Sheila Vakharia’s book advocates harm reduction

Sheila Vakharia, who now works for the Drug Policy Alliance, began her career as a clinical social worker in a conventional addiction treatment center, where she soon became disillusioned. “Few of my clients entered treatment voluntarily, most did not believe they had a drug problem, and most never completed the program,” she recalls in her new book The gap in mitigation“because they could not maintain abstinence and adhere to our strict structures,” which included regular urine tests that she had to oversee, much to her displeasure.

Vakharia’s next job, at a program that provided sterile injection equipment to drug users, opened her eyes to a different approach. Harm reduction rejects a black-and-white choice between abstinence and addiction, and recognizes that different drug use patterns carry different levels and types of risk. It accepts that people will continue to use psychoactive substances, as they always have, and seeks to minimize the negative consequences. Crucially, it recognizes that efforts to prevent substance abuse can cause their own, different kinds of harm, which it also seeks to reduce.

In addition to needle exchanges, harm reduction includes support groups, accurate information about drug-related dangers, and distribution of test strips to detect fentanyl and naloxone to prevent opioid overdoses. The approach also includes overdose prevention centers where people can use drugs in a safe, medically supervised environment, and policy changes such as decriminalizing drug use and—to counter the unpredictable dangers of black market products—legalizing drug supply.

What unites these efforts, says Vakharia, is a respect for individual autonomy and a willingness to meet people where they are. This does not necessarily correspond to the “drug-free society” that prohibitionists dream of.