Colorado Harm Reduction Presented as a Proven, Data-Driven Health Care Initiative to Halt Overdose Deaths; but the Gapped, Interconnected Layers of the Young Science Suggest Flaws
As the Maverick Observer has covered, Colorado has an illegal drug use problem. That’s true for the US as well. As such, harm reduction is gaining popularity in the media, academia, and elsewhere. In Colorado, a bill to allow the opening of so-called overdose prevention centers made it far but was quashed in late April.
Harm reduction generally falls along party lines, with Democrats for it and GOP against it. The glaring exception, of course, is former establishment-Republican NYC mayor Bill DeBlasio opening the US’ first safe injection sites in New York City in 2021.
Harm Reduction: An Imprecise Drug Treatment and Approach to Substance Use Disorders
Though advertised as a rock-hard science-backed answer to the spiraling drug crisis, the data and studies are not so plentiful or conclusive. Given that there is a galaxy of widely varying substances used to get intoxicated, the international practice of harm reduction is not a “silver bullet.” A surprising number of supporters will even concede this. Similarly, drug laws differ from nation to nation and state to state, further complicating the issue.
Harm reduction is a broader suite of philosophies and practices. The proponents believe in accommodating drug users with protective measures as the users continue their use. This accommodation could be with or without encouragement toward sobriety. Harm reduction includes supervised injection sites where hard drug use is monitored by personnel ready to reverse opioid overdoses and other adverse reactions. The few locations in North America are generally ignored by criminal justice or otherwise given a pass, as using illegal drugs is still mostly illegal. Additionally, a “crack house” statute in federal law makes these sites technically illegal, but the current safe-use places in the US are apparently left alone.
Harm reduction advocates’ ethical philosophy is on the spectrum. Bertha Madras, Harvard professor in psychobiology and former executive in White House and federal drug policy, explains this spectrum. She notes there are harm reduction advocates who believe that complete sobriety and abstention are the goals, while others believe that drug use is simply a human reality that needs to be managed.
Colorado Harm Reduction
Colorado entered the harm reduction fray a few years ago with Denver in favor of creating a safe injection site in the city. The city partially approved this in 2017 but with a key proviso: the state would need to formally allow safe-use sites.
The state almost did. But two Democrat state senators made the deciding vote against it. One of them was Kyle Mullica, an ER nurse, who has undoubtedly observed numerous overdose deaths or near-deaths in his work. His big concern was over the open-regulation framework in the bill. The other Democrat, Joann Ginal, voted “ no,” citing the incomplete research on the topic. She also read a letter from a constituent, a former addict, who was against the bill.
Harm Reduction: Preventing Death
Harm reduction proponents often cite “decades” of success in the international community. They frequently boast that there have been no deaths at the various drug-use safe sites in Barcelona, Australia, parts of Europe and elsewhere.
There has been a success as far as simply preventing deaths within the four walls of one building, and possibly limiting overdoses within the immediate vicinity of one of the various buildings comprising these sites. If the single metric is to save lives in or right near a building, then it does work where drug users ingest illegal substances.
But there are other metrics, and this adds complications.
The Hammer of Public Health (Complication 1)
Public health had a zoom lens put on it recently. For a time, it was considered the guide through the toxic safari of a very communicable disease.
Public health officials from 2020 to 2022 had mixed performances. There were many undeniable failures, bungled predictions, and some outright falsehoods pushed as policy by figures in both parties. Nonetheless, the public health sector became much more well-known, but the perception of public health as the experts of science became more prominent.
Public health policy from powerful government figures (and from other leaders) became the scientific solution. Sometimes that policy was to force unpopular but necessary measures. Public health used science as a hammer and where contagious disease was a nail. Many people have made the comparison. Regarding safe-use sites, public health science now says the safe-use model is necessary.
In 2023, drug treatments, opioid use disorders, and other complications are viewed as a nail when public health is considered the hammer.
But numerous definitions, terms, practices, and other complications are involved in the school of harm reduction. Complications on top of complications.
Defining Terms and Zooming In (Complication 2)
Drugs come in lots of styles, lots of delivery methods and are subject to many different laws.
Drugs are Complicated – So Is Harm Reduction
- Intoxicating substances are consumed in numerous ways: smoking, injecting, swallowing, and through the skin.
- Drugs can be legal by prescription but can concurrently be part of an underground market for illicit use: many opioids like fentanyl and oxycodone; benzodiazepines like Xanax and Ativan; other psychiatric medicines like Quetiapine.
- Some drugs are illegal: certain opioids like heroin, stimulants like cocaine, and hallucinogens like LSD.
- Certain drugs are legal by prescription but have illegal counterfeits made by dealers and cartels: fentanyl, oxycodone, others.
- There is a suite of substances connected to widely varying laws depending on the state or territory: cannabis, and certain psychedelics like psilocybin.
- Some substances are legal only in certain strains, concentrations, etc., such as CBD (a nephew of cannabis).
The earliest parts of harm reduction included needle exchange programs, a measure borne out of the AIDS epidemic of the 1980s and early 90s. The hope was to reduce the transmission of a disease that had a 100% fatality. Drug users—PWID, people who inject drugs in this case—could obtain free, unused needles without facing legal dangers for illegal drug use. But the practice did not stay there with needle exchange programs. Eventually, other paraphernalia came within the boundaries of harm prevention.
This article won’t cite the scandals regarding certain paraphernalia components being funded, even indirectly, by the Health and Human Services Department. To do so could garner penalties from search engine indexers. But regarding that paraphernalia, a very close, word-for-word reading of leftwing CNN’s fact-check says otherwise. Certain funding, even indirectly by reimbursement, could have funded clean “stems” for drugs consumed by smoking. And it was part of harm reduction.
Harm reduction is not limited to clean, safe, closely monitored, and sanitary booths for injection drug users. It includes anonymous and unstaffed needle exchange programs by mechanical dispensers, government or non-profit groups handing out safe-use kits, or so-called overdose prevention centers hosting or assisting drug users in a building.
Colorado Harm Reduction Policy and Five People in Europe (Complication 3)
The most popularly cited piece of pro-harm-reduction data is a new research style called a meta-study. This meta-study did a keyword search in science databases and culled relevant articles, which it then analyzed.
The conclusion of the analysis was a tepid affirmation that the safe injection sites did what they’d intended “without enhancing drug use or drug trafficking.” But the study is not so conclusive.
2014 Meta-Study Used as Bedrock Source for Harm Reduction Advocates
- The data pool was shockingly limited. 85% of the articles analyzed in the study were from two safe-use site locations: Vancouver, Canada and Sydney, Australia. In 2012, two years before the meta-study, there were eight countries with a drug consumption location. Why were six countries only accounting for 15% of the research data? For Sydney and Vancouver, how many habitual visitors to the safe use sites were accidentally counted multiple times across various studies and papers?
- European scholars’ analyses and studies may not be directly applicable to local or state-level public policy in Colorado. The five authors are professors or researchers that appear to be from only three different institutions or institutional systems. Their degrees or credentials beyond their institutions are not listed. Further, the diversity of opinion, lifestyles, public health laws and practices differ in Colorado from France and Switzerland. Even if the data were solid, it does not translate to policy.
Fundamental Reality: Illicit Drug Use is Never Safe
The use of illegal drugs remains largely illegal. Without detailed and good-faith efforts to understand chronic drug users’ thinking processes and motives, the long-term goals for harm reduction remain unclear.
The safe use debate acknowledges that there is no such thing as “safe use.” There is only “safer use.” Taking illegal drugs or circumventing the prescription process to take conditionally-legal drugs is never truly safe. While overdose deaths were not as bad for 2022 in Colorado as they were in 2021, advocates who stress data, science, and evidence must have a wider lens of harm reduction.
