Holding space for the unredeemed: harm reduction and justice

I spent last Friday in Chicago at the Midwest Harm Reduction Institute’s annual conference. The theme was Growing from Our Roots:

This year’s conference them reflects the importance of honoring the roots of harm reduction. We are thrilled to see harm reduction discourse and practice entering the broader workplace and world. At the same time we must reconnect to the grassroots of harm reduction, that is, people as experts in their own lives helping one another and informing our practice.

This was a timely topic for me and, I believe, the broader harm reduction movement, with a lot of rich discussions throughout the day and an agenda anchored in social justice principles. I left feeling inspired and challenged, with new ideas and questions and connections.

I’ve been spending a lot of time lately wondering what harm reduction means in 2016, and where it’s going. As the conference organizers noted, harm reduction has been going through a wave of success and visibility in the United States recently, particularly around syringe exchange and naloxone access. Much of this stems from the space opened up by the prescription opioid and heroin crisis and its particular geographic, demographic and political contours. This has pulled the harm reduction field towards the center of drug and public health policy after years — decades — of marginalization.

But legitimation has its costs. In a recent article entitled Harm Reduction Needs to Rediscover Its Soul, Shaun Shelly argued that the harm reduction movement has lost sight of its values and commitment to people who use drugs in a bid to mainstream core interventions and secure funding through appeals to cost-effectiveness and public health utilitarianism:

We need to remember: Harm reduction is not an HIV intervention — it is a basic human right that should be available to everyone.
Through their search for funding and a platform from which to advocate for drug-user rights, harm reductionists and even drug-user networks have arguably become complicit in the marginalization, pathologizing and exclusion of the very people they seek to defend.
The fact that US Drug Czar Michael Botticelli can receive a standing ovation at a harm reduction conference tells me that harm reduction has become mainstream and compromised.

I’ll be honest — that last part gave me pause. This was my organization’s conference; I’d arranged for Michael Botticelli to speak, introduced him myself, and encouraged the audience to give him a warm welcome. After his talk, I escorted him to another room where I’d arranged a meeting for him with people who use drugs. To me, this represented a significant achievement for the movement — for decades, the federal government had shut harm reduction out of both funding and policy. Now, the nation’s top drug policy official was coming to us and sitting down with drug users. How exactly does this compromise the movement?

Sometimes the critiques that get under our skin are the ones we most need to work through. By giving the Director of the Office of National Drug Control Policy a platform, did we convey that we were aligned with all of their policies? Did my introduction frame his talk in a way that discouraged protest? I’ve known Michael for a while and personally consider him a friend and ally; he and his staff have been very supportive of our issues and agenda, and it’s been a valuable and productive partnership.

But what does the harm reduction’s embrace of the drug czar look like to people at home and abroad who primarily experience U.S. drug policy as a destructive force in their communities? What did our conference signal to them about harm reduction’s values and priorities, about who we’re truly aligned with? Who are we fighting with, and who are we fighting for?

Which brings me back to the Chicago conference, which celebrated the growing influence of harm reduction — call it mainstreaming — while calling for an intentional reconnection to our grassroots and the people most vulnerable to drug-related harms. That’s the challenge: the prescription opioid and heroin crisis gives us unprecedented opportunities to change systems, structures and institutions that have traditionally been at best indifferent and at worst actively hostile to people who use drugs. We cannot afford to turn away from this moment when we have increased access and influence. But when we gain entree to Congressional offices, or get appointed to a Governor’s task force, or walk into a meeting at the White House, we must always ask ourselves: who are we bringing with us, and who are we leaving behind? What’s the price of access? To whom are we most accountable?

The day before the Chicago conference, I was on a panel in D.C. The best speaker on the panel was a young man from Rhode Island, Jonathan Goyer, whose work straddles harm reduction and recovery. The audience rightly and loudly applauded his remarks, which included his own story of recovery. And in so many spaces I’m in, we’ve become very comfortable in applauding recovery. This is a big achievement; shame and stigma mean that too many people still don’t feel safe in disclosing their recovery to family, friends and employers. The recovery movement in the United States — including groups like Faces and Voices of Recovery, Young People in Recovery, and Facing Addiction — have done amazing work in challenging stigma and giving voice to the experiences and challenges of recovery. Indeed, Michael Botticelli himself never speaks more compellingly than when he’s talking about his own recovery journey.

I’ve been thinking a lot about how to build bridges and alliances between the recovery and harm reduction movements, where we have shared goals and common ground, and what harm reduction can learn from the successful advocacy and organizing of people in recovery. But lately, every time I’m in a room that applauds when someone discloses their recovery status, I’ve wondered: would you also clap for someone who says, “I am a person who uses drugs, and I am surviving. I am taking care of myself; I am helping others. I am here and you will hear me”?

Growing from our roots must mean growing with our roots — not growing beyond our roots, not leaving our roots behind. We may be making friends in high places, but we need to fight to ensure that the rooms we now have access to have space to hold all of us. All of our values, all of our complexities, all of our communities. And not just space for the most acceptable, most presentable, most advantaged. We need to make space and hold space for the unredeemed.

An earlier speaker at the D.C. event briefly discussed naloxone and voiced concern that broader naloxone access would give people who use heroin and opioids license to use with “reckless abandon.” This is the figure of the unredeemed: the reckless, the relapsers, the recidivists, the recalcitrant, the resistant. A nameless, voiceless spectral figure of reckless abandon — a projected recklessness then used to justify abandoning them. A recent AP story — “Just Say No to Narcan? Heroin Rescue Efforts Draw Backlash” — traces this deadly logic:

Authorities say people have expressed frustration about rescuing addicts who often immediately resume using the potentially deadly drug. There are also concerns voiced about the wide-ranging social and government budget costs involved, including for the overdose antidote naloxone.

The lethal consequences of deeming people who use drugs as unrepentant and unredeemed extends far beyond overdose. It plays out when law enforcement justify their killing of Keith Lamont Scott in Charlotte, North Carolina by invoking his alleged marijuana possession. It surfaces in the police killing of another black man, Terence Crutcher, in Tulsa, Oklahama with insinuations that he — “a bad dude”, “probably on something” — was high on PCP. It circulates when the Republican presidential candidate blames drugs for a supposed surge in urban violence and calls for a national expansion of racially discriminatory stop-and-frisk policies.

Trump looks to Chicago and sees drug-fueled gun violence warranting aggressive use of failed policing strategies that have tightened the noose of incarceration around black and poor communities. For me, being in Chicago evoked reflections on police corruption — the cover-up of the killing of Laquan McDonald, a legacy of police torture, the Homan Square secret detention facility. What’s more, my Chicago visit conjured up powerful stories of resistance and racial justice organizing by groups like BYP100, Project Nia, Assata’s Daughters and We Charge Genocide.

These racial justice organizing efforts can feel both very close to and very distant from the harm reduction movement. But growing from our roots doesn’t just mean growing upwards; we should also grow outwards towards other movements. I take inspiration from the words of longtime Chicago organizer Mariame Kaba, who names harm reduction as “try[ing] to prevent more harm happening to people who are already harmed by the system” while fighting for prison abolition. I take inspiration from the work of Chicago’s Shira Hassan in fusing harm reduction philosophy with social justice organizing.

That’s the harm reduction that I want to practice: a harm reduction informed by and infused with racial justice. A harm reduction that grows from — but remains accountable to — our roots. A harm reduction that is making space and holding space for the unredeemed.