Harm Reduction
The whole Biden admin “safe smoking kit” brouhaha which was in the news this past week rekindled a heated debate about Harm Reduction.
I found it odd that there were some people claiming that it had hurt the overall Harm Reduction movement. The fact that the DHHS earmarked $29.2 million for a Harm Reduction Grant program says to me that the so-called “movement” is doing just fine.
I used to think Harm Reduction made sense as a drug policy, but I reevaluated my position after reading Michael Shellenberger’s 2020 book “San Fransicko”. I’d encourage anyone who feels strongly about the state of American inner-city poverty, and who still believes that progressives or leftists have the best possible solutions in mind, to refer to that book.
There’s a distinction to be made between capital-H “Harm Reduction”, Harm Reduction as signifier and as ideology, and harm reduction, an umbrella term for a well-intentioned act of charity or relief to drug users.
I can on the one hand agree that a needle exchange will play a positive role in enabling some addicts to get high safely, or recognize the life-saving potential in distributing and teaching the correct administration of Narcan, while still holding that Harm Reduction-first drug policy is a fundamentally flawed answer to the question of “what do we do about this growing epidemic of debilitating drug addiction?”, that it creates more problems than it solves, and that it willfully ignores material root causes in the process.
Harm Reduction-oriented policy – that is, Harm Reduction alone – cannot resolve the problem of epidemic levels of drug addiction. I found this evidenced best in Chapter 6 of Shellenberger's investigation, where he shows how the pivotal moment which turned the tables in the Netherlands towards success was when they reformed their drug policy to treat Harm Reduction as just one aspect of their overall addiction outreach and rehabilitation strategy, not as the primary means to an end.1
The neoliberal establishment has learned to love Harm Reduction, and why wouldn’t they? It fits neatly into their modern austerity governance model: locating executive responsibility directly within the public health bureaucracy is bad, using the health bureaucracy as a conduit for NGO grant distribution is good. Harm Reduction has the appearance of being cutting-edge and radical, in a way that dazzles a younger, radlib, DSA-adjacent voting coalition, but without compelling them to introduce reforms which would address the material conditions that have led to the drug epidemic in the first place, and without disrupting the Democrats’ cozy relationship with the pharmaceutical industry.
Speaking of the neoliberal establishment, a rule of thumb I have learned to live by is “if George Soros supports something, it’s probably not for the best”. At one point in his book, Shellenberger recounts a conversation he had with Ethan Nadelmann, whose pioneering work in late 80s and 90s “developed the scholarly case for decriminalization and harm reduction”:
“Around the summer of ‘92 I get a phone call from George Soros,” Ethan said. “We had lunch and hit it off. He didn’t know what harm reduction was. He was coming at this because he saw how open society ideals were being violated. As a businessperson and economist he saw the absurdity of trying to ban a popular commodity.” (emphasis added)2
Putting aside the frankly ghoulish implications of this anecdote, we can glean some insight into Soros’ political and philosophical sensibilities. His “open society ideals”, and his Foundations of the same name, are inspired by Karl Popper’s concept of the Open Society, which can be summed up as “the view that a society is equivalent to the sum of its members, that the actions of the members of society serve to fashion and to shape it, and that the social consequences of intentional actions are very often, and very largely, unintentional”.3
In matters of social policy-making, Popper calls for “a genuinely open society piecemeal social engineering [that] goes hand-in-hand with negative utilitarianism, the attempt to minimise the amount of suffering and misery, rather than, as with positive utilitarianism, the attempt to maximise the amount of happiness”.4
So it’s not hard to see how “Harm Reduction”, being as it emphasizes a primacy on the minimization of suffering within the domain of drug addiction, succinctly resonates with this odd concept of “negative utilitarianism”, with the degree to which, in terms of formulating social policy, the state “should concern itself with the task of progressively formulating and implementing policies designed to deal with the social problems which actually confront it, with the goal of mitigating human misery and suffering to the greatest possible degree.”5
We also get a sense for Soros’ maximalist free market economics, which Popper shared as well (albeit perhaps not to such an extreme degree). To me, “the absurdity of trying to ban a popular commodity”, driven to its utmost libertarian-capitalist conclusion, conjures a conception of society which would abolish all legal impositions upon the right of the capitalist to sell narcotics, and upon the right of the individual consumer to destroy his life with them. The state would intervene merely to facilitate the marketplace and means of exchange, and occasionally act to mitigate any suffering endured therein, nothing more.
Finally, in a pragmatic sense, donating to Harm Reduction Coalition offices is likely one way that Soros extends his ad-hoc patronage network composed of various city bureaucrats and NGO managers, evidenced in other cases by the local District Attorney candidates whose campaigns he finances, or his financial donations to various police reform advocacy groups. These efforts seem less a reflection of his liberal sensibilities and more so part of a strategy to build and maintain a network of influence throughout major urban liberal hubs in the US.
And in any case, Soros could also stand to gain financially. This is the same guy who shorted $10 billion worth of British pound sterling in 1992; the scale of capital with which he operates, the magnitude of the positions he’s willing to take, strongly suggest that he’s more than capable of gaming out the hollowing-out of inner urban cores in the long term, and profiting from the inevitable depreciation of urban neighborhood property values which is brought about by sanctioned open-air drug use. If he can do so in a way that affirms his neoliberal worldview, that’s all the better.
In short, Harm Reduction is a radlib crock of shit, little more than Open Society neoliberalism recast through the woke, post-Occupy anarcho-DSA lexicon. If and when Harm Reduction’s most fervent ideologues (the ones who have skin in the game) are pushed to justify its rationale, they often resort to sophomoric hand-waving couched in terms of discursively abortive root causes. Take, for example, Kristen Marshall, Associate Director for San Francisco Programs at the National Harm Reduction Coalition, who said in an August 2020 interview: “We can’t end overdoses until we end poverty, until we end racism, and until we end homelessness”.6
It’s abundantly obvious that the continuing degradation of material conditions among the impoverished American underclass and the contemporary drug epidemic are undoubtedly interrelated, yet Harm Reduction idealogues categorically fail to meaningfully resolve this dialectic. They present themselves as the harbingers of the cutting edge of modern drug policy which ultimately amounts to little more than giving addicts the means to stay addicted and crossing one’s fingers that the problem will eventually sort itself out.
I’ve not built up this argument to pivot to a comprehensive alternative – that’s way beyond the scope of this brief piece, and anyway Shellenberger does a much better job of that than I ever could.
Rather, my motivation has been to examine how Harm Reduction ideology is just one example of how the contemporary American New Left’s most sacred and ostensibly radical precepts can be and often are astroturfed by elite neoliberal interests.
In the future, I hope to examine other sacrosanct tenets of New Leftism – Mutual Aid being the next one – to find new ways of peering at its latent, inherent hypocrisy: a political milieu which bills itself as capable of radically critiquing and disrupting the neoliberal status quo, but ultimately remains complicit within it, which claims to act on the behalf of the underclass, while actively advocating for policies which will merely extenuate its immiseration.
Shellenberger, Michael. 2021. San Fransicko: Why Progressives Ruin Cities. N.p.: HarperCollins Publishers. 73-74.
Ibid. 45.
Thornton, Stephen. 1997. “Karl Popper (Stanford Encyclopedia of Philosophy).” Stanford Encyclopedia of Philosophy. https://plato.stanford.edu/entries/popper/.
Ibid.
Ibid.
Thadani, Trisha. 2020. “More Than One Person a Day Died in SF of an Overdose Last Year. This Year Is Expected to Be Worse.” San Francisco Chronicle, August 31, 2020. www.sfchronicle.com.