Public Injection Isn’t the Problem—It’s Stigma and Prohibition

    New York Governor Andrew Cuomo called for police to double down on the war on drug users while speaking to reporters about law enforcement in the state.

    “The police have to do their jobs, and they have to arrest people who deserve to be arrested,” Cuomo said at a September 29 press conference. “If somebody is openly injecting drugs on a city street, they should be arrested.” His contempt for unhoused people was further made clear, adding that they should should “be off the streets, like they should’ve never been in the subways.”

    Advocates condemned Cuomo’s remarks, arguing that he is misidentifying the problem and culpable of exacerbating it. “For years the Governor has blocked the funding and creation of supportive housing for homeless New Yorkers with mental health needs & substance use disorder,” tweeted VOCAL-NY.

    They also noted that Cuomo has had the opportunity to create “overdose prevention sites,” described by the organization as “safe spaces that would be used by the very people he stated ‘deserve to be arrested’ for openly injecting drugs on the streets.” Yet he is stalling, holding up the pilot program that New York City Mayor Bill De Blasio is backing.

    The problem debated by prohibitionists and harm reductionists is currently framed by the question of where people ought to inject drugs. For the likes of Cuomo, it’s nowhere; they should be in jail instead. For many advocates, it’s the private space of housing and overdose prevention sites.

    But the terms of a debate limited to these options are flawed. As a drug-user organizer, I believe it shouldn’t be about the best location for the relegation and control of drug users, but rather about how drug users are socially and materially empowered to choose when, where and how they use.

    If we don’t hold space for people who publicly inject in our analysis, we risk naturalizing the socially constructed conditions that produce harms.

    Within this framework centering drug users’ autonomy, guaranteed housing and safe consumption spaces (SCS) become imperative not because they may reduce public injection, but rather because they equip people with the material resources to decide where they experience pleasure and relief.

    Many would jump at the opportunity to not be forced to inject in the park or on the train, as studies have shown for people in places ranging from Baltimore, Maryland to rural West Virginia. But that can’t mean we abandon people’s choice to inject publicly. Even though more than three-quarters of survey participants in Baltimore and West Virginia said they would utilize an SCS, one quarter still indicated otherwise. They matter too.

    Ignoring them has consequences. For one, it violates their autonomy and hinders their participation in public life. Imagine expecting weed users to stay secluded in their apartments or to check into a clinic on a sunny day if they wanted to smoke a blunt. Drug use is a cultural and social practice; legally siloing it to out-of-sight spaces doesn’t align with how people often actually want to participate in it.

    If we don’t hold space for people who publicly inject in our analysis and strategy, we risk naturalizing the socially constructed conditions that produce associated medical risks and harms, like overdose, infections and vein-related complications. That would foreclose opportunities to identify far-reaching systemic solutions.

    For example, the fear of criminalization by and violence from militarized police pushes, often unhoused, people to rush their shots. A vast scientific literature exists supporting the claim that the threat of law enforcement interactions reduces the likelihood of safer injection practices. The sustained investment in policing and criminalization of drug use is a political choice. The abolition of police and prisons, as well as the decriminalization (and legalization) of oft-injected drugs, like heroin or crack cocaine, could alleviate this condition. Unfortunately, police are increasingly integrated into the harm reduction nonprofit industrial complex, and the US full decrim/legalization movement has yet to gain the necessary traction.

    Other civilians can similarly shape harm experienced. For some surveyed injection drug users, motivation to rush a shot “primarily” stems from the threat of assaults and robberies on the streets. Others have reported feelings of shame and “otherness” in their public consumption. Such dynamics are framed by widespread dehumanizing cultural representations and social attitudes that treat people who use drugs as disposable.

    The demonization of people publicly injecting can be addressed by structural policy changes that guarantee their basic human rights. Less discussed by harm reductionists, it can be contested through cultural interventions. Beyond centering the respect and dignity of drug users in our language, as is the aim of the Changing the Narrative project, harm reduction activists must broaden their political imagination to address the societal status of injection drug users.

    As a trans woman, I’d suggest looking to the history of queer activism. Like getting high, queer intimacy and transgressive gender expression have been viewed as illicit and unfit for the public eye. The stigma was formalized through criminal laws such as bans on cross-dressing and sodomy, and pervaded through cultural and social norms.

    In spite of this, queer activists did not settle for the erasure of their existence. Instead, they thrust the very practices reviled by the heteronormative public into plain sight. For example, in the 1990s, the militant activist group Queer Nation organized against cultural homophobia through kiss-ins at straight clubs and so-called “outreach programs”—wherein activists, according to a 1991 Newsweek article, went to malls dressed as “homosexual stereotypes as ‘go-go boys’ and ‘diesel dykes’.” Their point? To make something wished to be unseen undeniably part of being in the world.

    Syringe litter and its risk to non-injecting pedestrians is usually at the top of public health officials’, politicians’ and NIMBY-ists’ list of objections to public injection. It’s true that other routes of administration, like smoking, do not tend to carry the same risk of disease transmission through litter. But like the other problems I’ve explicated, that’s a pragmatic issue with pragmatic solutions—like making sharps disposal containers as common as recycling bins. Such an approach seems to be limited only by political will.

    Injection drug users ought to have as much right as picnickers sipping wine to hold public space for their own enjoyment and self-care.

    If the choice to inject publicly is dismissed by harm reductionists and drug-user organizers, we risk forfeiting hard-fought, life-saving interventions to city officials’ pursuit of gentrification—a spatial and cultural transformation that could end up displacing the very people for whom we advocate.

    There’s already a history of this appropriation. Scholars have traced how city officials in western Europe and Canada have seized on demands for SCSs to push drug users out of public space to satisfy bourgeois notions of “attractiveness” and public order. In a 2004 study, four critical drug studies scholars noted: “every [safe injection site] proposal or description explicitly includes—and, depending on the audience, emphasises—the reduction of public order or nuisance problems as one key objective.”

    Politics requires negotiation, and harm reduction advocates sometimes must make concessions, or deploy rhetoric to appease politicians, in order to win resources that will save lives. But we mustn’t conform our foundational beliefs to a political strategy that ends up emerging in the fight.

    Injection drug users ought to have as much right as picnickers sipping wine to hold public space for their own enjoyment and self-care. If we don’t affirm this, we are playing a hand in their continued literal—and symbolic—marginalization.


    Photograph of Platzspitz in Zürich, Switzerland in the 1990s by Gertrud Vogler.

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