This week, I’ve been thinking about Undoing Drugs: How Harm Reduction is Changing the Future of Drugs and Addiction by Maia Szalavitz, published by Hachette Go in 2021.
It’s a history of the harm reduction movement. The author is herself a former injection drug user and she’s been covering harm reduction and related issues as a journalist since the late ‘80s or early ‘90s. She opens the book with a powerful moment from her own life, making the case that if she had not had a chance encounter in the mid ‘80s with a couple of people who had been exposed to harm reduction practices and passed their learnings on to her, she would probably have ended up with HIV and AIDS, which in those years meant almost certain death.
The book is journalistic in its approach rather than scholarly, with lively writing and generous use of quotes from the many interviews the author has done over the years. It’s broadly chronological, and each chapter focuses on a moment or a place or an idea or an event, and tells the story of those things through the experiences of a specific person or people. It’s quite effective. The book’s main focus is the United States, though it does talk about the movement’s origins in Liverpool in the UK, and it devotes a later chapter to the work of the Vancouver Area Network of Drug Users or VANDU here in Canada.
Despite its US focus, I found it interesting and very useful — there are definitely differences between the two countries, but the overall cultural and political dynamics are deeply intertwined. I’ve been politically supportive of harm reduction for ages, but I learned a lot from this book about how it developed as both a movement and a set of practices, the obstacles it has faced, and the victories it has won. I’d say the main limitation of the book is that I don’t think it was as able to talk about causality — about what caused this or that development — as effectively as a more scholarly approach. But that’s a minor issue.
Interestingly, I also learned some important things from the book about abstinence-based responses to addiction. The book is not dismissive of the important role that abstinence can play in the journeys of some people — including the author herself — but it also makes clear how messed up some abstinence-based approaches have been, including not only through their disregard for what actually harms people, but also the encouragement by some of what amounts to abusive behaviour towards drug users, especially in decades past but to an extent still today. I had no idea.
I think this is a very timely read. Things have gotten substantially worse for drug users and for advocates of harm reduction in the few years since this book was written. Yes, that’s related to the political awfulness going on down south, but there has been growing hostility to harm reduction from a highly organized minority here in Canada too. These anti-harm reduction forces have zero interest in the evidence of what actually helps or harms people, a contempt for compassion, a commitment to amplifying stigma, and a devotion to using the issue as a wedge to empower the political right. I’ve seen that in my own province and my own city, and its very worrying. I think this book and other material like it can play a role in figuring out how we need to collectively respond.