The Rhetorical Pitfalls of Harm Reduction
The Rhetorical Pitfalls of Harm Reduction
On organized opposition to harm reduction and infighting within the movement.
After writing an entire 3,000+ word feature for Filter Mag about the state of (or rather, plight of) harm reduction across rural America, I started thinking much more clearly about the political and rhetorical battle lines being drawn across the country. You don’t have to read that story to understand this one but I recommend it.
It’s not only “red states” like West Virginia or Tennessee where the rhetoric of harm reduction falls on deaf ears. It’s also in “blue states” like California (aherrrrm, San Fransisco, which Tana has been covering like a champ). The usual “red” versus “blue” dichotomy doesn’t map onto the political realities of harm reduction. Republicans and Democrats alike express discomfort with harm reduction policies.
Just a few years ago, it seemed easier for elected officials to say that they were tackling addiction and overdose through a “public health approach.” Even law enforcement officials were saying things like, “We cannot arrest our way out of this crisis.” In 2015, The New York Times wrote this headline: “In Heroin Crisis, White Families Seek Gentler War on Drugs.” It seemed like a new way of looking at drugs and addiction was on the horizon.
But something changed. There’s been—if you’ll allow it —a vibe shift. Crime and punishment, law and order, the old ways, seem to have more traction right now than this softer, gentler approach.
Take, for instance, California’s Democratic Governor Gavin Newsom, who recently vetoed a bill that would have legalized supervised consumption sites (SCS) in Oakland, Los Angeles, and San Francisco. There was some genuine hope among California harm reductionists that Newsom would sign the bill into law. In 2018, Newsom said he was “very, very open” to supervised consumption sites. What happened since then?
Newsom’s office put out a letter explaining the veto. But to understand what he’s saying, and what’s going on with the politics of harm reduction more broadly, you kinda have to read between the lines and zoom out a bit. Why are the politics of harm reduction perennially difficult to square, even, and maybe especially, for liberal leaders? That is, unless you’ve got the confident swag of New York City Mayor Eric Adams:
So, come ride with me on a close textual reading of Newsom’s veto, and let’s drill down into harm reduction’s current political landscape. Here is a link to Newsom’s letter. But don’t worry, I’ll be quoting it at length.
And before we begin, to toot my own horn and show you that I really know what I’m talking about, Politico’s California Playbook said that yours truly had the TWEET OF THE DAY on Newsom’s veto:
“Journalist Zachary Siegel @ZachWritesStuff: “I feel like Dan and Amy from Veep took Gavin Newsom aside and said he could never be president if he signed the CA consumption site bill.”
Rhetoric and Its Disconents
First, let’s start at the very end of the letter, with Newsom’s signature. It’s the only part of this letter that we know for sure he wrote himself.
See the way his signature bleeds into and over the actual text of the letter itself? The giant cursive “G” scribbled over “Sincerely.” Maybe he isn’t being so sincere? The giant cursive “N” scribbled over “these programs.” Newsom’s big ass signature signifies big ambitions. His political future was looming large in his mind as he signed this. I don’t know what Patrick Bateman’s signature looks like, but I’d bet it’s the same sort of vibe.
Also, before moving further, there is something about Gavin Newsom that must be reiterated: In the early 2000s, Newsom was married to—get this—Kimberly Guilfoyle, who is now engaged to Donald Trump Jr.
Newsom’s letter begins, “I am returning Senate Bill 57 without my signature.” He then launches into:
“I have long supported the cutting edge of harm reduction strategies. However, I am acutely concerned about the operations of safe injection sites without strong, engaged local leadership and well-documented, vetted, and thoughtful operational and sustainability plans.”
Here, Newsom implies that there isn’t “engaged local leadership” dedicated to this, and that the plans to operate these sites are not “vetted,” “sutainable,” and fully thought out. (Big Lebowski voice) This is not a real concern, dude.
For starters, there are already overdose prevention sites operating in California. They’ve been underground and kept secret for years, but it’s more of an open secret nowadays. Researchers have even studied underground sites, and published their results in The New England Journal of Medicine, which is basically the New Yorker of research publishing. Newsom must be aware that there are consumption sites already operating, but in this letter he’s pretending they don’t exist.
Moreover, harm reduction groups in California have been agitating to bring consumption sites above ground for many, many years. They’re the ones who’ve been meeting with local leaders and state representatives ad nauseum, since at least 2016, asking for the tools and interventions to address overdose deaths in their communities. There’s a lot of unhoused people openly struggling with addiction in cities like Los Angeles and San Francisco. These conditions are practically begging for a consumption site.
It’s actually not that complicated: Bring some of the consumption indoors, into a compassionate setting, and begin the slow process of building trust with the people and learn more about who they are and what they need. It’s not often mentioned outright but SCSs are important because mainstream medicine has treated many of these people horribly. The trusting relationship that’s critical for any healing has been broken. And so building a new kind of health care, one that’s designed especially for them, is paramount. And that’s what SCSs do.
Local representatives have heard these arguments and responded to these conditions by listening to their communities and drafting legislation. That’s usually how government works. That’s how these bills came to be. So between multiple empirical studies and years of debate, it’s absurd to say that the plans to implement these sites aren’t vetted or fully thought out.
So right off the bat, the reason Newsom offers for his veto is already not making much sense.
On some level, Newsom knows these sites would probably do some good, which he says outright in the paragraph below. But here is where he alludes to some sort of conflict. A vague problem with the bill.
“The unlimited number of safe injection sites that this bill would authorize— facilities which could exist well into the later part of this decade—could induce a world of unintended consequences. It is possible that these sites would help improve the safety and health of our urban areas, but if done without a strong plan, they could work against this purpose. These unintended consequences in cities like Los Angeles, San Francisco, and Oakland cannot be taken lightly. Worsening drug consumption challenges in these areas is not a risk we can take.
First sentence: Newsom raises a technical flaw in the bill’s language, that an “unlimited number” of sites could theoretically open leading to a “world of unintended consequences.” These unstated consequences would, somehow, lead to “worsening drug consumption challenges.” Newsom raises a hypothetical risk.
But the bill puts a boundary on where the sites could open: Los Angeles, Oakland, San Francisco—major cities with very visible housing and addiction issues, cities where local leaders vocally support these sites. Newsom says SCSs could improve “safety and health,” but that they could “work against this purpose.” Again, he references some vague “unintended consequences.”
So Newsom is not actually saying the thing that opponents of SCS are saying. He’s alluding to it, but deliberately dances around it. This is a different track that Gov. Jerry Brown took in his veto of a similiar bill in 2018. In that letter, Brown was explicitly lifting up the rhetoric of opponents to SCS: That drugs “enslave” people, and SCSs enable this enslavement.
Below is the Orange County Sheriff’s opposition letter, which is kinda odd coming from him because this bill did not list Orange County as one of the cities a site would even open. OC would literally not be impacted by this bill at all. Law enforcement groups of various stripes are by far the most vocal opposition to this stuff. The police and their backers raise what they view are the “consequences” of supporting SCS: “Rather than helping the addict, this bill is the equivalent of buying an arsonist a new box of matches.”
“Our core view of the bill is that it is the practical equivalent of government-sponsored aiding and abetting of illegal and destructive drug use.” — Greg Totten, chief executive of the California District Attorneys Association.
You’ve probably heard a lot of this langauge before. These sites “enable” drug use; They “send the wrong message;” “Think of the children.” These are the “consequences” Newsom said without saying it.
The rhetoric against harm reduction from law enforcement, however off-base and misguided, is really nothing new. It’s the same thing people have been saying about harm reduction since the 1980s with the advent of syringe service programs during the AIDS epidemic. With every new type of harm reduction idea, from naloxone distribution to fentanyl test-strips and beyond, this same “enabling” rhetoric gets deployed. Every. Single. Time.
The critics stick with this rhetoric because it clearly works. It’s legible and easily digested by a mass audience, especially among Americans who have watched 800+ episodes of Cops re-runs over the past three decades.
In the LA Times, a Democratic consultant named Andrew Acosta spoke directly to the rhetorical disadvantages of harm reduction:
“It’s like many pieces of legislation that are more nuanced, but trying to explain it takes four paragraphs and attacking it takes five words. Politically, we live in a world that’s partisan, and people will take these things and attack them.” —Democratic consultant Andrew Acosta.
Fight Addiction, Don’t Enable It. Boom. Five easily understood words that can take down the whole project. For people who don’t think about this stuff everyday, this anti-harm reduction message is easy to understand. It’s a potent weapon. Unraveling this position takes a lot of time, effort, and work. Inducing a psychic shift around these already emotionally charged issues is an uphill climb.
No one is born with the knowledge of and arguments for harm reduction. In fact, the arguments for harm reduction are pretty counter-intuitive and takes some real wrestling with to understand. There’s some discomfort one must sit with.
Look, I’m not the type of guy who gets off on policing what activists say and do. But I have noticed, especially online, that some people in the harm reduction movement lash out and alienate those who are not on board. I even see people who try and lash out, alienate, and tear down those who are on board and are trying to do the work.
To be specific, here’s what I mean. A harm reduction group out of Ohio called “This Must Be the Place” distributes naloxone and other materials at music festivals all over the country. One of its founders, a guy named Perry, was incarcerated for 10 years and is now in recovery and works as a reentry counselor helping formerly incarcerated people. You’d think this project would be welcomed by the movement. But I frequently see Perry and the group get attacked on Facebook by people who claim the mantle of harm reduction.
Harm reduction still has a lot of work to do to get the broader public on board. So these internecine skirmishes and online infighting seems quite unproductive when the real enemies of harm reduction are quite powerful.
Law enforcement lobbying is one of the major impediments to advancing the goals of harm reduction around the country. Maybe, Newsom and other Democrats, hear the police side of things and think by siding with them they’re generating some good will and scoring some points with law enforcement.
Even in blue states and liberal cities, police, prosecutors, judges, etc. remain a powerful political constituency. They’re also highly organized, often unionized, and know how to throw their weight around in a poltical battle. I live in Chicago, and our liberal mayor Lori Lightfoot, who fancies herself a progressive-reformer type, is loathed by police. She was even federal prosecutor, and the police union still thinks she’s a liberal freak.
Back to Newsom’s letter, which ends with these final points:
“I am instructing the Secretary of Health and Human Services to convene city and county officials to discuss minimum standards and best practices for safe and sustainable overdose prevention programs.
“I remain open to this discussion when those local officials come back to the Legislature with recommendations for a truly limited pilot program—with comprehensive plans for siting, operations, community partnerships, and fiscal sustainability that demontrate how these programs will be run safely and effectively.”
It’s more of the same: technical hang-ups and vague conflicts.
If you read the bill, SB 57, all of this stuff is in there. Communities looking to site one of the centers would have a weigh-in period before the site is established; the bill discusses training protocols and qualification criteria for staff; the legislation would have expired in 2028, and a comprehensive study of the sites would need to be done by 2027.
So Newsom kicked the bill back to the legislature, asking for things they’ve already addressed. And finally, Newsom ended by saying that he is “open to this discussion.” This is the language of contemporary liberal technocrats: They’re always trying to “dialogue” about this or “discuss” that, or they’re inviting people to “have the conversation.”
The discussion and debate and conversation has already been had in California—for over seven years. It’s well past time for action. But the law enforcement stance, the conservative law and order rhetoric, seems to win the day. Though, I don’t think Newsom really believes what the police are saying about this. It’s more like, he believes that supporting harm reduction, signing off on it with his own big ass signature, is a political liability.
Jessica Levinson, a political analyst who teaches at Loyola Law School in Los Angeles, told the New York Times: “If he signs this, the ads kind of write themselves: He becomes ‘Governor Heroin.’”
This gets to Newsom’s ambitions in the future of Democratic politics. The celebratory accolades and props he would get for standing up for harm reduction did not, on balance, in this moment, outweigh the attacks and backlash. Harm reduction, at least through the eyes of many politicians, doesn’t have enough power—yet.
Patrick Bateman, ha! In all seriousness, though, he COULD score points later when after 1-2 years the overdose death rates dropped precipitously in areas where they implemented SCS. So frustrating. Expediency wins the day.