In 1971 President Richard Nixon declared a “war on drugs” and 52 years later the battle rages on – deadlier than ever. The crack era came and went in the 1980s, followed by the rural opioid crisis, and now many of our urban centers are being decimated by a fentanyl epidemic of plague-like proportions. In fact, over 70,000 people died in this country from fentanyl alone in 2021, according to the Center for Disease Control – compared to just over 17,500 overdose deaths in 2000 from all drugs combined. The war on drugs has gone from a battle to a bloodbath – and new solutions are clearly required.
With the launch of the first needle exchange program in New York City in 1988, the harm reduction movement emerged as such a solution. At first controversial, needle exchanges were eventually accepted as standard practice across the nation and helped stem the spread of HIV in intravenous drug users.
As a former heroin addict, I utilized needle exchanges and likely avoided HIV because of it. In fact, I was accepted into a detox center through a needle exchange program in Los Angeles. This was years ago, however, when the harm reduction movement went hand-in-hand with treatment.
Needle exchanges were introduced to incentivize drug users to trade in their dirty needles for clean ones. This is where the term “harm reduction” comes from, the literal reduction in harm – such as the prevention of new HIV infections. Such methods worked, but once the AIDS epidemic receded, harm reduction began to transform into something entirely different – an all-encompassing support system for drug addicts. It’s a strategy increasingly being touted by Washington, where Pres. Biden named harm reduction as a core element of his Administration’s drug policies.
Despite the initial outcry, needle exchange programs have actually become one of the most mundane components of modern harm reduction initiatives. The movement has expanded into far more dangerous focuses, such as building supervised drug consumption sites – including a pair in Upper Manhattan – along with the promotion of safe drug supplies for addicts. In cities like Boston and New York, this has even meant handing out free crack pipes and other drug paraphernalia. It’s all part of Pres. Biden’s billion-dollar push for harm reduction, implemented and overseen by his Drug Czar Rahul Gupta, a one-time harm reduction critic who has since fallen in line.
All of these measures clearly do more harm than good, but the greatest harm may be yet to come. Across the nation, a growing element of the harm reduction movement now rejects treatment or abstinence-based recovery strategies. Which is why harm reduction has emerged as a key flashpoint in the “Treatment First” vs “Housing First” debate over whether addicts receiving housing and other social services should also enter rehab. Add in recent calls to “defund the police” — and the sharp decline in prosecutions for most crimes — and cities like San Francisco are now contending with thousands of homeless addicts with no incentive to get clean.
Amid towering, unoccupied office buildings, San Francisco’s open air drug markets allow cartel-backed dealers to roam free, while a billion dollar industry of nonprofits such as Drug Policy Alliance vocally reject treatment as a viable solution. It’s no surprise that residents at the front lines are fed up with the results. In fact, nearly a quarter million people have fled the Bay Area in the last three years. Governor Newsom finally took a stroll through the epicenter of San Francisco’s drug disaster late last month and was clearly distressed: just a few days later, he announced that the National Guard would be called in to help clean up the crisis.
The issues facing San Francisco aren’t from a lack of funding. In 2021 alone, the city allocated $1.1 billion to its Department of Homelessness and its budget has risen 500% since 2016. The results: Homelessness actually increased 64% during the same period. Where does all this money go? Much of it is permanent housing ($423 million in 2022). But permanent housing will do little to mitigate addiction rates amongst the homeless without concurrent detox and treatment methods.
But such methods are simply not mandated: Of that nearly half a billion spent last year in San Francisco on permanent housing, none of it came with sobriety requirements. And homelessness numbers and overdose deaths continue. Of the 515 residents the city tracked in permanent housing since 2016, 25% died, while 21% returned to the streets.
Harm reduction is big business. How big? San Francisco alone allocated $268 million to nonprofits in the name of “homelessness prevention” in 2022, all of which must follow a harm reduction approach in order to receive funding. This number – the highest in the nation – is nearly 50 percent more than in New York, a city eight times larger than San Francisco.
Barred from mandating abstinence or treatment plans when housing the homeless, it’s hardly surprising that San Francisco also leads the nation highest in overdose deaths — nearly 80 per 100,000 residents, almost three times the number in New York, according to the CDC. True, those figures would be far higher without the distribution of Narcan from city harm reduction advocates. But the rejection of recovery-based harm-reduction strategies is doing far more damage than Narcan could ever do good.
At the beginning of 2022, San Francisco opened its first supervised drug consumption site in the Tenderloin district, which operated for 11 months. During this period, overdose deaths dropped about 4% citywide compared to 2021. But after the site’s closure last December, overdose deaths skyrocketed by 40% during the first three months of this year. Many harm-reduction activists, of course, blame the rise on the site’s closure. But overdoses also increased during the site’s final three months, mostly due to the introduction of xylazine, the deadly “zombie drug” now being used to cut fentanyl. Since xylazine isn’t an opioid, life saving overdose-reversal treatments like Narcan are powerless against it.
Local experts broadly agree that the consumption site prevented over 300 deaths, which is a miracle. But the most staggering figure is actually the number of people the facility knowingly failed to get into treatment. After all, the site was officially classified as a “linkage center” – with the goal of “linking” addicts to detox and treatment. As a former homeless addict now in recovery, this is a crucial objective. However, out of the estimated 50,000+ people that utilized the center, only 38 were “connected” to substance use treatment. Hardly surprising that the site dropped “linkage” from its name just months after opening.
In fact, the only linkage that seemed to be occurring was between the drug users, drug dealers, and stolen merchandise rings that completely enveloped the compound. San Francisco Mayor London Breed shut down the program after the resulting mayhem – along with pressure from Treatment First advocacy groups like North America Recovers and local business owners – proved impossible to ignore.
Supervised consumption sites like the Linkage center make sense as long as detox and treatment is the end goal for patients. And harm reduction can play a role in this process. There is MAT (medication assisted treatment), which utilizes opioid replacement drugs such as Suboxone – or anti-craving medications like buprenorphine – to combat the trauma of detox. And, of course, there’s Methadone, which for decades has served as a long-term replacement for heroin – as well as more recently for fentanyl addiction.
Without these interventions, harm-reduction sites are merely facilitating addiction while simultaneously destigmatizing antisocial behavior. Which is why winning that still unwon “war on drugs” requires a multi-pronged approach that includes harm reduction along with an increased shelter system, and highly incentivizing detox and treatment options.
Why then do radical harm reductionists and housing first advocates oppose such a path. Partly because of ideology, but the more important factor is that it’s the only way to keep the money train going. The passing of California’s SB1380 in 2016 outlawed any sobriety or treatment requirements for homeless drug addicts receiving state-funded housing. As a result, nonprofits seeking access to the cash cow of public funding must push a Housing First ideology that rejects any form of abstinence-based treatment for homeless drug addicts.
These zealots believe that addiction is generally a symptom of homelessness, whereas most formerly homeless addicts like myself say the opposite. Who do the politicians in San Francisco typically side with (and solely fund)? If you guessed the side with actual lived experience in both homelessness and addiction, you’d be wrong.
Folks advocating for treatment first approaches have not merely been sidelined, but incorrectly labeled as “far-right” and “quasi-fascist” by influential progressive activist groups such as DSASF. San Francisco politicians, virtue-signaling behind a facade of false progressivism, almost inevitably echo such sentiments. Gov. Newson is emerging as a rare outlier now that he’s stepped in to help his hometown.
But the National Guard is only being deployed to curb fentanyl distribution. Yes, this is a step in the right direction, and addresses the supply side of the issue. But what about the demand? Even if fentanyl was fully eradicated, thousands of homeless drug addicts would still need detox and treatment. Providing them with shelter and other social services may appear merciful, but merely staves off continued decay and inevitable death. Which is why harm reduction without the intent to end addiction is unlikely to deliver any permanent reduction at all.
Jared Klickstein’s writing can be found at jaredklickstein.substack.com; he’s currently working on the memoir, Crooked Smile, which will be published next year.
This story originally appeared on NYPost
