Harm Reduction Isn’t Inclusive — Here’s Why

Right off the bat, let’s get shit straight. Not everybody in harm reduction (HR) is unwelcoming. Not everybody in HR has shut out me or my opinions. Not everybody in HR has been uninclusive. Many people in HR have been good to me — or, at the very least, fair. I hope to be involved in HR until we’ve achieved the fair treatment of drug users across the United States. This is the only thing I’ve ever had a passion for.

When I say “harm reduction isn’t inclusive,” I mean this: Because some of my opinions haven’t fit the mold of the average American (or Canadian) harm reductionist, they have been written off by some or even most of the HR community. Not only that, I fear my reputation has been irreversably damaged by well-known community members — particularly one community member — speaking out against me. I worry this may also happen to others who wish to get involved in HR, especially those in rural, largely-right-leaning America. These areas, which make up the bulk of the United States, currently aren’t well-represented within HR.

Let me be clear:

  • The primary goal of this article is to ignite the discussion that the HR community might not be as inclusive as it wants to be.
  • Ultimately, I want to de-homogenize HR. In other words, I hope more diverse viewpoints will enter the fray, particularly those of people from rural, largely-right-leaning America; this will result in the tenets of harm reduction being adopted (1) more widely and (2) more extensively (in other words, people will adopt more of our views as opposed to just one of our views) by people in rural, largely-right-leaning America.

I’m choosing not to call anybody or any organization out by name — I don’t want to play into “call-out culture.” If I did, I’d be guilty of the same convention I’ve fallen victim to. Even if I were okay with calling others out and causing harm within my own community, that’s not my goal here. I also don’t want to identify those who have treated me well out of fear they, too, might face pushback from the community or its members.

Most of this article doesn’t chronicle my subjective experiences in harm reduction. Rather, the first several sections investigate the nature of HR, commonly-shared characteristics among harm reductionists, problems newcomers to all communities face, issues with entering communities online (specifically on social media), and human nature in general.

Again, I don’t want to push us apart. I want to bring us closer together. In order to become more inclusive and improve the adoption of HR across the country, we must examine ourselves and HR at large.

Understanding the Nature of Harm Reduction and Commonly-Shared Characteristics Among Harm Reductionists

The American mainstream has long written off drug users. Of course, alcohol, coffee, and tobacco are okay, but anybody who uses anything else is nothing short of a dirty, degenerate dopehead!

Of course, I don’t believe this, but the American mainstream long has — and, in large part, still does.

Harm reduction, although there isn’t a single widely-accepted definition, has included people who’ve long been cordoned-off from society — particularly people who use drugs (PWUD). PWUD who are interested in HR or who’re active in the field often fit the bill of “long-term, often-problematic drug user,” just as I do.

I became interested in HR after learning about it on Reddit’s r/Opiates subreddit some three or three-and-a-half years ago. I often visited r/Opiates and other drug-related subreddits because I felt as if I couldn’t talk about drugs IRL (in real life); further, there wasn’t enough solid information about drugs IRL, nor was there enough of it.

I love that HR welcomes people who’ve long been considered worthless or who’ve otherwise been unwelcomed by the rest of society.

However, when opinions that even kind of resemble those of the mainstream — those that people have faught against for decades, literally decades, before I became interested in HR — are floated in HR, they’re sometimes (if not often) met with disagreement, if not hostility.

The divisiveness of the modern American political landscape doesn’t help, nor does the fact that many (if not most) discussions about HR take place on social media. I don’t know how social media lends itself to divisiveness, but it unarguably does. Further, the fact we’re still living in the times of “cancel/call-out culture,” which arose around 2014, doesn’t help. If you’re not familiar with call-out culture, people get career prestige points by calling out others who don’t share similar opinions — so, even if someone doesn’t like the idea of dogging someone online (or IRL), they’re incentivized to do so; even further, further, it’s not just the missed opportunity of career prestige that’s at stake — not calling someone out can implicate a community figurehead (or even an average community member) as being complicit in fostering “uninclusive” or “microaggression-friendly” or otherwise-bad environments.

Many — I’d go as far to say most — harm reductionists have faced substantial drug-related harms in their own lives. Who else would be pushed to openly supporting “radical” things like syringe exchanges or supervised consumption sites? Again, I don’t consider these things radical, but it’s safe to say most people do.

Harm reductionists are sensitive to people, organizations, government agencies, and groups that could take away what they’ve worked so hard to secure. Wouldn’t you exercise caution, yourself? Or distance yourself from people who claim to be down with the cause but seem to have ulterior motives?

The Very Real Disadvantage of Being a Newcomer

This goes without saying, but newcomers to any community are discouraged from sharing unpopular opinions or sticking up for anybody — especially those who’ve been “canceled.” This is especially true online.

Newcomers to communities are likely to be scrutinized before being embraced. This makes newcomers less likely to share their opinions on hot-button topics or that are otherwise potentially-controversial than established community members.

Even then, established members are unlikely to speak out on topics for which they hold views that differ from the average community member. For example, in HR, a field that has little funding or employment opportunities, people who lead or work for funded organizations are unlikely to challenge popular opinions or otherwise “break the mold” out of fear they’ll lose funding, have their pay docked, be put on administrative leave, or outright fired. This can result in reduced community participation. Socially-astute individuals will “play the game” — they’ll unquestionably embrace widely-held opinions, avoid rearing hard-hitting questions, or even tolerating important conversations that seek to change long-held group norms.

We all “play the game.” In our lines of work, whether HR-related or not, we put our heads down and do what’s best for self-preservation. Well, at least anybody with half a brain would “play the game” (whatever that means). My dad has told me that dozens of times — “Just play the game, son, you’ll get farther in life. I’ve done it. You need to do it, Dan, just get with the damn program!”

Note: My dad is awesome and I love him very much. Rhetoric like this comes from nothing but the best place; he wants to see me succeed, and we all need people in our corners who’ll tell us shit that might be hard to listen to — shit that damn near nobody else is willing to tell us.

Newcomers Are Especially Disadvantaged in Online Discussions and Largely-Web-Based Communities

Like I said earlier, newcomers to any community are likely to go through an informal probationary period where established community members judge whether they’re worthy of inclusion. This isn’t an HR-specific thing — it’s a humanity-wide thing.

Online, we can actually quantify how well community members are supported in the form of post engagements, favorites, likes, reactions, shares, retweets, replies, followers, friends, and so on. Even if nailing down precise community support figures is difficult, it’s easy to gauge where community members stand on the proverbial totem pole.

Assume a newcomer shares an unpopular opinion in good faith on Twitter, Facebook, or in an email-based Google Groups community. The opinion has been developed over many months or years and was shaped by the newcomer’s real-life experience. The newcomer tries to be friendly, respectful, and level-headed in how they approach the issue. Do you think the newcomer’s idea will be taken seriously or given merit? How about if a well-trusted, long-established community member shared the same idea? Which one would get more community support for the same idea?

Almost certainly, the community figurehead — they don’t have to be a true figurehead for this example to work; just a well-trusted member of the in-group — will find more support for the same idea.

Newcomers are likely to get discouraged from sharing their off-kilter ideas after just a few unsuccessful tries — hell, maybe even after just one try!

If community support is the goal — of course, social inclusion is a basic human want, so doesn’t everyone operate with community support in mind? — community members are incentivized to discuss safe topics rather than veering off the well-trodden path.

“Just play the game,” right?

Isn’t that something we all do? Especially when we first get a job or start hanging out with a new group of friends — don’t we all do things to promote or, at the very least, protect our perceived value?

Don’t get it twisted — “playing the game” isn’t bad. It shouldn’t be frowned upon. Doing tried-and-true things in the interest of self-preservation is as old as humanity itself. If I knew what’s good for me, I’d play the game myself. That’s actually how I got into writing: I wanted to do something from home and travel to work, wear uniforms or adhere to dress codes, punch time cards, or put up with potentially-asshole bosses — I could make much more if I just played the game.

The “Rock-Star Effect”

Again, many people who’re active in HR have long been mistreated. They haven’t been included elsewhere. Wouldn’t you be protective of the one place you call home? I would, that’s for damn sure.

Some people in harm reduction have amassed relatively large, loyal followings over the years. I don’t think any of these people got into HR because they saw an opportunity to become a “rock star” — rather, they got involved because they’ve personally been adversely affected by drugs and wanted to spur change.

HR is one of the few spaces former/current drug users and sex workers can be accepted in — at least be accepted for who they truly are. These “rock stars” are largely responsible for gatekeeping, or deciding who can become bona fide members of the HR community and who can’t.

Calling people out for their mistakes — hell, even their unpopular opinions, even if they were expressed in good faith — is a form of fodder for HR rock stars. Do all harm reductionists with substantial followings or in-group clout “cancel” fellow community members? No. However, “cancel culture” has piqued the interest of countless pop culture fans over the past few years. Emotionally-dense social media posts involving “cancellations” disproportionately elicit likes, shares, responses, and other interactions from interested community members.

Of course, no “rock star” would turn down a chance of openly, harshly criticizing someone. After all, it drives social media engagement like wildfire. Further, as mentioned earlier, community figureheads can be held responsible by other community members if they have a chance to “cancel” — or call them out, in other words — someone and choose not to.

Are most HR “rock stars” aware of their “rock star” status? I don’t think so. However, we can’t deny the influence of social media engagements over our actions. We all do things on social media with the intention of eliciting attention from others in the form of sweet, sweet post engagement. Even though I like to think I’m better than that, I’m no different.

Reliving Trauma When Facing Viewpoints That Our Oppressors Have Used to Keep Us Down

Trauma, contrary to popular opinion, isn’t tucked away in the mind; rather, we physically relive trauma when triggered. Once a spouse is undeservingly yelled at or beaten, they relive the horror of seemingly-inescapable domestic abuse every time someone yells at them. I’m not a psychologist, so I can’t explain the mechanisms behind this phenomenon, but it’s true — trauma is stored in the body, for lack of better words.

HR community members aren’t used to seeing opinions that break the mold. When they are, they’re especially averse to idly letting them pass by without openly criticizing those views — and oftentimes their creators in ad hominem fashion. Even though damn near all of us know that personal attacks aren’t logical or cash money, we’re still prone to insulting people, rather than reasonably deconstructing their ideas, particularly when sensitive topics are at play.

If I say drug users should take more responsibility for their actions, it’s easy to understand why harm reductionists might take offense. This sounds like something a police officer would say to someone arrested for drug possession while transporting them to the local jail, or a loved one — y’know, one of those who thinks doing anything for someone in active addiction constitutes “enabling” behavior? — might offer up to a drug-addicted family member.

I better understood such outlash once I learned that trauma was stored in the body — and our emotions can easily overtake reason, which is even more likely when such a super-sensitive topic is at hand.

Why Are Most Harm Reductionists Left-Leaning and Seemingly Not Familiar With Rural, Largely-Right-Leaning America?

Admittedly, I don’t have any research to back any of this shit up — I think all of my assertions and postulations are well within reason, though — but most harm reductionists aren’t just left-leaning, they’re largely-left-leaning. They’re used to hearing accusations of being “radical,” whether or not they actually are. This long-term mmmmmm-blockin’-out-the-haters (Brandon Bowen’s Vine, remember this one?) is conducive to not accepting differing viewpoints now or in the future, especially when surrounded by fellow harm reductionists.

But, seriously, these people are used to fighting opposing viewpoints. That’s how they got here to harm reduction. They’re still used to fighting opposing viewpoints. Can you see how this would breed intolerance, despite how inclusive people in this space strive to be?

Many, if not most, people in HR are from areas that are left-leaning and already have HR-type resources in place. Whether or not these resources were in place when they started isn’t relevant, in my opinion, because you can’t draw parallels between ass-backwards rural Tennessee and, I dunno, fuckin’ Massachusetts 20 years ago.

Here’s My Point

It’s been difficult for me to share my opinions within HR. Just to put a timeline on things, although I’ve been giving out supplies and educating people about drugs for much longer, I started writing about HR-related issues as Daniel Garrett (that’s my government, in case you’re wondering) around November 14, 2019. I did so to let others know that I’m out here putting in work. How else would people know I’m here? The grapevine ain’t that long.

When I try to stick up for Poor Whites or say that shit really is that different here in the rural South… it’s difficult. Because some of my opinions — like we often-problematic drug users should, in fact, try to be more responsible for our actions — I’ve been widely unwelcomed to the space of harm reduction.

I thought this space was inclusive — but I gets no clout tokens for growing up bisexual in rural Tennessee, being involved in sex work for some four years, having used drugs in an often-problematic fashion for a decade, nun-a-that. And that hurts. It’s so tempting to give up this HR shit. To give up being the only motherfucker in Northwest Tennessee giving out syringes and shit, which I’m doing on an unpaid and unfortunately-illegal basis. Don’t forget I’m on two probations. I often hear people say they’re willing to go to jail for this shit — have fun with that! I went to jail for the first two times in 2019 and I’m too much of a pussy for that shit. It’s in my best interest to never illegally distribute another syringe, but I know I’ll be doing this for a while — no matter how difficult it is for me to spread my unconventional opinions in this space.

And hopefully, one day, I’ll be able to help some other youngblood find his footing in this very space. Maybe even for sharing unpopular, somehow-controversial opinions.

Here marks the end of the article. If you’d like to learn more about my subjective experience, keep reading.

My Experience With the Harm Reduction Community

I’ve been giving out safe drug use supplies for about two years now. Much of the syringes, naloxone, fentanyl test strips, etc. I’ve given out have come from a mail-based supply distributor based in New England. I don’t want to name them here because the outfit isn’t supposed to mail supplies outside of the state they’re located in.

In the past few months, two individuals — one in Washington, one in Indiana — have sent me a collective 3,000-or-so syringes, not to mention single-use bacteriostatic water containers, tourniquets, cookers, cottons, fentanyl test strips, antibiotic ointment, and even condoms (I’ve never really given out condoms, as they’re already widely available here; I’m primarily interested in giving out supplies that aren’t often available active drug users in rural West Tennessee).

I haven’t paid a dime for these supplies.

I’ve had long, rousing, stimulating chats with dozens of harm reductionists online and over the phone. I only came across these people on social media — I’d “cold messaged” them on social media or via email and, luckily for me, they were willing to entertain my requests for help. I still keep in contact with some of these folks today.

Through Facebook, I reached out to a lady in East Tennessee, some six hours away from me, who I heard was involved in HR. Over the past 15 months or so, she’s taken me to two HR-related conferences and given me other opportunities that I wouldn’t have had otherwise. In a field that’s full of organizations “held together with twigs and bubble gum,” as a more-experienced counterpart told me in late 2019, I’ve found several diamonds in the rough who’ve done a whole lot for me.

Don’t mischaracterize my words and say I hate all harm reductionists and they’re all pieces of shit — that’s not at all the truth. Like all humans, most people have good intentions.

However, due to several factors already mentioned — not all of which are HR-specific, as you might recall — as well as the fact that most American (and Canadian) harm reductionists are largely-left-leaning people, I think the modern HR community isn’t as inclusive as its membership thinks it is.

Here’s an Anecdote

Back when I first got active in HR circles on social media, I challenged someone who said something I didn’t agree with.

The other person was a panelist at a rural-oriented, HR-related speaking engagement at November 2019’s International Drug Policy Reform Conference in St. Louis, Missouri, which was put on by the Drug Policy Alliance. They shared some solid advice at the event and I looked up to them. On Twitter, they quoted an article in which a licensed social worker and state public health official stated that “[Naloxone] is not meant to be the solution to a person’s overdose.”

The state official was more or less saying that, while naloxone should be readily-accessible and is a useful tool in reversing opioid overdose, it shouldn’t be the cure-all for dealing with opioid addiction or otherwise-problematic opioid use.

I agree with this statement. Although I’ve been revived from opioid overdoses thrice with naloxone and even though I give the life-saving drug out to fellow drug users and laypeople throughout West Tennessee, I think we should invest more in programs that intervene early on in children’s, teens’, and young adults’ lives; schools should expand sports programs to include more than basketball, football, and baseball (which seem to be the Holy Trinity here in the South); and so on. Will this solve drug addiction or otherwise-problematic drug use? Of course not. However, I think such measures will reduce problematic drug use. These solutions resonate with me, particularly, because I wasn’t involved with any social programs in school outside of basketball for one year (I wasn’t good enough to make the team again), I wasn’t engaged in many healthy activities, I didn’t have a mom for the latter half of my childhood (the full list is rather lengthy; I’ll stop here for the reader’s sake). I picked up drugs because they satisfied otherwise-unmet needs in my life. I actually ended up attempting suicide at 16, almost certainly due to a many-layered combination of intersecting issues in my life at the time.

Note: The article doesn’t specify what is meant to be the solution to opioid overdose, but I assume medication-assisted treatment and improved early-life social involvement are both fine alternatives — though they aren’t alternatives for reversing opioid overdose (that’s naloxone’s job), exactly, we’d rather not have people experiencing overdose in the first place. I do agree that naloxone should be the first-line reactive (rather than proactive) treatment for opioid overdose.

I piped up — this was on Twitter and I had, like, literally zero followers at the time; I just made my account a few minutes prior — and argued the state official’s ideas were worthy of merit. I was shamed for not understanding (illicit) opioid use here in the United States and also advised not to speak to women if I wasn’t spoken to first. The Twitter user got several favorites, retweets, and co-signs from fellow harm reductionists and other people who’re interested or active in public health, medicine, pharmacy, and related fields.

Of course, I got zero.

Some More Anecdotes

I won’t explain these as extensively as the story above — it’s just not necessary. Just know that sharing off-color opinions within this community has proven difficult for me.

Even though I’m openly bisexual, I’ve been called a “cis White male” by people who know I’m bisexual at least a dozen times, likely more. And this isn’t in general — this is only within the HR community. If these people weren’t aware of my sexuality beforehand, once I made it clear, they still denied that I could take the title of “queer.”

Sometimes, when I share opinions that unarguably fit that of the average harm reductionist, I’m shot down just because people recognize that others have said bad things about me. This holds true when others share my writing or interact with me.

I’ve been told several times that people won’t associate with me openly because of the bad reputation I’ve picked up for myself. So, they feel like shooting down my viewpoints are necessary to avoid being viewed as guilty by association.

In my time as a harm reductionist, I’ve never heard anybody talk about Poor Whites — actually, yeah, I heard one talk of Poor Whites at a conference/convening back in March. Outside of that, it’s only been about racial justice.

I don’t like dwelling on this shit. I don’t wanna think about it anymore. There are dozens, if not hundreds of times where others in HR have wrongly slighted me or not given me the chance. I haven’t yet mentioned that time that one popular harm reductionist called out my writing and got hundreds of comments and hundreds of likes on her posts for “canceling” me. I still face the fallout of that today. Just for having a different fucking opinion.

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