Our top medical journals still publish bona fide scientific studies. But the editors’ primary concern these days seems more about promoting woke ideology and politically progressive public policies.
I have repeatedly provided examples in these pages. Frankly, I could post several examples a month. And now, true to form, The Lancet has editorialized in favor of legalizing hard drugs as a matter of “health”–and the favorite “go to” of progressives–“harm reduction.” From, Drug Decriminalisation: Grounding Policy in Evidence:”
The Global Commission on Drug Policy’s latest report, published ahead of World AIDS Day on Dec 1, describes decriminalisation of drug use as an essential precursor to ending HIV and viral hepatitis as public health threats. Since its formation in 2011 by political, economic, and cultural leaders, the Commission has advocated for decriminalisation as part of a rights-based approach to drug policy, rooted in scientific evidence and principles of public health, to minimise the harms arising from drug use…
Decriminalisation alone is, of course, not sufficient. In its report, the Commission emphasises the need to expand harm-reduction approaches alongside decriminalisation of personal drug possession and use.
Using Portugal as an example, here is what such harm reduction would entail:
Comprehensive medical, psychological, and social support need to accompany decriminalisation to address factors such as homelessness and unstable housing, ill mental health, poverty, racial inequities, and inadequate access to health care, all of which might drive people into drug use.
That’s what they said about emptying the mental asylums, remember? Whatever happened in Portugal, it won’t happen in most places. And Portugal’s experiment is showing signs of failure.
Moreover, there is plenty of contrary evidence that the editorial conveniently fails to address. Think San Francisco, where drug decriminalization via (in)action as well as formal policy, rules the day. What do we see? Squalor in the streets, open-air drug markets and usage, used needles befouling parks and city streets, and the need to distribute Narcan to try and save people from death by overdose. It’s a debacle.
The editors blame criminalization for HIV and hepatitis transmission:
What has long been clear is that punitive approaches are both ineffective and harmful. Decades of criminalisation have not only spectacularly failed to disincentivise drug use but also propelled the global epidemics of HIV and hepatitis by hindering efforts to prevent transmission and provide care for people in need.
Alright, let’s talk about that. Here’s the problem: “Harm reduction” policies almost always slouch toward license, with the strict guidelines meant to induce those engaged in self-destructive/community befouling behaviors into accepting care, soon forgotten.
San Francisco’s old needle-exchange policy to reduce HIV transmission is a perfect example. As first envisioned, it required drug users to exchange used needles to get new, clean ones, one new needle for each needle turned in. And, for a while, that was the case. (I lived in and near San Francisco in those years.) But over time, the needle policy shifted to pure needle giveaway, no exchange required, no questions asked, obtainable at “needle access” centers–or even, delivered by helpful harm reduction volunteers. No wonder San Francisco is littered with tens of thousands of used and dangerous hypodermics. Oh, and don’t forget the homelessness crisis, which is also part of the “harm reduction” equation in Baghdad by the Bay.
Or look at Oregon, which decriminalized the use of hard drugs in 2020. Users get tickets, which require them to call authorities or pay a $100 fine. This is supposed to help guide them into a “healthcare approach”. But most who receive citations never make the call. And, true to form, officials don’t care.
So, the decriminalization happens, but the “harm reduction” doesn’t. And things get worse for users and on the streets.
It is certainly relevant that opioid overdoses have shot through the roof in Oregon. In 2019, the year before decriminalization, there were 280 opioid overdose deaths. Last year, there were 955. Yes, rates of opioid deaths have risen throughout the country — but faster in Oregon than the national average. As a consequence, majorities of those polled in Oregon either want to totally or partially repeal the law.
And that doesn’t even get us into the fentanyl crisis, from which Oregon has the nation’s highest death rate. Why might that be? Perhaps it is a simple matter of cause and effect.
The evidence is increasingly clear that harm reduction usually doesn’t reduce harm to those with self-destructive behaviors, because they have no concomitant duty–and little incentive–to change their ways. As a consequence, harm reduction policies generally increase harm to communities, rot social cohesion, and undermine public safety. At the very least, a medical journal should grapple with these inconvenient facts rather than pretend they don’t exist.
Rather, they write:
Stigma and discrimination only make it less likely that people who use drugs will get the help they need.
It seems to me, that the opposite is true. “Harm reduction”–as actually practiced–reduces incentives to get clean because there are no responsibilities imposed on those receiving care in return for the services they receive, which enables addiction.
The Lancet editorialists accuse those who oppose decriminalization and “harm reduction” of basing their policy preferences on ideology. That seems a classic example of projection to me. Physician, heal thyself!
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