Sheila Vakharia, now at the Drug Policy Alliance, started her career as a clinical social worker at a traditional addiction treatment center, but she quickly became disillusioned. “Few of my clients volunteered for treatment, most did not consider themselves to have a drug problem, and most never completed the program,” she recalls in her new book harm reduction gapwhich frustrated her “because they were unable to remain abstinent and adhere to our strict structure,” which included regular urine testing that she was required to oversee.
Vacaria’s next job was in a program that provided sterile injection equipment to drug users, which opened her eyes to a different approach. Harm reduction rejects black-and-white choices between drug recovery and addiction, recognizing that different patterns of drug use carry different levels and types of risks. It acknowledges that people will continue to use psychoactive substances, as humans have always done, and strives to minimize negative consequences. Crucially, it acknowledges that efforts to prevent substance abuse can cause different types of harm, which it also seeks to reduce.
In addition to needle exchanges, harm reduction includes support groups, accurate information about drug-related harms and the distribution of test strips that detect fentanyl and naloxone to reverse opioid overdoses. The approach also includes establishing overdose prevention centers where people can use drugs in safe, medically supervised environments, and policy changes such as decriminalizing drug use and legalizing drug supplies to address the unpredictable dangers of black market products .
What these efforts have in common, according to Vacalia, is respect for individual autonomy and a willingness to connect with people where they are, which doesn’t necessarily fit in with the prohibitionists’ dream of a “drug-free society.”
