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What would you really want for your loved ones?

Supervised Injection Facilities (SIF) are one of the core strategies used by supporters of “harm-reduction” as an alternative to a drug-free goal for drug policy.

Before considering SIFs, it is useful to understand the foundation on which all “harm reduction”strategies are built. The principal “harm” associated with drug use focused on by harm reduction leaders is the “harm” associated with the criminal justice system, including arrest and imprisonment. The “harm” from drug use itself is minimized or ignored entirely in these calculations. For this reason, a central goal of harm reduction strategies is to legalize the sale and use of drugs as the ultimate way to remove the criminal justice system from drug policy.

Harm reduction accepts nonmedical or “recreational” drug use as inevitable and declares the drug-free goal delusional. Examples of harm reduction that minimize the “harm” that flows from drug use include giving intravenous drug users clean needles and giving opiate addicted drug users syringes loaded with an antidote for overdoses for their emergency use or for their fellow drug users. Harm reduction treatment accepts continued drug use while in therapy until or unless the drug users spontaneously decide that they want to stop drug use. The logical extension of this view is 1) to provide addicts with drugs so they do not have to rob, steal or sell drugs to support their drug use, and, 2) to give addicts a safe place to inject their drugs where they can be encouraged to use safer injection practices and where they can be rescued if an overdose occurs.

In considering the wisdom or folly of SIFs for drug users, their families, and their communities, I suggest two simple thought experiments. The first is to think how you would help a close family member – say a child, spouse or sibling – who is addicted to drugs. What steps would you take to help that loved one? Where in that list of options would you put giving them clean needles? Where would you put giving them syringes with an antidote if they or their drug using friends overdosed? Where would you put providing them with drugs and a “safe” place to inject?

Now, as you contemplate this question, think about where on the list you would put insisting that they stop drug use and enforcing that standard with serious consequences for their continued use. When thinking about intervening with this loved one where would you put “cutting down” their drug use as a goal versus stopping their drug use?

To me, based on my four decades of working with addicted people, the answers to these questions are beyond obvious. My loved ones get the message that stopping use entirely is vital; it is the only way to recovery and the only way the family can be successful.

Here is the second thought experiment for you to consider. When laboratory animals – often rats – are introduced to drugs of abuse they work harder to get drugs than for they do for any other rewards, even food, water or sex. To get drugs, rats routinely walk across electrified grids – an act they will not perform to get these other rewards. If they have continuous free access to the drugs they continue use the drugs until they die from that use. They do not tire of using the drugs. The rats do not “decide” to stop using as long as the drug supply lasts. THAT is the special vulnerability of the mammalian brain -- not just the human brain but the brains of all mammals.

Now, with those two thought experiments in mind, think again about the analogy of SIFs versus the drug-free standard for your addicted loved one. Which path would you choose?

Sometimes complex public policy questions are that simple. This is one of those times.

Robert L. DuPont, M.D. bobdupont@aol.com