Page 10
However, the argument that drug abuse is a public health issue, rather than a criminal activity, has renewed the debate over existing drug policies. For instance, the theory that drug addiction is a neurological disorder, not a moral flaw, has caused some to view addicts less as criminals and more as sick individuals who need treatment and compassion. To this end, voters in Arizona and California recently approved measures that give minor drug offenders the choice between rehabilitation and prison. Also, “harm reduction,” an approach that focuses not on preventing drug abuse, but instead on reducing the risks associated with drug use, is gaining attention as an alternative to America’s hard line drug policies. Advocates of harm reduction assert that a practical and nonjudgmental approach in confronting drug abuse is more effective than disciplinary action. According to drug expert Robert W. Westermeyer, harm reduction is based on three pragmatic central beliefs. The first belief is that “excessive behaviors occur along a continuum”; the moderate use of substances causes less harm than abuse. The second belief is that “changing addictive behavior is a stepwise process, complete abstinence being the final step.” He explains that the harm reduction model “embraces” any movement away from the harms of drug use, no matter how small. The third belief, Westermeyer states, is that “sobriety simply isn’t for everybody” and that drug abuse is a fact of life for some individuals. He contends that harm reductionists “hope that addicted individuals will ultimately come to eliminate their high risk behavior completely, though it is accepted that the only way to get people moving in the direction of abstinence is to connect with them ‘where they’re at.’” The case of writer and former heroin addict Maia Szalavitz exemplifies the goal of the harm reduction approach: If abstinence is not a choice, the risks of using drugs should be minimized. “I was at risk of AIDS,” she says, reflecting upon her intravenous drug use during the mid-1980s. A friend advised her to always either use her own needles or clean a shared needle with bleach and water before using it. By following that advice, Szalavitz did not contract HIV or hepatitis B during her years as an addict. She feels that harm reduction saved her life. The practice of harm reduction began in the Netherlands in the late 1960s, when health experts proposed that decriminalizing the use of marijuana would reduce the use of cocaine and heroin. They believed that removing marijuana from the illicit drug market would lower marijuana users’ exposure to the culture of hard drug abuse. Today in the United States, the harm reduction movement consists mainly of two programs. Methadone maintenance, in which doctors prescribe the synthetic drug methadone to hardened heroin addicts as a less harmful substitute for heroin, generates little controversy. On the other hand, needle-exchange programs, which allow addicts to exchange their used needles for clean ones without fear of legal repercussions, are often the center of heated debates. These programs were first mobilized in the 1980s as a response to the epidemic of HIV and hepatitis B infections among intravenous drug users (IDUs), which was caused by the sharing of infected needles. Many drug abuse professionals claim that encouraging IDUs to trade their used hypodermic needles for new ones lowers their risk of HIV and hepatitis B infection by preventing drug addicts from sharing needles. According to one study, the Scottish cities of Glasgow and Edinburgh, which experienced similar heroin epidemics in the 1980s, demonstrated the importance of the availability of clean needles for IDUs. Edinburgh, which banned the selling of hypodermic needles at the time, experienced an alarming rate of HIV infection among IDUs—approximately 50 percent tested HIV-positive by 1984.