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: https://www.ncbi.nlm.nih.gov/pubmed/9758016
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.)
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: https://www.cbc.ca/news/canada/british-columbia/phs-injectable-dilaudid-program-launching-1.4965641
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.