Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction | Review

Maia Szalavitz is an author and journalist focused on neuroscience, addiction and drug policy. She has written for the likes of High Times, VICE, The New York Times and The Guardian. Her newest book, Undoing Drugs, provides a comprehensive history of North American harm reduction movements, which arose as a response to the frightening AIDS epidemic of the ’80s. It details the harm reduction movement’s evolution from the late ’70s onwards. Groups like ADAPT (The Association for Drug Abuse Prevention and Treatment) and ACT UP (The AIDS Coalition to Unleash Power) and later, organisations like the DPA (Drug Policy Alliance) and the NHRC (National Harm Reduction Coalition) are explored. Undoing Drugs covers a range of topics across drug policy; the devastation of AIDS, the fight for supervised injection facilities, overdose prevention via Naloxone, compassionate changes to addiction and pain treatment and the emergence of national drug reform organisations.

The book is a tribute to ‘The Goddess of Harm Reduction’, Edith Springer, who is credited with introducing the harm reduction concept to America, thanks to a meeting with Allan Parry. Parry ran a successful harm reduction programme with Doctor John Marks in Liverpool, England. At one time, they were legally prescribing unadulterated, safe doses of heroin and cocaine to drug users. They also ran a needle exchange programme where they’d provide sterile needles in exchange for used ones, which they would safely dispose of. Clean needle programmes weren’t something that had been successfully organised yet in the States. Initially, they focused on educating injecting drug users on how to clean needles out with bleach and water, before re-using or sharing them. The book credits an exhaustive list of players in the harm reduction movement, from those mentioned above, to people like Yolanda Serrano, Jon Parker, Michelle Alexander, Dan Bigg, Stephanie Comer and Dave Purchase. All made valuable contributions to harm reduction in different periods, but tragically, not all of the groundbreaking and inspiring figures in this movement would survive to now, due to overdoses or illnesses.

Szalavitz experienced a major shock in 1990, when she first learned of the link between shared needles and HIV. She describes the ‘utter hell’ of waiting on HIV test results for two long weeks, before receiving the welcomed news that she hadn’t contracted it. It was at this point in her life that she decided that educating people about harm reduction and helping to introduce public harm reduction measures was precisely what she would devote herself to doing. Like Doctor Carl Hart, Szalavitz examines the racist origins of the war on drugs. She tells that even alcohol prohibition in the US had racist reasoning behind it: ‘..many white Protestants felt their power was threatened by rising numbers of immigrants from Germany, Ireland, and Italy, as well as Eastern European Jews. Prohibition was seen as a way to take back control.‘ She touches on the precedent set by The Harrison Narcotics Tax Act of 1914 and explains how in 1930, Harry Anslinger, as the first Commissioner of the Federal Bureau of Narcotics, fought for a strict federal ban on cannabis on the premise that weed ‘would seduce white women and lead to widespread insanity among previously pure white youth‘.

He ignored 29 of the 30 Doctors he interviewed about cannabis, who said that it wasn’t harmful enough to ban. This reckless anti-drug attitude would continue later, most notably with Presidents Nixon and Reagan. Szalavitz outlines the public mindset, from the ’60s onwards, as follows: ‘..illegal drugs had been firmly linked in the American mind with poor, Black, and brown criminals — and the stereotype of the “addict” as a lazy, devious, and violent sociopath mapped perfectly on to the racist stereotypes many whites held about those groups. With a compliant media, it was easy to blame violence and poverty on drugs — and not the socioeconomic circumstances that actually do lead people to problematic relationships with substances. It was also easy to spike fear that the evil drugs used by poor Black and brown people would soon be coming for innocent white babes.‘ Elsewhere, she quotes a lawyer, who said the following about crack cocaine in a New York Times op-ed in 1986: ‘If we blame crime on crack, our politicians are off the hook. Forgotten are the failed schools, the malign welfare programs, the desolate neighborhoods, the wasted years.

It’s apparent from these descriptions of the anti-drugs rhetoric of US authorities that the narrative on drugs has long been manipulated by those in power, to avoid taking responsibility for the neglect of various social issues and as a means of scapegoating ethnic minorities, particularly African Americans. The narratives of traditional and dominant twelve-step recovery programmes are challenged, such as those found at Narcotics Anonymous and Alcoholics Anonymous, where their only measure of success for an addict is total abstinence from intoxicating substances. Addiction is viewed as a ‘progressive disease’, such that if someone changed from buying crack every weekend to smoking a joint once or twice in a month, that person would be labelled ‘still using’ and ‘not in recovery’. This is because ‘progression of the disease’ is seen as inevitable, meaning that in their view, such an instance of seemingly controlled cannabis use ‘will ultimately spiral back to chaotic crack addiction’.

Szalavitz also covers the Housing Works organisation, which was founded to combat homelessness and addiction through the provision of free housing. The organisation was based on the ‘Housing First’ premise that it’s ‘highly unlikely that someone living in an unstable setting or entirely without shelter will be able to quit alcohol or other drugs while still on the street.‘ Along with the likes of Stand Up Harlem, they were shown to have tremendous success in reducing chronic homelessness and by extension, addiction rates. They stood in stark contrast with housing provision programmes that demanded the near-impossible from drug users – that they be entirely ‘clean of drugs’ before granting them accommodation. Root causes for many people who end up in damaging life scenarios are mentioned by the author, where she states: ‘Virtually everyone who ends up homeless, addicted, mentally ill, and HIV positive has a long history of childhood trauma, typically compounded by the experience of racism and the extreme distress and social rejection that comes with living on the street or being incarcerated.

Although Undoing Drugs is often heartbreakingly tragic, it is a vitally important book that highlights the success of applied harm reduction and the contrasting failure of continued ignorance and stonewalling. It considers the countless people who take drugs who are routinely stigmatised, marginalised, and de-humanised due to conservative, hardline drug policies. The key message throughout is an urgent need for the powers that be to adopt a more humane and effective approach for drug policy. Emphasis is placed on the importance of protecting human lives above all else. Maia Szalavitz‘ book is full of data that proves the success of initiatives which treat drug users with respect and dignity, helping them to stabilise themselves and restructure their lives enough to feel ready to quit the drugs that they were disrupting their lives with in the first place. Perhaps by now, world leaders should be sitting up and listening keenly to the likes of Ms. Szalavitz, instead of ‘being tough on drugs’.

* The Green Lens would like to thank Hachette Books for providing us with a review copy of this book.

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