Safer Smack?

by Jonah Shepp

John Knefel explores the controversy over harm reduction as an approach to heroin addiction:

Though some advocates in the U.S. express hope that their country will one day have supervised injection facilities, even less controversial methods are by no means universally accepted. Needle exchanges, for example, are still effectively illegal in about half of the states, and federal money can’t be used to fund them. President Obama lifted that ban in 2009, but Republicans in 2011 fought successfully to reinstate it. …

Other observers criticize exchange programs for not being aggressive in promoting detox and rehab for heroin users, and suggest a harsher approach.

“Using the criminal justice system to force them to go into treatment has proven to be very productive,” David Evans, special adviser to the Drug Free America Foundation, tells me. “The drug courts that do that have an outstanding record of success of freeing people from their addictions.” (Critics of drug courts argue coerced rehabilitation actually expands, rather than lessens, a punitive approach to drug treatment.)

Some opponents of harm reduction also express skepticism about expanding naloxone access to family and friends of drug users. “Naloxone can save lives in an overdose situation, but many opioid users do not use with their family,” John Walters, who was drug czar under President George W. Bush, writes in an email. “[T]hey may use alone or in the company of other users, who may not be a reliable source of emergency medical care.” Using alone is dangerous, without question, but available data largely contradicts fears that other users can’t administer naloxone effectively. A 2013 scholarly study found that overdoses are overwhelmingly witnessed by other users, and, in the study, administration of naloxone was 98% effective in reversing the overdose.