The Lurie administration is limiting the distribution of harm-reduction supplies, and otherwise appears to be pivoting from harm reduction as a key strategy for mitigating the dangers of drug addiction.
Is this shift in focus reasonable? Short-sighted? On Tuesday night, in a panel of public health experts moderated by Mission Local’s managing editor, Joe Eskenazi, at Manny’s, there were no easy answers.
Behind the glass doors, an intimate crowd gathered Tuesday night to hear Eskenazi and University of California, San Francisco researchers Dr. Daniel Ciccarone and Dr. Nicky Mehtani demystify what harm reduction is, and to discuss its role in drug-use treatment.
“Harm reduction is about restoring and supporting people’s dignity, no matter where they’re at, and making them feel like their livelihood and their worth matters, even if they’re using drugs,” said Mehtani, a clinician whose research area focuses on the use of psychedelics in addiction treatment.
“It is a public-health approach that increases engagement and care, so that when people are able and ready, they have the opportunity to engage in recovery and in healing,” she said.
The harm-reduction movement emerged in the ’80s out of the HIV/AIDS crisis, which devastated communities and became a leading cause of death among young adults.
Catalyzed by government inaction, community organizers risked arrest and prison time to mobilize and operate syringe exchanges, which successfully lowered the rate of HIV transmission.
The demonization of harm reduction
Ciccarone, who has studied treatment and prevention for HIV/AIDS and opioids, noted that the increasing prevalence of drugs that are smoked, like meth and fentanyl, has led to more overt, in-your-face substance abuse in San Francisco. He feels this has contributed to a shift toward demonizing harm reduction as enabling drug users.
Ciccarone said that there is a desire from the public for a “silver bullet,” one solution that will end the crisis. This has led to “grasping at straws” and increasing calls for abstinence-based and/or compelled treatment.
From this, harm reduction has become framed as the source of the crisis at hand.
“We have to recognize that harm reduction is not causing people to use drugs,” said Mehtani. “It’s human nature to want to point to one issue … but what we do know, what the science says, is that people use drugs to cope with pain, which comes from societal, deeply rooted issues.”
A recent New York Times op-ed by Keith Humphreys, a professor of psychiatry at Stanford, illustrates this growing sentiment, arguing for mandatory treatment.
Still, Humphreys himself conceded that the evidence is muddled:
One of the largest and longest-term studies found that one year after treatment, those whose care was mandated were somewhat more likely to avoid drug use than were those who entered treatment voluntarily… Other studies found that mandated patients do somewhat worse or the same as voluntary patients.
Ciccarone emphasized this ambiguity. “The use of the term ‘somewhat better outcomes,’ tells you all you need to know. There isn’t significant evidence favoring mandatory treatment.”
Continuing further, Ciccarone called attention to the tremendous costs associated with mandatory treatments that require drug-users to go through the court system.
The UCSF doctor, however, acknowledged a point made by former police chief and Brown University researcher Brandon Del Pozo, who questioned if harm-reduction practitioners had a “blind spot” regarding disruptive and antisocial public behavior by drug users.
A pathway forward
Both experts emphasized the need for collaboration between city entities like the San Francisco Board of Supervisors and the San Francisco Department of Public Health. The UC researchers also voiced the importance of the mayor’s office supporting evidence-backed approaches to drug-abuse prevention and treatment.
Ciccarone emphasized, “This is a good time for leadership to say, ‘Hey, we know that there’s certain elements of harm reduction on the prevention side of things that are pushing people’s buttons,’ but we are going to explain how they work, why they work well and why they’re needed.’”
Ciccarone further noted that progress requires focusing policy on income inequality and homelessness, which drive drug use. Mehtani seconded his opinion, emphasizing the importance of tackling root causes and remaining focused on the work in front of them.
Mehtani pointed to a recent San Francisco ad campaign as a sign of hope. The advertisements read, “I am proof that recovery works.” It’s a message she believes everyone needs to hear.
“People get better,” she said. Understanding that “is important not just for patients to know, but for all of us.”
“The UCSF doctor, however, acknowledged a point made by former police chief and Brown University researcher Brandon Del Pozo, who questioned if harm-reduction practitioners had a “blind spot” regarding disruptive and antisocial public behavior by drug-users.”
Absolutely. People are sick and tired of the continuing degradation of public space by the increasing number of fentanyl, et al, addicts plaguing SF.
The doctors probably live in nice neighborhoods where disruptive and antisocial behavior doesn’t exist. Unlike the unlucky folks living near 16th and Mission, they have somewhere to escape the drug use and squalor their initiatives enable and attract to San Francisco.
The argument isn’t that harm reduction causes drug use. It’s a question of which harm is being reduced. Yes, for the people looking to get wasted 24/7 unmolested, I am sure they feel as though they are being less harmed by society enabling their substance dependency. But in terms of their well-being they are clearly harming themselves, and are also making themselves a public nuisance, thereby harming others.
The countries in Europe that adopt harm-reduction policies pair them with carrot-or-stick choices, of treatment or incarceration. Public use of fentanyl is not embraced by any social democracy. This policy was an abject failure, and people still making excuses for it is galling. At what point will people recognize that drugged-out zombies on every corner is a bad outcome?
Getting rid of harm reduction is not going to stop people from using drugs. It will make potentially serious infections requiring hospitalization more likely, however.
SF General is filled with people doing drugs with “harm reduction” equipment regularly visiting the emergency room.
Drug tourists will obviously congregate in areas where harm reduction supplies are given out, ruining whole areas for actual residents. We are concentrating the problem in a few unlucky neighborhoods in SF. The area around 16th & Mission has essentially become a party of people in their 20’s and 30’s freely smoking their drugs of choice, trashing the streets, and creating unsafe street conditions for families and children. I have to shut my windows, even on hot days, to stop secondhand meth and fentanyl smoke from coming into my apartment.
The vibe is hopefully shifting, but this city has historically been on the side of drug users and criminals, to the extreme detriment of law-abiding residents, and everyone I know is absolutely sick of it.
““Harm reduction is about restoring and supporting people’s dignity, no matter where they’re at, and making them feel like their livelihood and their worth matters, even if they’re using drugs”.
No. Harm reduction is about not letting addicts experience the consequences of their actions, and forcing neighborhoods like the Tenderloin and Mission to deal with it instead. Chaos, violence, theft, closed businesses, vandalism and filth – that’s the legacy of harm reduction. “Experts” who continue to advocate for this policy without regard to the social consequences are fools.
Harm reduction for a specific segment is not what these “pie in the sky” researchers should consider. Harm reduction for the entire population of an area is the issue. Walk your kids to school around 16th and Mission and then talk about harm reduction for everyone.
Zero drug tolerance
These are young idealist doctors
They dont have much life experience or experience taking care of addicts ,
How many addicts have they taken care of ?
Talk to them in 20 years ; they will change their tune
“young idealist doctors ”
Five years ago, I attended a similar kind of event at Manny’s: Similar harm reduction talking points, different two doctors. Plus Supe Mandelman and one poor recovering meth addict trans immigrant fella they rolled out like “cancer boy” in Thank you for Smoking. I felt bad for him.
So Mandelman aside (obviously), though he seems to be singing a different tune now, it would be interesting to learn where they are all today.
“Harm-reduction is not causing people to use drugs” is besides the point, just like saying, it wasn’t gravity that was causing the plane to crash into the mountain. The actual question: Is “harm reduction” actually leading to greater harm? Taking in the misery in our streets without numbness filter, you’d have to think, yeah, pretty darn sure it is.
This is the dumbest POV: “Those whose care was mandated were somewhat more (or somewhat less depending on the study) likely to avoid drug use than were those who entered treatment voluntarily … There isn’t significant evidence favoring mandatory treatment.”
Are you serious? The comparison should be between mandated treatment and no treatment at all. Sounds like mandated treatment is a little better or worse than voluntary treatment. Either way that’s WAY better than no treatment at all. Do drugs on the street? Treatment or jail. Those should be the options. Carrot or stick
Would work if we had the funding. Have you not read any of ML’s coverage of how hard it is to actually access those programs?
Reminder: you do not learn how to do statistics in medical school! You mostly memorize facts about biology. Most doctors are horrible statisticians, case in point these two!
The interests of the dignity of the individual to use fentanyl in public conflicts with the interests of residents to not have to deal with public squalor and associated negative impacts at our transit stops, in front of our homes and businesses and most certainly not around our local elementary school.
Opiate treatment is effective maybe half of the time for those with the wind at their back, support, resources, a reason to live. Forced opiate treatment that merely compels addicts to confront a shit life stone cold sober is a prescription for relapse. But relapse under a forced treatment regime means revenues for treatment nonprofits. So the nonprofits have an interest in thrashing people in and out of treatment, maintaining public squalor to create the conditions where people demand solutions to public addiction that’s used to throw good money after bad at the nonprofits. Relapse is good business.
As far as supervised consumption sites go, that’s not going to happen under Trump and even after, siting an addict magnet near residences, senior services agencies and an elementary school is not going to fly. Besides, imagine what happens when fentanyl addicts, who are addicted to a narcotic, narcotics that make one sleep, nod out in the consumption site. Do they kick the nodder out out into the neighborhood? Or do they get to nod out in the facility? What happens when someone wants to safely consume a stimulant? How do tweakers play with fentanyl folders? The grift for running this freak show tried to eclipse any sober (!) analysis of how this would play out in the wild. The worst part about this whole discourse is when young mostly white MPP and MPA interns who cycle through the nonprofits presume based on their demographic prejudices that residents have no experience with hard drugs or users.
The kind of harm reduction we need are latter day opiate dens for fentanyl addicts where people can use and fentanyl fold out of the public realm.
It does not seem that there was any critical analysis of the political economics of how these policies would play out in the real world at this event. This takes nonprofits at their word despite ample evidence of self dealing and corruption.
The criminalization of “drugs” has destroyed more lives than any “drug” could ever do.
Just legalize everything and defund all smuggling by providing them at cost from the government.