The Harm in Harm Reduction
Forces throughout the world are attempting to change the face of drug prevention and treatment forever through the introduction of “harm reduction” with the ultimate goal of legalizing all drugs every where. Prevention and treatment specialists and other drug policy leaders must understand this drug legalization campaign and be positioned to combat it. This paper will discuss the campaign strategies and guidance for drug policy leaders in developing policies to combat this destructive campaign.
Key Words: Policy, Legalization, Harm Reduction, Prevention
Drug legalization is being promoted worldwide as the “solution” to dealing with the problems associated with drug use and trafficking. However, most advocates of drug legalization do not use the “L” word - in other words they do not openly speak of legalization. Rather, they promote more innocent-sounding theories and strategies such as “alternatives to the War on Drugs,” “harm reduction,” “safety-first education,” and “reality-based education.”
As drug prevention and treatment specialists and other community and policy leaders struggle with policy development for dealing with drug legalization issues, it is important for them to understand who the advocates for drug legalization are and what strategies they are promoting in order to achieve their ultimate goal of drug legalization worldwide.
It is important for drug policy leaders to understand that the battle against drugs must include a battle against those who wish to legalize them. It is a battle that is being fought through a multi-faceted effort of parents and other family members, clergy, teachers, youth, law enforcers, employers, and national and local community groups working to change attitudes and turn the tide against the use of dangerous, mind-altering drugs.
This battle is waged through drug-free workplace programs, drug-free schools and communities programs, laws against driving while intoxicated, parenting programs, treatment efforts, employee assistance programs, and the like.
The drug legalization movement is gaining momentum across the United States, as well as in other countries, due in part to a softening of public opinion regarding drug use accelerated by a concept referred to as "harm reduction."
This misleading phrase was introduced in the United States over a decade ago to further the idea that society should try to minimize the damage done to addicts by drugs (such as disease and overdose) and to society by addicts (such as crime and health care costs). Who wouldn't favor a policy that reduces the harm a dangerous substance poses to the user, and in turn, the user to the community?
The serious flaw in this approach to dealing with the drug problem was highlighted by General Barry R. McCaffrey, former director of the United States Office of National Drug Control Policy, when he stated, "No reasonable person advocates a position consciously designed to be harmful. The real question is which policies actually decrease harm and increase good. The approach advocated by people who say they favor 'harm reduction' would in fact harm Americans."
What is Harm Reduction?
Harm reduction advocates believe that illegal drug use is an inherent aspect of the human condition; that society should simply accept the fact that people are going to use drugs and that it is in everyone's best interest to assist drug users by teaching them "safe use." As the Harm Reduction Coalition asserts in its mission statement, harm reduction "accepts for better or worse, that drug use is part of our world," and that harm reduction meets drug users "where they're at."
But even if illicit drug use was a natural, inevitable component of being human, should we advocate its use, even support the users? Murder, child abuse and prostitution are all human activities that will most likely never be eliminated from our species, yet does society turn a blind eye to their causes and aid the offender so as to simply "reduce" the harm of the act? No. In alcohol treatment programs, under the assumption that the alcoholic will never be able to quit, is the addict given "a clean Scotch tumbler to prevent meningitis?" Again, no.
Harm reduction is quite simply a veiled crusade to legalize, or in the words of Ethan Nadelmann, director of the Drug Policy Alliance, formerly the Drug Policy Foundation and the Lindesmith Center, (a pro-drug legalization organization), to "decriminalize" or "normalize" drug use. The December 1994 issue of the Drug Policy Report quotes Nadelmann: "I am a big fan of harm reduction. It is about making prohibition work better, but on our terms." In essence, embracing the tenants of harm reduction would bring our country one step closer to the legalization of harmful drugs of abuse.
As stated in a paper authored by Robert L. DuPont, M.D., and Eric A. Voth, M.D., both of whom serve on the International Scientific and Medical Forum on Drug Abuse, a division of Drug Free America Foundation, "Clearly, all forms of legalization, including harm reduction, are strategies ultimately aimed at softening public and governmental attitudes against nonmedical drug use and the availability of currently illegal drugs."
Today's public policy for reducing the harms associated with alcohol use and smoking tobacco, both legal substances, involves more stringent consequences for driving while intoxicated and restrictions on smoking. Harm reduction advocates propose softening restrictions on the use of illegal drugs. Their focus is on reducing or removing criminal penalties for drug offenses, providing needle-exchange programs for intravenous drug users, offering harm-reduction education classes in lieu of abstinence-based educational programs, such as D.A.R.E. (Drug Abuse Resistance Education), and distributing heroin as "treatment" to hard-core addicts.
Needle "Exchange" Programs
Harm reductionists have seized upon the ill-conceived notion of reducing the spread of AIDS by providing clean syringes for intravenous addicts of heroin, cocaine and other injectible drugs. Several cities in North America sponsor government-funded needle exchange programs (NEPs) under this assumption. Ironically, there is little exchange of needles going on under these programs, as addicts are not required to return their used needles to receive a fresh supply. These programs are better defined as “needle giveaway programs” than as exchanges.
Supporters of NEPs point to various studies reporting that the programs have led to a decline in HIV infection rates. However, the studies that they refer to contain many flaws:
-First, the studies are unscientific reports that failed to control for variables. For example, NEPs are usually performed in conjunction with AIDS outreach education and treatment programs; therefore one cannot pinpoint the exact cause for a lowering of HIV infection rates. The argument supporting studies that suggest NEPs are the only way to reduce HIV/AIDS rates is refuted by a study isolating Chicago outreach/education programs (that did not include provision of needles) which showed that seroconversion rates dropped from 8.4% to 2.4%, a 71% decrease.
-In addition, the studies that harm reductionists rely on to support their pro-NEP argument failed to examine the adverse effects of rising drug use, and they failed to compare results with those of mandatory drug treatment and outreach/education programs.
-Perhaps the biggest flaws of the studies are the reliance on self-reporting rather than actual disease rates, plus the fact that the high dropout rate of NEPs makes follow-up studies impossible, thereby adding to the risk of sample errors.
Edward Kaplan, PhD, one of the authors of a New Haven study that concluded NEPs reduce the rate of HIV infection by 30%, conceded at a pro-NEP conference held by the Drug Policy Foundation (a pro-drug legalization group now known as the Drug Policy Alliance) on March 10, 1995 that critics of the study can claim that the initial high-risk injectors had dropped out of the study, leaving low-risk injectors, therefore creating a sampling error. He countered this potential criticism by arguing that other high-risk behaviors by the remaining study participants, as self-reported, had remained the same. Reliable reporting by drug addicts? According to Janet D. Lapey, M.D., "This is an over-reliance on self-reporting by addicts who are notoriously unreliable. Studies which rely on addicts' unverified self-reported behavior cannot be considered truly scientific."
After reviewing the major needle exchange studies, David Murray, Director of Research for the Statistical Assessment Service in Washington, stated, "Most studies have had serious methodological limitations, and new studies in Montreal and Vancouver have revealed a troubling pattern: in general the better the study design, the less convincing the evidence that clean-needle giveaways protect against HIV."
In a study of Montreal's NEP that did test 1600 addicts' blood every six months, it was found that program participants were three times more likely to contract HIV as non-participants. Widespread needle-sharing by the addicts was found by the researchers, as reported by the study's lead author, Julie Bruneau. In the report, Bruneau stated, "We believe that caution is warranted before accepting needle-exchange programs as uniformly beneficial in any setting."
A study of Vancouver's NEP also found a "high level" of needle sharing, even among HIV-positive participants. In fact, the HIV rate of the city's drug users increased from 2% in 1988 to 23% in 1997.
An April 6, 1998 ONDCP memorandum by D.B. Des Roches to General McCaffrey summarizing a visit to the Vancouver NEP states "Harm reduction believes that by giving addicts the means and knowledge to safely use drugs (i.e. needles), most of the negative effects of the drug abuse can be alleviated. Yet this approach still requires that the addict responsibly use the needles that he is given; the HIV statistics show that he does not. With an at-risk population, without access to drug treatment, needle exchange appears to be nothing more than a facilitator for drug abuse."
NEPs therefore are clearly not reducing the harm to drug users as the pro-legalization movement contends.
By proposing to offer addicts their drug of choice, the clinical definition of "treatment" as we currently know it has been completely re-defined.
For example, a trial of "heroin maintenance" has been proposed for addicts in Baltimore. The trial would be based on a 3-year study of a Swiss heroin maintenance program under the flawed opinion that "offering controlled doses of heroin might lure some addicts off the street and into a setting where they can get health care and counseling and eventually kick the habit."
This assumption is flawed for many reasons:
-"Kicking the habit" is not likely to be an outcome of heroin maintenance, as evidenced by a 19-year New York City methadone (a heroin substitute) distribution experiment in which only 15% of the clients were cured of their addiction.
-Even drug addicts recognize the truth that addicts will go on using heroin as long as they are supplied with the drug.
-Quite simply, addiction cannot be cured by supplying the patient with their drug of choice. As with the afore-mentioned metaphor about handing the alcoholic a clean Scotch tumbler, neither would the health professional mix a fresh cocktail for the addict.
-Heroin maintenance programs are bound to fail due to the fact that most opiate addicts are polytoxicomaniacs (addicted to several drugs) and these programs would supply them with their base drug, free of charge.
-Along the same vein, the psychic effects of opiates make it very difficult to get in touch with the addict emotionally; therefore, psychotherapy is almost impossible. A patient in a heroin maintenance program is still under the influence of the drug and has no motivation to begin a therapy leading to abstinence.
-Finally, a report of the External Expert of the WHO (World Health Organization) studying the results of the Swiss heroin trials soundly rejects heroin-supported therapy. According to the WHO report, no improvement in health and social well-being can be attributed to the distribution of heroin. Additionally, the effect of psycho-social care in the scientific evaluation of the Swiss trials has been ignored: "From the very beginning, the design of these trials was not suitable for providing an answer to this question."
The only proven method for breaking the cycle of addiction is to remove the patient from the drug scene and apply abstinence-based therapy. It stands to reason that heroin maintenance programs are setting the patient up for failure if the ultimate goal is indeed the defeat of heroin addiction.
Not only has the harm reduction movement infiltrated the arena of drug treatment, it has also entered classrooms. Couched in such catchy phrases as "responsible use," "risk education," "safety first" and "reality based" drug education, the basic misconception is that "total abstinence may not be a realistic alternative for all teenagers."
A conference entitled "Just Say Know: New Directions in Drug Education" was held in San Francisco in October, 1999 by The Lindesmith Center (now known as the Drug Policy Alliance) and the San Francisco Medical Society. All of the organizations sponsoring the conference, with the exception of the San Francisco Medical Society, and many of the speakers are well-documented supporters of drug legalization. At the meeting, drug legalization proponent Ethan Nadelmann contended, "Ultimately it isn't about keeping kids drug free."
According to "Just Say Know" conference presenter Sandee Burbank of Oregon-based Mothers Against Misuse and Abuse (MAMA), "Drugs are tools like knives, saws, etc. 'Safety first' is used for everyday tools, and drugs should be treated the same." In MAMA's goal statement, the belief is asserted to "Teach basic drug consumer safety and provide complete and accurate information about all drugs." MAMA, partially funded by a pro-legalization organization, bases its approach on "Personal Responsibility - No matter what anyone tells you, YOU decide if, and how, you will take a drug."
Examination of the facts reveals historical data that demonstrates when the perception of harm of drug use has been up, drug use has gone down and, conversely, when the perception of harm has been down, drug use has risen. After drug use escalated in the U.S. in the mid-1970s, some 4,000 parent groups formed, dedicated to stopping drug use by children. These groups included National Families in Action (NFIA), the Parents Resource Institute on Drug Education (PRIDE) and the National Federation of Parents for Drug-Free Youth (now the National Family Partnership, or NFP). Among other goals, these groups strongly advocated that "responsible-use" messages be removed from drug-education classes. By 1992, with the help of America’s First Lady Nancy Reagan, the media, government, and communities in general, the efforts were rewarded when regular drug use among adolescents (ages 12-17) and young adults (ages 18-25) was reduced by two-thirds.
In contrast to harm reduction education, programs such as D.A.R.E. teach students that any use of an illicit drug is unlawful and harmful, and they provide information on alternatives to using drugs and how to find abstinence-based treatment. Most importantly, these abstinence-based drug education programs focus on the majority of young people, whereas harm reduction drug education, operating under the assumption that "they'll do drugs no matter what," targets primarily those who are already involved with drugs. According to Alan Markwood, prevention projects coordinator of Chestnut Health Systems, Inc., Bloomington, Illinois, "The rationale for harm reduction comes from the public health concept of 'tertiary prevention.' In creating their version of drug education, 'harm reduction' advocates commit two errors, or acts of deception. One is the application of a tertiary prevention approach to a primary prevention population. In other words, every young person is treated as if they already have an intractable drug problem, or are predestined to use drugs."
Clearly, needle "exchanges," "responsible drug use" education and heroin maintenance programs are cloaks for the ulterior motive of drug legalization. If harm reduction advocates truly wish to reduce the harm associated with drug use, their goal would be to prevent the use of and to continue to prohibit illegal drugs, since data clearly show that legalization would only increase drug use.
Medical Excuse Marijuana Initiatives
Another ploy of those who advocate for the legalization of drugs in the United States is ballot initiatives to legalize marijuana and other dangerous drugs as so-called medicine. Voters in various U.S. states are unknowingly making legal Schedule I drugs, including cocaine, heroin, methamphetamines, marijuana and more than a hundred other mind-altering substances. The true intent of the pushers behind the drug legalization movement is far from medical or even close to being scientific.
The groups pushing these initiatives are using medicine as a guise to soften public opinion about drugs and to chip away at the U.S. drug policy.
The major financial contributors to the initiatives are affiliated with drug legalization organizations rather than with any medical or scientific organizations. Billionaire financier George Soros, has almost single-handedly funded the drug legalization movement with multi-million dollar contributions to the Drug Policy Foundation, the Lindesmith Center (both now known as the Drug Policy Alliance) and to initiatives in Arizona, California and other states. In recent years, his contributions for state initiatives have been matched by John Sperling, founder of Phoenix University and Peter Lewis, Chair of the Board of Progressive Insurance Company.
A predictable - yet highly successful - pattern of activity by the legalizers has evolved in the states targeted for ballot initiatives. Groups such as Americans for Medical Rights and the Drug Policy Alliance (formerly the Drug Policy Foundation and the Lindesmith Center), backed by Soros and his colleagues, move into the targeted states to work with and mobilize legalization proponents there.
Once the legalizers have moved into a state, they then hire political consultants to hone their message and purchase broadcast time to flood the state’s airways with commercials that tug on the heartstrings of voters. Compassion for the sick and dying is misused effectively to mislead voters. These groups have media manipulation down to a science, and they are financially prepared well ahead of time to buy up massive airtime in the months prior to the election.
In recent years, the billionaire trio of Soros, Lewis and Sperling has also bank-rolled state initiatives that are promoted as “treatment” initiatives. In reality, these initiatives are intended to cripple the ability to enforce drug laws and to undermine legitimate substance abuse treatment efforts.
Propaganda of the advocates of drug legalization
Advocates of drug legalization have done a tremendous job of spreading their propaganda and leading the public to believe that our efforts to curb the drug problem have failed, leaving us with no alternative (according to them) except to legalize drugs.
The truth in the United States is quite different than the picture that they paint. The fact is that we have made great strides in dealing with the drug problem in the U.S. We have had great successes through a comprehensive approach of prevention, treatment, enforcement, and interdiction.
In 1993, the percentage of current drug users was half what it was at its peak in 1979. Since 1985, the peak period for cocaine use, the percentage of current cocaine users dropped by more than two-thirds and adolescent drug cocaine use by 80 percent. In almost all categories, adolescent drug use was at the lowest level since national measurement began in 1975.
If a similar 50 percent to 80 percent reduction was achieved in other social pathologies such as teenage pregnancies, dropouts, the spread of HIV and AIDS, it would rightly be considered a great victory.
When the former Presidential Administration reduced efforts to combat drug abuse, we lost ground in our efforts however. Casual teenage drug use rose and annual or infrequent teenage experimentation with illegal drugs was replaced by regular, monthly or addictive teenage drug use. This reversal was also greatly due to the very deliberate efforts of the pro-drug lobby. Those groups wishing to surrender to and legalize drugs have greatly undermined drug prevention and enforcement efforts with their well financed campaign of misinformation. They are well networked and working hard to influence public opinion and public policy. They have interjected their drug culture into music, movies and fashion, once again glorifying drug use. They realize that they cannot reach their goal of legalization in one giant leap and therefore, strive to reach it one step at a time through the nonsense of “harm reduction” and other related issues. They have worked toward legalization by proactively promoting (and funding) initiatives such as medical excuse marijuana, needle exchange programs, and hemp for the environment. They also try to pit public health officials against law enforcement. They subscribe to the nonsensible theory of teaching our children to use drugs “safely” and “responsibly” rather than to teach them not to use drugs at all.
Fortunately, we have seen recent improvement with our national drug epidemic under the leadership of the current Presidential Administration and with more community grass-roots groups becoming more proactive in opposing the efforts of the pro-legalization movement. The results of the Monitoring the Future survey, released December, 16, 2002, jointly by the National Institute on Drug Abuse (the study’s sponsor) and by the University of Michigan (which designs and conducts the study), demonstrate the improvements. According to the survey, which includes responses from students in the 8th, 10th and 12th grades, the proportion of students reporting the use of any illicit drug in the prior 12 months declined at all three prevalence periods – lifetime, annual, and past 30-days use.
The survey shows that for 8th graders, the annual prevalence of marijuana use in 2002 of 14.6 percent is down from the recent peak of 18.3 percent in 1996. At 30.3 percent in 2002, annual prevalence for 10th graders is now somewhat below the recent 1997 peak of 34.8 percent, but use by 12th graders is down only modestly, from the recent 1997 peak of 38.5 percent of 36.2 percent in 2002.
According to the survey, ecstasy use among American teens is down in all three prevalence periods in all three grade levels surveyed. Use of ecstasy among high school seniors declined from a rate of 9.2 percent to 7.4 percent.
It is also important to note that the survey found increases in the perceived risk of using ecstasy to be an important leading indicator of downturns in its use. In 2000, only 38 percent of 12th graders said there was great risk of harm associated with trying ecstasy. That figure jumped to 46 percent in 2001 and again in 2002 to 52 percent. This strongly reinforces concerns about the dangers of embracing harm reduction strategies in our drug education programs because this approach gives the illusion that drugs can be used safely if one just knows how.
Marijuana use also showed some decline in all prevalence periods for all grades in 2002. For 8th graders the annual prevalence of marijuana use in 2002 of 14.6 percent is down from the recent peak of 18.3 percent in 1996. At 30.3 percent in 2002, annual prevalence for 10th graders is now somewhat below the recent 1997 peak of 34.8 percent; but 12th graders are down only modestly, from the recent 1997 peak of 38.5 percent to 36.2 percent in 2002.
History has proven that to be effective in combating substance abuse, we must have a combined effort of prevention, treatment, enforcement, and interdiction. When laws and enforcement of our laws have been tough, drug use has been down. When we have weakened our laws or failed to enforce them, drug use has gone up. We need to get back on track with what history has shown to work. There must be consequences for the behavior of drug dealers and drug users.
Law enforcement must remain a vital component in our efforts to curb drug use and trafficking. Enforcement serves three purposes in the drug effort:
-First, it exacts a high price from those who would profit from the misery and addiction of others, such as their loss of freedom and seizure of their undeserved profit.
-Second, it keeps potential drug users from falling prey to drugs by virtue of their fear of arrest and the embarrassment of being caught.
-Third, it shepherds drug addicts into treatment through laws that offer treatment as an alternative to incarceration. Few people seek treatment without the impetus of a significant event, such as arrest, to propel them to that decision. Roughly a third of all addicts entering treatment in the United States do so through the criminal justice system.
Community and national drug policy leaders must understand what strategies are being utilized by those that advocate for the legalization of drugs. They must also understand who these advocates are and that they are the enemy as much as the drugs are our enemy. Drug policy leaders must position themselves proactively by developing position statements on various issues such as harm reduction and then standing firmly by those positions.
Support for these efforts can be found through already existing coalitions such as the international groups of volunteers at the Drug Prevention Network of the Americas (www.dpna.org), Drug Watch International (www.drugwatch.org), the Institute on Global Drug Policy (www2.globaldrugpolicy.org), and the Drug Free America Foundation, Inc. and its International Scientific and Medical Forum on Drug Abuse and Institute on Global Drug Policy. (www.dfaf.org).
Drug Watch International is a volunteer non-profit information network and advocacy organization which promotes the creation of healthy drug-free cultures in the world and opposes the legalization of drugs. The organization upholds a comprehensive approach to drug issues involving prevention, education, intervention/treatment, and law enforcement/interdiction. The International Drug Strategy Institute is a division of Drug Watch.
The International Scientific and Medical Forum on Drug Abuse, a division of Drug Free America Foundation, Inc. is a brain trust of international scientists and physicians who are leading experts in the field of drug abuse and/or the application of valid medicines and techniques in treating patients.
The Institute on Global Drug Policy is a think tank of leading international drug policy experts and is a division of Drug Free America Foundation, Inc.
Drug Free America Foundation, Inc. is a 501(c)3 drug prevention organization committed to developing, promoting and sustaining global strategies, policies and laws that will reduce illegal drug use, drug addiction, drug-related injury and death. It is based in St. Petersburg, Florida.