While still suffering the toll of a deadly global virus, we begin the delicate process of rebuilding our communities under an abnormal “new normal.” How can we safely reconnect and enjoy our social lives as fully as possible, while minimizing risks? In terms of COVID, our return to socializing, and our consumption of psychoactive substances, how can we balance our personal desires and sources of joy against potential harms to ourselves, our loved ones and our communities?
A comparable dilemma was faced by the LGBTQ community in particular, recalled Daniel Wolfe, after activists and health professionals urgently mobilized to curb the HIV/AIDS crisis that developed in the 1980s. Wolfe is the director of the Open Society Institute’s International Harm Reduction Development Program, and he, like many leaders of today’s harm reduction movement, became an activist at that time.
“Whether it’s talking about injecting drugs or oral sex between men whose serostatus is unknown, we’re negotiating questions of risk and pleasure,” Wolfe told Filter. “I think that is really at the center of some of the questions about harm reduction, which is how do you diminish the risk and hold on to the pleasure, and how do you talk to people about that in some way that they can relate to?”
Monique Tula, the executive director of the National Harm Reduction Coalition, acknowledges that there is no universal definition of harm reduction, even if her organization upholds certain principles. “Generally speaking, it’s the practice of advising people how to mitigate risk in real time in real-world conditions,” she said. “So no fear-based public health campaigns that fail to provide people with practical solutions to really complex situations. Demanding that somebody wears a condom or just says no doesn’t work for everyone. And it fails to recognize the lived experience of people who’ve often spent decades navigating risk and personal trauma.”
Because harm reduction is often associated with specific public health policies, public discourse around it often loses sight of the bigger philosophical vision.
Harm reduction at its core is about challenging stigma. It means respecting people for their whole selves and lived experiences while avoiding judgment. It prioritizes people whose identities are marginalized by society, and who are therefore especially vulnerable.
“Harm reduction is more than just a package of interventions,” said Judy Chang, executive director of INPUD (International Network of People who Use Drugs). “Harm reduction is linked to social justice and human rights, as a movement for radical love and acceptance.”
But because harm reduction is often associated with specific public health policies—such as providing resources like sterile syringes and naloxone, establishing safe spaces for drug use, or increasing access to safer alternatives from methadone to nicotine vapes—public discourse around it often loses sight of that bigger philosophical vision.
Drug policy reform advocates’ messaging has sometimes unwittingly contributed to this. For example, phrases like “treatment instead of incarceration” may be effective in getting public officials and media to buy into certain programs, but also sit uncomfortably with deeper aspects of harm reduction.
“I think people understand the immediate need for harm reduction. I’m not always clear if people get the underlying tenets of self-determination and choice,” said Kassandra Frederique, executive director of the Drug Policy Alliance (DPA). “Some of our arguments, and some of the ways that we win politically, are about, you know, we get syringes because they help with blood-borne diseases? We have syringe exchanges, so there won’t be syringes in our parks. We need safer consumption spaces, so we don’t see the person using heroin. And all those things can be true. But they’re not the driving reason why we do these things. The driving reason why we do these things is because we’re trying to create a world that recognizes that people use drugs.”
The myth of a drug-free world has created generations of discriminatory and misguided policies that persecute people who use drugs, instead of working towards the pragmatic and constructive goal of developing a more functional societal relationship with drugs. Harm reduction, in contrast, accepts the reality that people will always consume various psychoactive substances to achieve pleasure and relieve pain.
Fifty years after President Nixon declared a “War on Drugs,” the consensus that it is time for a different approach has never been stronger. The term “harm reduction” is popping up in more mainstream conversations and even government strategies, especially in light of the ongoing overdose crisis in the US. However, harm reduction programs continue to face backlash and opposition, often emerging from the absolutist goal of abstinence.
“What harm reduction confronts is an abstinence-only ideology that puts abstinence on a pedestal higher than life itself,” said veteran drug policy reform advocate Ethan Nadelmann, founder of DPA.
This is perhaps the biggest challenge in harm reduction: how to forge ground to work effectively while constantly butting up against an ideology that sees drug use as inherently bad, and opposes any intervention that prevents an addicted person from hitting the absolute “rock bottom” deemed necessary to force change.
Harm reduction says no one needs a “rock bottom.” Although it encourages tools to address chaotic drug use, it doesn’t see people’s struggles within a vacuum. Someone’s problematic drug use is likely to be a symptom of a stressful, challenging or trauma-filled life. Empowering a person to be well is the goal, and abstinence is not the only way to get there.
From a harm reduction perspective, a person is defined by how they show up in the world, and not by labels or what they put into their body. “You don’t call somebody dirty or clean or you don’t say they’re a dope fiend or a crackhead,” said Dinah Ortiz, vice chair of North Carolina Survivors Union, Jails Action Committee member at the New York Women’s Foundation, and a harm reduction expert specializing in mothers who use drugs. “These types of phrases alienate and stigmatize people. You want people to be seen as human beings … Drug use is not the only thing that I am or that I do. I’m a parent. I am a grandmother. I’m a professional. There are so many other things that I am.”
That larger purpose entails building connection. And it is this that might make harm reduction exactly the right vision to help guide recovery from the pandemic.
What is truly powerful about harm reduction is it does not aim to be prescriptive or to force people into boxes. It provides a framework for transformative relationships, and it does not only have to be about drugs. Harm reduction in its bigger form is the fundamental recognition that humanity is broad and inclusive, and that every human being has inherent worth and dignity.
That larger purpose entails building connection, bringing people in instead of pushing them out. And it is this—beyond using analogies between face masks and condoms, syringe access and vaccines, to raise public awareness—that might make harm reduction exactly the right vision to help guide recovery from the COVID-19 pandemic. Our communities are looking for ways to rebuild connections, and to help people calculate risks, while treating each other with compassion and empathy.
“I do think that people will hear a message that they can easily adapt to,” said Ifetayo Harvey, founder of the People of Color Psychedelic Collective, noting the debilitating and even life-threatening impacts of isolation. “As opposed to saying, ‘Don’t have any contact with folks, just stay inside all day long,’ saying ‘If you decide to go to the park with your friend, this is how much risk it is. Wear a mask and distance, versus going to a restaurant. Indoors is different…’ Breaking down those scenarios gives people the agency to choose: This is how much I’m willing to risk.”
Advocating for an expansive COVID-inclusive harm reduction vision might seem more of a nice-to-have than a must-have priority. According to the CDC, there was a 29 percent increase in fatal overdoses in 2020 from the previous year, and, if current trends continue, drug overdose will soon kill more Americans every day than COVID-19. Meanwhile, life-saving harm reduction programs are under constant threat.
However, a core part of harm reduction philosophy is interconnectedness. No crisis exists in isolation. Since trauma and loneliness are often contributing factors to risky drug use, what do we think the months and years ahead might look like? And what about the rush to have a good time that comes along with opening up? Even people who don’t identify as “drug users” but consume alcohol, can benefit from common-sense harm reduction messages like go slow, be conscious of the dangers of mixing substances, drink water and remain mindful of risks to others.
Shira Hassan, a longtime activist for sex workers, LGBTQ youth and harm reduction, spoke about applying harm reduction principles to safer hugging during the pandemic, especially with people who are immune compromised, who are elders or who are unvaccinated. “Well, you can be back-to-back or have energetic hugs, or what if everyone masks and your faces are turned away from each other and the hug is less than 10 seconds?” she asked. “We’ve been having sweet and tender conversations about that, and I think in some ways, talking about COVID has made harm reduction more accessible for people who never think of it as personally related to them. A hug itself is not a high-risk behavior. In the same way that framing sex work as a high-risk behavior ignores all of the ways that sex work is care work and sex workers protect themselves, and that community has supported and cared for each other—while at the same time taking care of the biggest threat of all, which is criminalization and policing.”
“We have gotten so bad at disagreeing. We fight each other, and we tear each other down … I think we need to take better ownership of our own brokenness.”
Another urgent harm reduction message at this time, including to new audiences, is simply to accept and support one another, despite our inevitable missteps and imperfections.
Louise Vincent is a leader with the national Urban Survivors Union and North Carolina Survivors Union, promoting harm reduction and supporting drug users in a very politically contentious context. She hopes the harm reduction philosophy can help transcend the many judgments and labels that keep us apart.
“We truly are scared to talk to people who don’t totally agree with us,” she said. “Our news is full of the people who agree with us and [that’s how] we surround ourselves. We have gotten so bad at disagreeing. We fight each other, and we tear each other down… I think we need to take better ownership of our own brokenness, our own inability to understand, and our own confusions. There’s something really powerful about taking ownership of all of our brokenness and all of our beauty, all at the same time.”
Photograph by Mehmet Turgut Kirkgoz on Unsplash
The Influence Foundation, which operates Filter, has received a restricted grant from the Open Society Insititute to support promotions relating to the film Liquid Handcuffs. The Influence Foundation previously received a restricted grant from DPA to support a Drug War Journalism Diversity Fellowship.