs. 

    These are facts, not partisan issues. 

    Those of us who use drugs are all too accustomed to this vitriol. Perhaps the Biden administration was unprepared.

    But more than just the science, what gets to me most as someone who has worked in harm reduction for 15 years, is the lack of compassion. Every person, regardless of choices around substance use, deserves to be treated with respect and dignity. There is no compassion, no dignity and no respect in the hatred spewed by politicians with toxic Twitter accounts.

    Those of us who have worked in harm reduction, and those of us who use or have used drugs, are all too accustomed to this vitriol. Perhaps the Biden administration, which only recently claimed harm reduction as a pillar of its overdose strategy, was unprepared. But if the administration plans to continue to adopt harm reduction—and I really hope it does—it will need to be ready next time to respond with firm arguments based in science and compassion. 

    One way the government can prepare is to establish confidence in the evidence. Government can show this confidence with significant investment, by seeking out our expertise, and in the public language it uses.

    Our lifesaving work in harm reduction has been underfunded for decades. Few private or public funders have been willing to face the reactionary backlash. And even fewer have been willing to show strong public support. 

    Suppose the administration, faced with opposition, had signaled its support with a tweet that said, “Our goal with harm reduction is to save lives.” That’s it. Full stop. That’s the kind of political support the harm reduction community needs. 

    Another way the government can be better prepared is by partnering with an intermediary funder, such as my organization, AIDS United. We have decades of grant-making experience, subject-matter expertise and deep relationships in communities. We can ensure funding gets into the hands of those who care profoundly about people who use drugs, their well-being and their human rights.

    Without considerable investments we will see more HIV outbreaks, hepatitis C infections and overdose deaths. Black, Brown and Indigenous communities will bear the brunt.

    Regardless of government support or the lack of it, the harm reduction community isn’t going away. We’ve been saving lives for decades, and will continue to do so. 

    But let’s be clear: Without considerable investments and reduced criminalization we will see more HIV outbreaks, hepatitis C infections and overdose deaths. Black, Brown and Indigenous communities will bear the brunt—as always—intensifying needless disparities and suffering. 

    And we’re tired, deeply so. From the early days of the HIV epidemic through the present overdose crisis, the isolation and grief are overwhelming. 

    It’s beyond time to support harm reduction. Enough is enough.

     


     

    Photograph of a protest in Ontario, Canada by Carlyn Zwarenstein

    • Christine is a dyed-in-the-wool harm reductionist and currently the senior program manager for harm reduction at AIDS United. She has 15 years’ experience in drug user health across HIV, viral hepatitis and overdose prevention, and has worked in varied roles across policy advocacy, capacity building, training and direct service in the public and nonprofit sectors. She earned her Master of Public Health from the University of California, Berkeley, and her Bachelor of Arts in American Studies, specializing in sociology, from Pomona College.

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