By Susan E. Collins, PhD
Editor’s note: This Tuesday, the Washington State Legislature will convene in a special session to pass a new drug law, after a 2021 state supreme court decision known as Washington v. Blake effectively decriminalized drug possession. The legislature passed a temporary law re-criminalizing drugs until July 2023, expecting to pass a more comprehensive drug law during the legislative session that just ended; when legislators failed to reach an agreement, Gov. Jay Inslee called a special session to deal with Blake.
After decades of the failed and costly war on drugs, we have collectively learned that we cannot punish and incarcerate people into sobriety and wellness. And in the wake of the 2021 Washington State Supreme Court Blake decision, we have a once-in-a-lifetime opportunity to ensure recovery, not punishment, for people with substance use disorders by using the evidence-based tools of harm reduction.
However, more punitive measures are currently gaining traction, as state legislators and local government officials consider making public use, drug possession, and/or failure to comply with sobriety-based treatment punishable with jail time and fines.
Why? Some argue jail time can serve as a wake-up call. But recent studies have shown incarceration is associated with worsened physical and mental health, including increased drug use. And it can be deadly: Washington state has the fourth highest jail mortality rate in the country. Due to stronger opioids like fentanyl, jail time can also set people up for overdose. That’s why, in Washington state, people who get out of jail have a risk of overdose death that is at least 16 times higher than for everyone else.
We talk about how to be safer and healthier, even if patients continue to use, and we track metrics to show incremental positive changes. Our studies show this approach to be engaging and effective.
Once we learned these old ways were hurting and not helping, my colleagues and I at the Harm Reduction Research and Treatment (HaRRT) Center at the University of Washington started to ask people who use substances how we could do better. They told us to meet them where they are and not require them to get sober to get help. They wanted to learn, step-by-step, how to reduce substance-related harm and improve quality of life for themselves, their families and their communities. This is called harm reduction.
After spending the past 15 years testing such approaches, here’s what our research and clinical group has found.
Our evaluations of law-enforcement assisted diversion showed that diverting people away from jail to harm-reduction case management and legal assistance was associated with 60 percent lower recidivism, reduced legal and criminal justice system use and costs, and greater likelihood of obtaining housing, employment and legitimate income.
Another successful community-level intervention is providing Housing First, or immediate, permanent, low-barrier housing and supportive services that do not require sobriety to help people meet their basic needs. Contrary to some people’s initial fears, our research has shown that providing Housing First does not “enable” substance use. Studies of Housing First here in Washington State show that it is associated with long-term reductions in alcohol use, alcohol-related harm, and use of jail and publicly funded healthcare. These findings have held in rigorous tests in other parts of the world as well.
Low-barrier shelters, which provide safer-use equipment and spaces, are another effective way to reduce harm. Our evaluation showed this approach did not increase substance use. In fact, people staying in the low-barrier Navigation Center in Seattle were 23 percent less likely to report any alcohol or drug use for each month after their move-in date. Instead, this approach was linked to better general health and a stronger commitment to protecting self and others through safer use.
In another approach, harm-reduction treatment, which can include counseling alone or combined with medication, clinicians set aside a demand for sobriety and instead ask patients, “What do you want to see happen for yourself?” We talk about how to be safer and healthier, even if patients continue to use, and we track metrics to show incremental positive changes.
Our studies show this approach to be engaging and effective. Over 90 percent of those approached have accepted help. We have also seen use and substance-related harm cut in more than half. And even though this harm-reduction treatment approach doesn’t require sobriety, positive urine tests for alcohol decrease as well because some patients decide to get sober after all.
In the case of one client, it took a year and a half to stop using, but even before then, he was reducing his use, recovering from depression, and rebuilding a relationship with his family after 5 years of prison and unsheltered homelessness. He sent me a picture of him and his family at Disneyland, captioning it with “It took a village. But harm reduction worked for me. For the first time in my life, I am truly happy.”
At this watershed moment, let’s remember to support and not punish people for having a substance use disorder. It’s not only the right thing to do, it’s what works.
Dr. Susan Collins codirects the Harm Reduction Research & Treatment Center at the University of Washington School of Medicine. The center receives no funding from the tobacco, vaping or pharmaceutical industries. She also is a professor of psychology at Washington State University. The views expressed in this op-ed are those of the author and not the positions of the University of Washington or Washington State University.
7 thoughts on “We Must Support People Who Use Substances, Not Punish Them. Here’s How.”
The damage to society from drug addicts including theft, robbery, assault, overdose deaths, destruction of parks and transit system are too great to just let drug addicts keep doing these behaviors thru harm reduction.
Theft, robbery, assault and destruction of parks and transit system are separate crimes than taking illegal drugs, and have their own laws and penalties. If you want to be irrational as punishing a drug user right up front for these other crimes they may or may not have committed then maybe we should start punishing landlords, NIMBYs, and real estate investors for driving up the price of housing and therefore causing homelessness, which leads to drug addiction (and therefore theft, robbery, assault, etc.)
I quite like it. It fits right in to your logic, and by lowering the cost of housing it would be hugely beneficial to our community.
Consider that harm reduction policies are practiced in Vancouver BC without succeeding https://t.co/24mfhXqDAb
There’s no evidence presented that what works for alcohol works for fentanyl and meth, and the specific harm reduction practices differ between all three drugs. Just cause we use the same phrase & mindset doesn’t mean one specific intervention is as successful as a wildly different one also called harm reduction.
I’m sorry, but it hasn’t been enough. It’s time for more testament and accountability, in addiction to harm reduction. It’s not either/or.
Yeah, a big NO on this approach.
IOW, tax the normies into bankruptcy providing cozy solutions for junkies and tweakers while leaving them unusable public facilities overrun with the same junkies and tweakers. And shut up about petty crime, break ins etc… what matters is what benefits junkies and tweakers. Not one mention of anything else, the impacts to boring old normies stuck living in the middle of this, etc…
And you wonder why compassion fatigue has set in.
I haven’t seen compassion fatigue set in. Just the same old noisy people saying the same thing they have for the past 40 years. Which has never worked in the past 40 years either.