Is harm reduction harmful?

NICK EICHER, HOST: Today is Wednesday, July 24th. Thank you for turning to WORLD Radio to help start your day. Good morning. I’m Nick Eicher.

MARY REICHARD, HOST: And I’m Mary Reichard.

Coming next on The World and Everything in It: preventing deaths from overdose.

For decades, a deadly opioid crisis has ravaged the United States—ever since the drug company Purdue Pharma started to aggressively market its addictive, but government-approved painkiller in the 1990s. Since then, more than 800,000 Americans have died from overdose.

EICHER: As the crisis rolls on, some advocate so-called harm reduction. That’s what the Biden administration named as a goal of federal drug policy two years ago.

But does harm reduction do more harm than reduction? Here’s WORLD’s Grace Snell.

SOUND: [Rushing cars]

GRACE SNELL: Joe Solomon stands in a sun-baked parking lot behind the Unitarian Universalist Church in Charleston, West Virginia. Not long ago, it was a hub for drug users. The church invited them here.

JOE SOLOMON: In the height of COVID, we actually threw grassroots harm reduction health fairs in this parking lot that had their own line of about up to 240 people…

Solomon is a local city councilor and co-director of the harm reduction group SOAR West Virginia. The lot is empty now—but it’s alive with memories for Solomon.

SOLOMON: Over here is where we would give out the mountain of naloxone, syringes, and down the line, you know, tourniquets or cookers or band aids or what have you…

Here, organizers handed out clean needles and naloxone—a drug that reverses opioid overdoses. Also sandwiches and clothes, medical students provided wound care and recovery coaches offered life advice.

Their message for drug users was simple: Just. Don’t. Die.

It’s a philosophy known as “harm reduction.” And it’s a very different approach than the traditional emphasis on quitting drugs. Harm reduction assumes some people are just going to use drugs, so the best thing to do in the face of the staggering death toll is to help them do it safely.

It’s a controversial tack, and some treatment providers say it feeds the cycle of addiction. Solomon says city leaders weren’t thrilled about his team’s efforts.

SOLOMON: This was actually the place of one of the last stands to actually show how it could be done.

Charleston may not be embracing harm reduction with open arms, but other cities and regions are. States ranging from Indiana to California have officially named harm reduction as part of their vision for fighting the opioid crisis.

New York City has gone a step further—creating the nation’s first “safe injection sites” in 2021. Drug users can shoot up there without fear of prosecution.

That’s a trend Haley Walker finds pretty alarming. Walker also lives in Charleston, where she directs an abstinence based recovery program for women. We spoke remotely after my visit.

HALEY WALKER: How could you not support harm reduction? Well, it’s not that I don’t support harm reduction. What I don’t support is I don’t support enabling active addicts to continue on their destructive pathway with taxpayer dollars.

Government agencies like the CDC say these programs effectively reduce overdose deaths, stop the spread of infectious diseases, and connect users to treatment options. And a collection of scientific studies appear to support their claim.

But—not all of them. One nationwide study from the Journal of Public Economics found that communities recorded an increase in deaths. And a psychiatry professor at Stanford University says it’s hard to scientifically study harm reduction strategies and there are no randomized trials proving it works.

Sarah Stone is SOAR’s board president. And she’s also in recovery. That gives her a lot of compassion for people struggling with drug addiction.

SARAH STONE: The first time I used them was when I was 18, which was in 1998, and the last time I used them was when I was 34 years old, which is in 2014.

Stone tried to kick the habit. But she could never get past day three of the agonizing withdrawal.

Then—one day—she heard a voice.

STONE: I was literally disassociating because of my drug use. And I thought to myself, ‘Who is saying that?’ I’m looking around and it’s me, and I don’t recognize my voice, I don’t recognize the words I’m saying. And I was like, ‘Okay, I gotta, I gotta do something different.’

She went straight to her mom’s house and spent the next few days sleeping and shivering in the basement. After that, she headed straight to a twelve-step recovery meeting and never looked back. Five years later, she and her friends launched SOAR.

Stone found recovery by quitting cold turkey. But she doesn’t think that’s for everyone.

STONE: My end goal would be that everyone feel respected, everyone feel like they’re empowered to take care of themselves and to, if they are going to use, to use drugs safely and to not worry that they’re going to catch HIV or die of an overdose alone.

One of the ways Stone does this is by stocking dropboxes with overdose-reversing naloxone kits.

STONE: Yeah, I can’t keep up with it, and I live here…

They built this box just over a year ago. In that time, about 300 kits have passed through its glass door.

SOLOMON: And we wish we could put syringes in this box, you know, like, we would love to spend that money on political courage, too, you know.

Haley Walker also battled years of drug addiction. She came to some very different conclusions than Stone.

WALKER: It took me being held accountable for my actions and feeling the consequences of my actions to make me find myself in a position where I was, the pain was greater than the pain of change.

Walker is onboard with naloxone distribution. But strongly opposes giving people needles and syringes.

WALKER: Is it because I don’t have compassion for the active alcoholic and addict? No, I was one. I’m the first one to say, of course, I have compassion for them, but I’m the second one to say that if someone would have given me an easy, free, clean place to cook meth and shoot it in my arm, I would be dead today.

Back in Charleston, Stone stands in her kitchen flipping through a book.

STONE: This is a list of our friends who are not with us anymore. And it is long. My list starts right here and ends right here.

Stone’s list has the names of 60 people—friends who have died. She says that’s the reason she keeps doing what she’s doing. It’s also why Walker sometimes calls Stone for help handing out naloxone.

At the end of the day, they both want to save lives.

Reporting for WORLD, I’m Grace Snell in Charleston, West Virginia.

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