N.Y. Journal: True harm reduction

New York City has written a helpful pamphlet for heroin addicts. It's not about how to get off heroin or why to get off heroin. It's about how to use heroin safely.

The pamphlet---printed by the city in 2007---provides "10 Tips for Safer Use." Always use with a friend and don't share syringes, it says. It tells you where you can get clean syringes, and tells you how to "Prepare Drugs Carefully." (Hint: "Don't touch" the cooker!) It advises you to jump up and down before injecting and helpfully illustrates the instruction to "Tie off to make your veins visible."

The point of the pamphlet, which cost $32,000 to print and distribute, is to at least make sure drug users are using drugs safely---an approach called "harm reduction." But predictably it created a furor. City Councilman Peter F. Vallone told The New York Times the pamphlet was only helpful for drug-using novices, not hardened addicts. Others said it portrayed drug use as normal instead of harmful. But City Health commissioner Thomas Farley said the pamphlet would stay in circulation.

I asked Jim VarnHagen, executive director of the New York City Rescue Mission, what he thought of the pamphlet. He said it misunderstood the nature of consuming addiction. Addicts want what they want, when they want it: "They have the needle in one hand; they have the drugs in another hand. . . . They're not going to be reading a pamphlet."

Beyond that, though, the idea that we should settle for "harm reduction" belies the possibility of redemption. "It's rather absurd," said VarnHagen. "They're not going to use clean needles. They need to be instructed not to use any kind of needle."

The New York City Rescue Mission has a year-long program that tries to instruct just that, using Biblical principles to bring "spiritual regeneration." Last year, of the 72 men enlisted in the program, about half made it through the first 30-day phase. Of those remaining, 15 graduated---the highest graduation rate the mission has seen. The mission has random drug and alcohol testing, and if participants violate the rules of the program, the mission asks them to leave---but always in a way that welcomes their return.

They don't always hear from the people who graduate or the people who don't graduate, but once in a while they do. VarnHagen said he got a letter the other day from an ex-addict who was now living in California, where he was renewing his relationship with his daughter. He had a place to live and a community. "We would never have known about that except he decided to write us a little note," VarnHagen said, pointing out that it had been a full 10 years after he left.

He said the mission's success rate is 100 percent, meaning it fills 100 percent of the empty bellies and preach the Gospel to 100 percent of the people who get a bed. VarnHagen calls that a lasting harm reduction: "We teach a message of salvation and we present the gospel in such a way that people realize that they can have a new way of life. They don't have to live that old life of using drugs."