Harm minimization

In 1999, Portugal had a serious drug problem. One percent of the nation’s people were addicted to heroin. Folks were dying of overdoses, health complications, and H.I.V. due to sharing needles. The prisons were full, and the government was exasperated.

In a last ditch effort to do something, Portugal decriminalized personal drug use. They still prosecute drug dealers and traffickers, but people with less than a ten-day supply of pretty much any drug are generally sent to counseling, not prison. They call this “harm minimization” because it’s focused on reducing violence, disease, overdoses, and other threats to the health and safety of both addicts and the rest of the population.

I recently read Michael Specter’s “Getting a Fix,” a New Yorker article that compares Portugal’s approach to that taken in the U.S. He asks whether the “harm minimization” approach is working: Are incarceration rates down? Hospitalizations due to drugs? HIV and AIDS? The answer, for Portugal, is yes.

But he misses what I believe is the more important point when he fails to discuss the qualitative benefits of resisting the urge to incarcerate folks picked up once, or twice, or even ten times for simple possession. Above all, those people are allowed to continue living their lives. They can be productive employees, parents, partners. They won’t have to worry about re-entry stresses like finding a new job, getting a driver’s license back, or simply re-learning how to grocery shop. 

I like the phrase “harm minimization.” It’s an appropriate description of the way we approach loved ones with substance abuse issues. If you find out that your mother is an alcoholic, for example, you might be angry or frustrated, but my guess is that your ultimate goal will be to minimize harm – help her recover from her dependency while impeding as little as possible on the rest of her life. In fact, the vast majority of legal and illegal substance dependency problems are already treated this way, in America and elsewhere, through family intervention, private treatment, and emotional support.

No ones likes when someone they care about has an alcohol or drug problem, but we don’t typically advocate for our friends and family to be incarcerated, either. As a nation, Portugal has starting treating their citizens as though they care about them, and their families. Wouldn’t it be neat if we adopted a similar national stance?

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