^{Wealth & Poverty Review} The Harm in “Harm Reduction”

Every major city in the United States seems to have its designated opioid district, a tucked-away part of town where normal rules are suspended and the drug trade shapes the social order: Kensington in Philadelphia, the Tenderloin in San Francisco, Pioneer Square in Seattle. The scenes are sadly familiar: disheveled men and women living under blue tarpaulins, dealers doing hand-to-hand transactions between large trash receptacles, and dope fiends searching with their fingertips for the last good vein. Methadone clinics and rescue missions operate amid a steady rumble of ambulances and police cruisers, vehicles sent not to enforce public order but to manage the status quo.

Political leaders have long sought to transform these places. Among progressive policymakers, the prevailing trend is “harm reduction,” a public-health approach that accepts widespread drug use and directs resources toward mitigating its negative consequences. Harm reduction began with needle exchange and methadone clinics, which helped, respectively, to reduce the transmission of blood-borne diseases and to stabilize addicts with opioid replacements. Now, as Western nations confront the opioid crisis, cities in Canada, Australia, and Europe have adopted a new harm-reduction strategy: so-called safe-injection sites, where addicts can take drugs—predominantly heroin and methamphetamine—under the supervision of medical professionals, who intervene in case of emergency.