Opinion: With overdose deaths at 100k per year, ‘harm reduction’ isn’t working

In November, the Centers for Disease Control (CDC) released information showing that, for the first time, over 100,000 Americans died in a single 12-month period from drug overdoses.

Surveying our nation’s attempts to slow this flood of deaths, one just sees many naive, wayward, and weak attempts at “harm reduction.” But if we’d return to first principles, we’d see that Catholic ethics can provide the moral clarity — based on the dignity of the human person and the rejecting of evil — to develop effective strategies that can begin to bring these numbers down.

To put that 100,000 in context: from the 1970s through the late 1990s, the number of annual drug-overdose deaths hovered around 5,000, sometimes reaching as high as 9,000. But then in 1999, that number jumped to almost 17,000 and was considered a major crisis at the time. Now health officials look back and wish we could “only” have 17,000 deaths in a year, as every year seems to smash the record of the year before.

Only days after the CDC’s announcement of breaking six-figures for the first time, New York City announced they would be opening two “supervised injection sites” where residents can shoot up. The city says they will provide clean needles to prevent diseases and can even reverse overdoses with naloxone. For those who want it, they will also discuss treatment options. These types of projects are popular in larger American cities. Meanwhile, the state of Oregon is also now experimenting with decriminalizing hard drugs in user amounts as part of their more-compassionate approach.

Even Catholic Charities in Albany, New York, operates a needle-exchange program, called “Project Safe Point.” The Vatican’s Congregation for the Doctrine of the Faith weighed in on a similar move by nuns in Australia in 1999, saying, “the good intention and the hoped-for benefits are not sufficient to outweigh the fact of its constituting an extremely proximate material cooperation in the grave evil of drug abuse and its foreseeable bad side effects.”

But this, naturally, hasn’t stopped many well-intentioned Catholics from pushing ahead with such programs. They seem to be adopting the logic of the enabling parent who hosts teenage experimentation with sex and drugs, because, “Well, they’d be doing it somewhere. At least I know they’re safe.” Anyone who went to high school in the past 50 years knows this approach often created the dangerous environments rather than being an alternative to them. And as someone who has lost more friends than I can count on one hand (nearing two hands) to drugs, the naivety of bringing this attitude to official public policy is beyond infuriating.

The “logic” used is quite similar to that used with “safe sex” education, which created an attitude and environment in which consensual sexual activity was not to be judged—only its harms mitigated. Unsurprisingly, just like with the overdose spikes in the age of judgement-free drug use, we’ve seen the out-of-wedlock birth rate rise in the age of judgement-free sex, going from single digits before the late 1950s and then rising constantly until constituting a near-majority of births today.

The theory behind “harm reduction,” which is now the official drug policy of the enlightened, is a utilitarian calculation. So, rather than starting with the belief we can lead people away from the scourge of deadly drugs with moral confidence (similar to the old DARE model), drug addiction is seen as simply a choice the person is making—and it’s not our place or right to judge personal choices. The best we can do is to help reduce the harm such choices cause them. If they choose to stop, that’s their call, but that is not in fact the main goal. This is why war has been declared on “harm” rather than on drugs.

Consider this definition taken from a book titled Harm Reduction: National and International Perspectives (SAGE Publications, 2000), especially noting the view that “abstinence may be neither a realistic nor a desirable goal for some,” which is defined as the “pragmatic” view:

Harm reduction has as its first priority a decrease in the negative consequences of drug use. This approach can be contrasted with abstentionism, the dominant policy in North America, which emphasizes a decrease in the prevalence of drug use. According to a harm reduction approach, a strategy that is aimed exclusively at decreasing the prevalence of drug use may only increase various drug-related harms, and so the two approaches have different emphases. Harm reduction tries to reduce problems associated with drug use and recognizes that abstinence may be neither a realistic nor a desirable goal for some, especially in the short term. This is not to say that harm reduction and abstinence are mutually exclusive but only that abstinence is not the only acceptable or important goal. Harm reduction involves setting up a hierarchy of goals, with the more immediate and realistic ones to be achieved in steps on the way to risk-free use or, if appropriate, abstinence; consequently, it is an approach that is characterized by pragmatism.

It’s worth noting here that Oregon, New York City, and their compatriots do want to increase funding and access to drug treatment programs. This is good. Also, harm reduction’s focus on overdose reversal through drugs such as naloxone is a practical way to save lives of people who are overdosing. This is also good.

But these programs, plus a safe couch to shoot up on, are not enough.

The problem is that without a strong moral stand against a drug like fentanyl, understood as something that damages a person’s dignity and will, the drug is generally just too powerful to allow the person to make the decision to stop themselves. Strong drug laws and more frequent use of involuntary-commitment orders for those who no longer have control of their lives are necessary tools to help as many drug addicts as possible. These tools do not deprive a free person of choice; rather, they take an enslaved person and free them.

In C.S. Lewis’s The Silver Chair, Prince Rilian finds himself living deep in a cave and under the spell of a witch. His will is obedient to her all day, but when he is strapped to a particular silver chair at night, he returns to his former self and cries out to be freed. I have known many opioid addicts, and this has been my experience with them. They are under the spell of the substance for much of the day, doing things in order to serve the drug that they would never do if they were free. But once they have the drug, they realize how miserable they are and will tell those around them how much they miss their family, how much they regret what their life has become, how much they want to be clean. But, tied to the enchanted chair of addiction, they cannot achieve those good things.

They need our help to break free of their addiction, not people who will put a pillow behind their back in the chair to make them more comfortable, or reduce the physical impact of serving the witch. Their dignity as a human person, created in the image and likeness of God, demands more of us.

A model that does seem to work is long-term treatment — as in years, not just months. And as harsh as it seems to some, deferred criminal sentences and involuntary commitments are often necessary to keep the person there in the early days. The spell is powerful and if it’s left up to them, they frequently give up. They should not be presented the choice between addiction and recovery as if they were two equally reasonable choices being offered to a person with a functioning will. The actual choice is one we have to make—and it’s between paying for long-term recovery for addicts or watching them kill themselves at the current rate of 100,000 a year.

There is a good example of a successful, long-term treatment program near where I live, called TROSA. Before COVID hit, I volunteered weekly and saw up close the fragile but hopeful state of those recovering from addiction. At TROSA, recovering addicts are monitored and live in community away from drugs, provided with ample therapy to help heal and recover from their mental illness, addiction, and trauma. They also work for TROSA’s multiple businesses that help sustain the program: lawn care, a moving company, Christmas tree lots, and a thrift store. Mitigating costs by operating businesses in this way helps make these expensive long-term programs more viable.

This kind of program needs to be replicated throughout the country if we’re to have any hope of reversing the steady upward trend of overdose deaths. Job training, tutoring for a GED, a community of support, and intensive therapy builds a foundation that can be built on after the program. But, again, it is a long-term proposal and commitment. Thirty-day detoxes do next to nothing for a serious opioid addict.

An addict’s inherent dignity requires us to take the needle from their hand and show them another way—not provide them a “safe injection site.” Their recovery is found in leaving drugs behind, not in reducing the harm that drugs cause. The utilitarian calculation of reducing harm for those trapped in a death spiral is not working, as the sharply increasing overdose death totals reveal with stark clarity. It’s time for something more demanding, different, and truthful.