Harm reduction for the 21st century

Needles collected for dispersal at the Syringe Exchange Program at Outside In. Photo by Kristina Wright

By Alex Zielinski, Staff Writer

On Nov. 15, the Harm Reduction Coalition’s national conference came to Portland for the first time. Covering topics from political shifts in drug treatment to overcoming drug user stigma, the conference touched on a variety of issues related to national drug use. To get a better grasp on the breadth of harm reduction and its current role in the local and national spheres, Street Roots spoke with Allan Clear, who has been the director of HRC since 1995.

Alex Zielinski: Can you define harm reduction? It seems to encompass a wide variety of areas, from health care to legal policy.

Allan Clear: Harm reduction, or at least what we’ve done with it, is looking not at drug prevention or treatment, but focusing on people who are currently dealing with drug-related effects.

A.Z.: How does Portland play into harm reduction practices from a national perspective?

A.C.: While this is the first time our national conference has come to Portland, this city is ahead of the rest of the country in a lot of ways. Specifically, the Syringe Exchange Program, the easiest example of harm reduction. It’s so exciting to be here, the birthplace of the program in the country.

A.Z.: And how is harm reduction treated at the national level?

A.C.: We’ve seen a big and national change in the federal government’s take on harm reduction in the last four years. Primarily in drug, public health and law enforcement efforts. Under President Obama, we’ve begun to see this change, and we’re hoping it will continue now that he’s re-elected. He’s put a big focus on overdose prevention programs, which most leaders won’t touch.

A.Z.: What about drug injection sites and programs, which have popped up across Europe, Canada and Australia, but not in the U.S.? Is that in the country’s future?

A.C.: Drug injection sites (safe public places for people to use drugs) remain controversial in the U.S. While it’s unauthorized in the country, there are many illegal programs that do facilitate injections. I think we’re moving in that direction, but it will take a massive shift for this country to do that.

A.Z.: Then what would you say the next big harm prevention technique or program in the country will be?

A.C.: In Seattle, the police chief has sworn to not put people in prison for drug use. This is pretty big. It’s key that officials are aware that we need to look at this issue more extensively.

A.Z.: Can you describe what you see as the difference between the country’s institutional attitude toward drug use and recovery and the reality of it?

A.C.: Institutionally, we still treat drug addiction as a criminal act, not a disease. We have prevention programs, like DARE, and treatment, where only 20 percent of people succeed, and those in between get nothing for their illness. As a country, we can succeed best when we create a space where people can actually survive in the environment. We aren’t doing that now. It’s a heavily stigmatized disease.

A.Z.: What do you think needs to be done in the country to get past this stigma?

A.C.: Part of the issue is that you have these epicenters of drug use in big cities. If you tell an elected official in a small town in Minnesota that they should create harm reduction programs, they won’t care, because they think it doesn’t affect their constituents. But what we’re seeing is that drug abuse is really the same in every state, across the board, from heroin to over-the-counter medicine. It will take leaders making drug addiction a personal issue — by realizing that their family, friends, constituents are effected by it — to get to real change. People need to realize that drug addiction touches all states, all cities, it’s not for some weird other people from the Bronx or “The Wire.”

A.Z.: What role can people who are actually using drugs play in fighting the spread of HIV and even preventing drug abuse?

 A.C.: Before this weekend’s conference, we got drug users together around the country to talk about how the stigma of drug use affects their lives. That’s something we’ve done a really bad job at in this country, giving users a voice, an opinion. Drug treatment could probably be real more effective if we ask drug users what they think about it. It’s time we give them a major leadership role.