“The future is harm reduction”

Dear President Biden,

One aspect of the endless construction on the street in front of our house is that there are lots of big orange-on-one-side-silvery-on-the-other-side signs for directing traffic, including some that aren’t in use and are just leaning up against the chain link fence just outside the park across the street. The other morning I noticed that one of them has been tagged with:

“the future is harm reduction”

It seems like a pretty random thing to spray-paint on the back of a construction sign and an even more random thing to spray-paint twice, which is apparently what someone did since Laura saw another one with the same thing painted on it further up the road. Who knows, maybe there are scores of them across the city.

So someone really wants to get the message that “the future is harm-reduction” across to people living along 15th Ave NE in Seattle, but what is this message getting at? I somehow doubt the person is really trying to make a statement about harm reduction as it pertains to alcohol and drug use, which you probably know, is generally what the phrase is about. I mean, speaking as an addiction treatment researcher and clinician, it would be great if the future of substance abuse treatment were harm-reduction. Such a future wouldn’t preclude people opting to be abstinent – it’s definitely the best path for a lot of people – but it would probably help reduce a lot of misery if harm reduction were more widely embraced since lots of people are more likely to engage in treatment if they didn’t think they HAD to quit drinking or using drugs completely, forever.

Ok, so let’s go ahead and say “yes” to the above idea that the future of addiction treatment is harm reduction (and I know, some people think this transition has already been made, but I know there are still a lot of old school programs still out there….). I’m thinking, though, that whomever penned (painted) the message is suggesting we apply this idea much more generally than just to substance misuse.

Taking this person’s cue, what if we were to look at virtually everything through a harm reduction lens? What if we gauged everything by whether it reduced harm for everyone both now and into the future? I know I’m freighting a lot onto those five words that may or may not have been intended, but I like the idea of thinking so broadly and putting our choices and decisions through such an analysis. It would require that the old way of pitting one group’s benefit against another group’s harm be jettisoned, so it’s really quite radical.

If we adopted this as a goal it would require that we be super clear about a lot of things. What is and isn’t harm? How do get clear about who is and isn’t impacted by whatever the choice or decision is? How will we measure harm and benefit and who is in charge of taking those measurements? At what intervals will the measurements be reported out? And what is the process for making changes in the plan if harm, in fact, is not being reduced? It’s complicated and some of it’s super gnarly and contentious, but I’d appreciate it if you and your team would give it some thought since it could help us (finally) get clear about our mutual inter-dependence and stop dumping on each other, literally or figuratively.

May we all be safe from harm.
May we all be willing to forego benefits to ourselves if they result in harm to others.
May we see that we will be stronger collectively if we truly look out for one another.
May we accept responsibility for the collective.

Tracy Simpson

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