Harm reduction: just read about providing safe drugs in Canada

[Kimera757]

Harm reduction has a place. For instance, there’s controversy about vaping because the flavors are (supposedly) intended for kids. But when adults vape, it’s better than smoking because it’s reducing the harm they suffer. It also doesn’t even smell as nasty to non-smokers such as myself.

When it comes to illegal drugs, harm reduction is supposed to be about “respect”. Some drug addicts aren’t “ready” to enter a treatment program. In Canada and the US, there are safe injection sites so these people can inject themselves with clean needles and avoid infection risks. These sites don’t provide drugs, so users bring their own, but they’re controversial anyway because the police aren’t allowed to round up drug users. Furthermore they don’t treat drug addiction, they merely provide protection against a few of the hazards of drug use (infectious diseases and overdoses).

I read about this here: The moral economies of homeless heroin addicts: confronting ethnography, HIV risk, and everyday violence in San Francisco shooting encampments - PubMed

There’s a story from the field notes early in the PDF, but you have to log-in, and not everyone will have an account. The field notes are too long to replicate here, so I’ll just quote it a few times.

It took place in San Fransisco in 1995, and the researcher is decrying the hopelessness of teaching about clean needles. The cost of a bag of heroin was $20, and because this particular group was homeless, they could barely afford to split it three ways for $7 each. There was a hierarchy of those whose schemes brought in enough money to afford drugs, and those who didn’t. Each of these were desperate to get a hit for the night to avoid an overnight attack of withdrawal symptoms. (There were more than three people involved here. One of them was just begging, and another beggar turned violent.)

Meanwhile, Scotty and Butch were cursing because someone had
stolen their stash of clean syringes. Scotty rummaged through some foul
looking rags, and pulled out three previously used syringes. Before I had
time to protest that they should at least bleach and rinse these dirty syringes,
Scotty had already filled one with water from the Styrofoam cup
Pete had left on the ground and squirted it into the cooker where he had
placed the $20 hunk of black tar heroin, about half the size of a pencil
eraser. I tried to remind Max that he should at least rinse the dirty syringe
Scotty had just handed him, but he ignored me. He was intently
watching every movement Scotty was making in order to ensure that he
knew exactly how much water was being put into the cooker since that
determines how much heroin solution is allocated to each person involved
in the three-way share.

Max had to be very careful because Scotty and Butch were running
partners. He was the outsider, and they might collude to rip him off.
There was no way under these conditions that he was even going to think
of diverting his attention from the preparation process to rinse a dirty
needle let alone go search for a clean one.

When Scotty began cursing that he had no cotton to use as a filter,
Max refused to go fetch some. Instead, he picked up an old cigarette butt
from the mud at our feet-permeated by the smells of feces and vomit and
pulled a piece of the filter out with his teeth, all without taking his
eyes off of the cooker.

To warn Scotty and Butch against trying to hustle him, Max launched into an argumentative tirade, insisting on holding each syringe up to the firelight to reverify its contents. He obliged Scotty to empty 10 units from Butch’s syringe back into the cooker, claiming it had been overfilled. They then redrew Butch’s 10 excess units into the other two syringes, thereby introducing yet another potential HIV vector since Butch’s syringe was also dirty, but also fairly ascertaining that
each person had been allocated his precise share of 45 units. Max was also worried Scotty and Butch might collude in executing a “finger roll” or “two finger dip trip,”

I realized that it was impossible under these conditions for Max to pay attention to my HIV prevention slogans. More immediately pressing concerns than HIV were consuming him.

Unfortunately, there wasn’t an attempt to treat them, just protect them from diseases. As a result, they will live this lifestyle a long time, going through this daily, possibly for life. I don’t think harm reduction is doing enough for them.

So then I read about this: 'Safe supply' program will distribute free opioids to entrenched users | CBC News

‘Safe supply’ program will distribute free opioids to entrenched users

This is not a clean needle program, but a “clean drugs” program, so the patients can avoid exposure to fentanyl and other contaminants. It turns out isn’t the only program like it in Canada. One was opened a few years ago and is mentioned in the article. Unfortunately none of these seem to be treatment programs. They’re basically methadone replacement at best, which generally involves attempts to taper the patient’s drug use.

When it comes to illegal drugs, I don’t think harm reduction does enough. On the other hand, drug treatment is really expensive. Apparently it’s just easier to give them uncontaminated drugs.

[MichaelEmouse]

Doing more for them would largely involve taking away their ability to make independent choices. You say that more should be done but if they don’t really care about the cleanliness of their needle, you can only make them use clean needles by treating them akin to legal minors.

Harm reduction may be all that’s possible unless either A) The person is willing to do what’s required on their end to get better or B) You can make them, somehow.

In the specific example you provide, what would have had the harm reduction organization do? Give them drug treatment right there and then? It’s not the sort of thing you do in some alley in 10 minutes. Even if it were, they didn’t seem interested in drug treatment. My impression is that a lot of drug addicts are bad decision makers with some kind of mental illness who’ve been digging themselves into the hole they’re currently in for years.

So, do you want it to be easier to legally compel people to take part in drug treatment? What would that require?