Text Gen Esco
Photography Julian Lucas

In the past couple of months I have found myself more actively and more loudly defending harm reduction and housing first philosophies. Most of the people I am making these defenses to have been in the field for some while longer than I have and are very honest regarding their discomfort about what they see as enabling unideal behaviors i.e. substance use and untreated mental health issues. They perceive things such as safe-use clinics and free needle exchange programs and somehow encouraging people to keep engaging in immoral and dangerous behaviors. 

But the way I see myself as a service provider of a housing first program, and the way I explain harm reduction to those who work for me is this: I am not praising their behaviors, I am not rewarding their behaviors. What I am doing is making it safer for them to continue engaging in behaviors they are going to engage in anyways. 

A drug user is going to continue using chemical substances until they make the decision for themselves that they are ready to stop. By engaging in housing first, I am helping to take the person off the street and mitigating the risks associated with using on the street i.e., assault, sexual violence, death. I like to give people the benefit of the doubt and I believe that most people who argue against harm reduction practices are doing so because they are guided by a set of morals which drive them to value a person’s life; and when they see someone engaging in self-harm behaviors such as drug use, they are driven to do anything in their power to keep that person safe. But what if I told you that your personal morality has no place in your work as a professional? What if I told you that by allowing your personal morality space in your work as a professional is ethically ambiguous and may be even causing more harm than good?

Any time I am somehow engaged in a discussion of harm reduction I like to share that I have helped a client budget for their methamphetamine use when we were reviewing their finances and creating a budget for the month. I get a kick out of the looks of shock and disbelief. How dare I? What kind of professional am I? I have had people tell me that I took it too far. I have had some kinder people tell me that they might be more comfortable creating a budget which left the client with extra money once rent, food and bills were accounted for; but that they would never acknowledge what it was for. 

As well intentioned as that response was, it doesn’t work. If all my years working with individuals experiencing substance use issues have taught me one thing, it’s this: drug dependency flourishes when there are two specific things happening at once. (1) The person’s drug use is shrouded by a shield of secrecy and denial. Everyone knows it’s happening, everyone knows this is the reason everything else in life is falling apart but nobody is talking about it. (2) The individual has no meaningful connections to their community. This person can’t keep a job, can’t pay rent or child support because of their drug use but no one is talking about it. At least, no one is talking about it in an honest and loving way. Most people are sitting pretty on a pedestal of morality talking down to the individual about all the should’s as if this person’s one bad choice somehow invalidates their ability to make any choice. 

And I don’t know about you, but any time someone has come at me from that higher-than-thou stand point I become defensive; my ability to listen and engage has gone out the window. IT. DOESN’T. WORK.

Harm reduction challenges you -the service provider- to get off that pedestal, throw away everything you thought you knew about morals out the window, and to value the person’s life over your beliefs. Because at the end of the day keeping someone alive is better than watching them die on the street because our morals made it uncomfortable for us to engage these people from a standpoint with which they were comfortable, right? Harm reduction is the acknowledgement that this isn’t about me or you, or what we believe. Harm reduction is not being a cheerleader for the bad choices that people have made, harm reduction is the acknowledgement that safer is better than dead. 

When I helped that client to create a budget which included his methamphetamine use- it was uncomfortable as hell! It is definitely not what I thought I would be doing that day. But my willingness to engage in this was me and my client facing reality together. By speaking about it openly, I was disassembling that shield of secrecy and deniability. It was happening and there was no avoiding it. But I was also doing something else: my engaging in this discussion from a caring and non-judgmental standpoint, I was helping this person to forge a meaningful connection with me. A connection which over time, and when leveraged well, can often result in the forging of other meaningful connections: housing, employment, education, family. Because that is what harm reduction is: the first of many interventions on the road to a full and meaningful recovery.

Editors Notes
According to the Drug Policy Alliance in 2017 Philadelphia officials will make history by pushing an effort to make the city the first in the U.S. to allow drug users to inject opiates at a medically supervised facility. In 2017 the number of overdoses related deaths rose to 1200. Many who died were homeless. Through this radical motion the city hopes to cut down on the number of over-doses.

In other parts of the world there are approximately 66 safe injection facilities. Countries include Switzerland, Germany, Netherlands, Norway, Luxembourg, Spain, Australia, and Canada.

In an article published by Vox in Jan 2019. In response to 3800 signatures collected by coworker.org. Starbucks began installing needle disposal boxes after baristas would find discarded hypodermic needles in trash cans, tampon disposal bins, and diaper changing stations, putting employees at risk of being poked while cleaning the restrooms.