Harm reduction is a movement that marks a significant change in our approach to the addiction epidemic. While it serves as a great first step, the message of harm reduction is questionable at best; it insinuates that there is inherent harm in drug use, regardless of one’s relationship to psychoactive substances.
Carl Hart Ph.D. is a veteran and the first African-American science professor to get tenured at Columbia University. Initially, he pursued neuroscience to find a “cure” for addiction, believing drug use was the root of many social problems. Through his research, Hart came to view drug addiction as largely misunderstood, finding that many of the problems associated with drug use stem from societal factors and punitive policies rather than the drugs themselves. The evolution of his understanding led to his examination of current frameworks for addressing drug use.
“Harm reduction preoccupied us with drug-related harms,” Hart writes.
The fundamental problem lies in the harm reduction framework. By calling it “harm reduction,” one reinforces the idea that anyone that has used a drug is causing harm to themselves and the community at large.
To use an analogy, say you go take a driver’s lesson except now it’s called “Driver’s Harm Reduction” and not “Driver’s Safety.” It would be absurd, would it not? Both cars and substances bring potential risks and benefits and are used globally to speed up one’s arrival at a particular destination, be it a physical, social, or psychological one. Checking if seat belts are buckled, that tires are not too worn out, and that the brakes work more aptly fall into the category of “safety”—just like making sure you finish up all pending assignments and get a good night’s sleep prior to April 20 on Foss Hill can be better put as “health and happiness.”
“[Harm reduction] narrows our associations, conversations, feelings, memories, and perceptions about drugs and those who partake. Perhaps even worse, it relegates drug users to an inferior status,” Hart writes. “Surely, only a feebleminded soul would engage in an activity that always produces harmful outcomes, as the term implies.”
Furthermore, harm reduction can also serve to promote a sense of substance exceptionalism, where alcohol, cigarettes, cannabis, and psychedelics are usually not included in the “harm reduction” picture. This separation and identity superiority is associated with certain substances and works to paint this picture of good and bad drugs, working to create artificial hierarchies between substances, strengthening stereotypes. It’s not uncommon to come across individuals who use psychedelics but criticize those who consume alcohol at the University. In reality, these substances are all inert materials. It is in the ways that we interact with them that allows their appraisal and judgement of value. Binding certain substances to certain schemas and typecastings only works to stiffen negative stereotypes, and in turn make it harder for people to come out about their use and recovery.
Additionally, overstating the dangers of opioids can make the epidemic look more dire than it actually is, leading to reinforcement of negative stigmas. If an autopsy were to state that there were traces of three different drugs in the deceased, this oftentimes is reported as three separate overdoses by the CDC. Just as the CDC allows for individual deaths to be counted multiple times, opioid-focused harm reduction overemphasizes the risks of opioid use on campus while not bringing attention to more multifaceted and campus-relevant issues. It only takes a couple of shots of high-proof alcohol to induce fatal respiratory depression. When mixed with other substances such as opioids and dissociatives, tiny doses can become lethal.
While well-intentioned, harm reduction strategies can inadvertently reinforce negative stereotypes associated with opioid use, painting all users with the same broad brush. This stigmatization can lead to reduced access for patients who genuinely require opioids for legitimate medical reasons, as they may be unfairly labelled as “drug seekers” or “pill fiends.” Although practicing ample caution is good, these misconceptions can and have resulted in inadequate pain management for many patients, as healthcare providers become overly cautious or restrictive in their prescribing practices.
The media and political discourse surrounding the opioid epidemic often seeks to blame external actors such as China or Mexico, rather than examining the complex, multifaceted nature of the crisis. This oversimplification not only diverts attention from domestic factors contributing to the epidemic, including healthcare practices, socioeconomic issues, and pharmaceutical industry influence, but also hinders the development of comprehensive solutions. Harm reduction, alongside modern Western medicine, as a whole, focuses heavily on symptom suppression instead of cause prevention, where the individual is solely responsible for their own health instead of the collective. By focusing on a more holistic approach to addiction, we can start to address these issues as symptoms of wider societal problems, improve access to evidence-based treatment, and implement policies that prioritize public health over punitive measures.
Accurate information is essential for developing appropriate drug safety measures and education. MDMA-related deaths are often mischaracterized and sensationalized in the media as “overdoses,” the University’s 2015 incident included. While dosage is a factor, and there have been some cases where individuals take over 20 times the normal amount, most fatalities and hospitalizations occur at normal recreational doses due to external circumstances. Such causes include MDMA-induced hyperthermia (heatstroke), pre-existing heart conditions, and hyponatremia (water intoxication) from excessive water intake, which can lead to swelling in the brain. Hot, crowded and stuffy venues with inadequate hydration also contribute to many MDMA-related fatalities. Labeling these incidents as overdoses will hinder drug safety strategies, shifting a large portion of blame solely onto the drug instead of the context in which one partakes. If interested, check out MAPS to keep up to date with MDMA research.
While many cling to harm reduction as a preferable alternative to the failed war on drugs, we must recognize that this approach still falls short of addressing the core issues. It’s time to move beyond these limited paradigms and explore more comprehensive and compassionate solutions that neither stigmatize users nor restrict access for those with legitimate medical needs. Our syntax has to change in order to prevent worsening damage.
Jerron Chan is a member of the class of 2025 and can be reached at jchan02@wesleyan.edu.
2 Comments
aikimoe
I've been an advocate for harm-reduction policies and an admirer of Dr. Hart for many years, now, and I've never thought about the implications of that wording, before. It makes a lot of sense that "drug safety" is a more useful, constructive term than "harm reduction." Thanks for a well-written piece that got me thinking.
Wiley C
The overarching goal of the harm reduction movement is to save lives, and there is no question that measures promoted by the movement- such as readily accessible naloxone- have saved thousands of lives. Some privileged drug users are able to procure drugs from knowledgeable, careful and ethical drug dealers or, like the good Dr. Hart, can inject their ethically-sourced heroin in a safe private den in Portugal. However, the vast majority of the world's drug users are in fact at risk of grievous harm, and to argue otherwise is naive or deceitful. The pharmaceutical industry astro-turfed similar arguments about the harms of opioid stigma and inadequate pain management when marketing legal opioids, and it's sad to see them recycled here. Under the guise of concern for the imagined dangers of harm reduction, we have marketing material for unrestricted and unregulated access to recreational drugs. A safe and fun argument when protected by the reliability of an ethical campus dealer, but not so much just down the street in Middletown or Hartford or pretty much most of the world.