They were a couple that shared a lot, including and especially needles. They were both frightfully white, and that made for a clear view of their distended, overworked veins. They were also rail thin. She was all grunge, at least in terms of her style and personality. Musically though, she was EDM, and even told me what her SoundCloud profile name was, so I could check out her mixes. 

He, meanwhile, was so emaciated that his clothes wore him; he was constantly pulling his pants up. A winning smile revealed sets of deeply eroded teeth and gums. His father was a professor at Cornell, where I went to school. They came to our center in downtown Ithaca, NY, because we offered so-called harm-reduction services for people who use drugs. 

I entered the professional substance-use world unintentionally. I was part of a service-learning program that matched students with community-based organizations in Ithaca. I chose the local center fighting AIDS. I was surprised when I showed up at the place and quickly learned that substance abuse, especially and almost exclusively heroin, was the primary concern when it came to HIV transmission. 

These outfits are officially called “comprehensive harm-reduction centers” to stress that they offer more than needles. The main “support,” though, was the syringe exchange. The clients exchange dirty needles for clean ones, to lower their risk of transmitting HIV and Hepatitis into their bloodstream from repeated and shared use. 

Harm reduction is the idea underlying this crucial service: We should take measures to protect the health of people who use drugs, the thinking goes, because that’s the right and humane thing to do. This made sense to me. To this day, I know harm-reduction practices like syringe exchange and naloxone distribution—naloxone being an overdose reverser—are lifesaving and compassionate at their core. 

Looking back, however, there is something I need to come to terms with about my experience. Especially considering what “harm reduction” seems to mean now.

At first everything seemed fine, but in time, it became clear that the culture and politics of the place hurt the clients. Substance abuse was at the very least deemed a “right,” but more commonly it was seen as something to be celebrated as an expression of freedom and individuality and part of a broader social rebellion. Such notions dominated the political culture of Ithaca, a progressive bastion. The center reinforced them by doing things like playfully naming the community room Point Place (as in, the point of a needle). Much more concerning, the music-festival fundraiser I was planning with the clients explicitly evoked these themes, both in the music selected and the planned messaging throughout. 

One client in particular took the co-lead in planning the fundraiser. An Ithaca College graduate, he wanted to speak at the festival on the systematic oppression of people who use drugs; he majored in sociology. Drugs weren’t the problem, a virulently anti-drug society was, and the drug user was oppressed and even persecuted. He added that drugs were actually essential to his creativity. It was painfully clear that drugs were also essential to his dysfunction. That is one reason why the fundraiser fell through. 

Today, the drug dealers aren’t the only peddlers. Under the facade of enfranchising the downtrodden, many harm-reduction activists are “meeting them where they’re at” and inadvertently keeping them there until they fatally overdose. But there are people who benefit from this approach. The harm-reduction movement is a boon to the addiction-treatment industry and the network of nonprofits that urges people to integrate their substance abuse with their identities, as we did in Ithaca. It creates a sustainable pool of artificially oppressed people that the nonprofit-industrial complex can perennially work toward saving.

Of course, many of those who abuse drugs have been mistreated and oppressed. And, as I said, there are elements of the harm-reduction approach that are good. But the culture that manifested in the center I volunteered at is only compassionate if you don’t look too closely. Constructively challenging someone to become his best self isn’t being judgmental—it’s being genuinely supportive. People who use drugs should live, not just stay alive.

Many of the clients, if not most, were hopelessly isolated, with few social connections apart from fellow users. They shot up together, which, from a harm-reduction perspective, is safer. But it’s still sad. It’s social darkness. In this context, the center, for all its problems, was a ray of light. They came to the center not just to pick up needles, but to be cared for and even care about others. “I’m the grimiest person in the world,” I remember one user telling a staffer. The staffer replied, “Well, even if you are the grimiest person in the world, I still got you.” 

“Drug treatment should start … with unconditional love, but not unconditional license.”

Drug treatment should start here. It should start with unconditional love, but not unconditional license. Allowing those immiserated by substance abuse to retreat into further misery betrays the kind of concern I sometimes saw at the center. Being true to the noblest instincts of the people there means raising users out of their condition—and in doing so, raising ourselves.

Love was something else that the couple who shared syringes shared. I’m sure that their valuing their life enough to come to the center and get fresh syringes had a lot to do with the fact that they loved each other. While I was working at the center, I never saw one without the other. They were responsible to each other, and that made them responsible to themselves. At least, responsible enough to keep each other alive. I sure as hell hope they still are. 

Freedom from responsibility is no freedom at all. Fulfillment, which is true freedom, lies in being responsible to and loving one another. Because that’s who we are. Being part of this compact is ultimately the greatest right anyone, including people who use drugs, have. Here’s hoping this idea moves us closer to genuine harm reduction.

Nethan Reddy is a drug-policy specialist at a state agency.

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