In recent years, drug policies have begun to shift dramatically in many countries. After decades of viewing drug users as criminals, governments have started to implement more measures focused on harm reduction. In selecting these policies, governments accept that drugs are never going to be eliminated, so it is best to give up the quixotic fight and make drug use as safe as possible.
Approaches to harm reduction are varied. Minor steps include the creation of needle exchanges, sites where drug users can receive sterilized equipment, and Good Samaritan Laws, legislation that protects individuals present at the scene of an overdose from arrest or prosecution. Perhaps the most widely discussed and studied approach to harm reduction is the creation of safe consumption sites, where users can take drugs in a supervised environment without fear of legal prosecution. Canada has long been a leader in this space. Insite, North America’s first legal supervised consumption site, opened in 2003 in Vancouver, and there are currently 37 similar facilities across the country.
More recently, the personal use of drugs has been decriminalized in some places. Portugal famously decriminalized small amounts of many narcotics on the condition that users undergo treatment for addiction. In Oregon, voters overwhelmingly passed a ballot measure in 2020 that reduced the punishment for possessing many kinds of drugs to the equivalent of a parking ticket. In May 2022, the province of British Columbia follow suit by announcing its intention to decriminalize the possession of small amounts of drugs beginning in January 2023.
However, these efforts are not without opposition, often on moral grounds. Conservative governments around the world have often resisted the implementation of harm-reduction measures, arguing that they increase drug use overall or encourage anti-social and dangerous behaviour. The recent announcement of decriminalization in BC elicited just such a reaction from both high- and low-profile opponents:
This action will likely result in a dramatic increase in drug use, violence, trafficking and addiction. – Jason Kenny, Premier of Alberta
Lets ban legal guns and legalize illegal drugs. Pretty much describes the entire progressive ideological agenda. The Liberals are oxymorons. – National Post comment, received 24 likes and 0 dislikes
Looks like moral outrage to me, so let’s reach for the best policy tool to understand these reactions: values analysis.
The Values
In 2019, a group of scientists, armed with the six values of Moral Foundations Theory, provided an online questionnaire to more than five thousand Americans that explored their attitudes towards needle exchanges and other harm reduction strategies. They found that the moral disagreement over needle exchanges is rooted primarily in the tension between two sets of values:
Values that Favour Harm Reduction Policies
- Care/harm (i.e. it’s morally right to help people and wrong to hurt them)
- Fairness/cheating (i.e. outcomes should be equitable and/or proportional to contributions)
Values that Oppose Harm Reduction Policies
- Authority/subversion (i.e. it’s morally correct to follow those in positions of rightful authority)
- Sanctity/degradation (i.e. some actions are inherently corrupting and dirty, and therefore, wrong)
In other words, people who strongly feel the care/harm and fairness/cheating values tend to support harm reduction policies. In contrast, those who are high in the authority/subversion and sanctity/degradation values usually oppose harm reduction measures. Let’s dig into these four values to find out why.
Support for Harm Reduction Policies
The 2019 survey gives us vital hints about the moral force of the support of harm reduction measures. Simply put, most policies of harm reduction probably save lives by reducing overdose and disease rates among drug users. Strong evidence suggests that some interventions, such as supervised consumption sites and needle exchanges, are effective and cost-efficient approaches to reducing death and disease. There remains room for scientific disagreement about the impact of more significant interventions (such as the society-wide decriminalization of drug possession), but the evidence is beginning to build up in their favour. All of this resonates with our care/harm value. To many people, reducing the toll of drugs on the vulnerable is a morally worthy endeavour.
There are a few possible explanations for why people high in the fairness/cheating value tend to support forms of harm reduction. First, drug users could be viewed as victims of a medical condition – addiction. Victims, by definition, do not deserve to suffer, so society has a moral responsibly to help. Second, supporters of harm reduction methods may bristle at the inequitable application of drug laws. Racialized populations are disproportionately affected by drug criminalization, even though some evidence suggests that rates of drug use are comparable across races. Finally, the somewhat arbitrary division between legal and illegal substances could elicit a response under the fairness/cheating value. Although by some measures it is a more harmful drug than heroin, alcohol is legal, and all sorts of harm reduction measures are available for alcoholics. Is it fair to provide different levels of support and sympathy to addicts based on the substance they use?
The reaction on social media to the announcement of drug decriminalization in BC featured moral arguments based on the care/harm and fairness/cheating values. For example, here some highly rated comments on the top thread on the Canada Reddit subforum:
The median income for someone with a criminal record is 12k$ 14 years after their release. A criminal record is a financial death sentence and we shouldn’t hand it out haphazardly especially for victimless crimes like drug abuse. – 1,000 net likes
Drug abuse shouldn’t even be a crime. It’s literally a health problem. Imagine if alcoholism was illegal. – 550 net likes
I swear that many Canadians have lost their sense of empathy. A sensible person can agree that hard drugs are damaging, while also acknowledging that many addicts come from serious trauma/abuse. I think the number is at least 50 percent, maybe even higher. I know that I had a small taste of that dark world, but was lucky to have a solid family to fall back on. Without that sort of support, drug addictions become a disease very quickly. – 180 net likes
These comments show how care/harm and fairness/cheating reasoning can be combined and applied to the question of drug decriminalization, eliciting both sympathy for the pain of the drug user and frustration at the unfairness of the current system.
With regards to safe consumption sites, support appears to be directly linked to the care/harm value. For example, in July 2021, a small but significant protest was sparked when the government of Alberta tried to shutter a safe consumption site in downtown Calgary. “Dead people don’t recover. Harm reduction saves lives” read one placard at the protest. “No one disposable” read another. Dr. Alan Chu, an anesthesiologist at the protest, made the following comment to the media:
I, frankly, cannot see how a government can withhold harm reduction or decrease harm-reduction services given that we should be prioritizing saving lives through relatively cheap, cost-effective programming and interventions.
Under only the care/harm value, Dr. Chu is entirely correct. But, of course, there is more to morality than simply saving lives. So, why do so many people oppose harm reduction techniques?
Opposition to Harm Reduction
According to scientific findings, the most significant value that explains the moral opposition to harm reduction is the sanctity/degradation value, which is closely related to natural intuitions related to disgust and uncleanliness. These themes are prevalent in our vocabulary relating to drugs: a urine sample with traces of drugs is “dirty”, while a recovering addict is “getting clean.” This phenomenon is not restricted to English. In many languages, the term “clean” is used to refer to people who no longer use drugs (proprein French, чистый in Russian, limpio in Spanish, 干净in Mandarin, نظيف in Arabic), and some languages introduce their own unique phrases. An alternative French term for “drug addiction” is toxicomanie, from the Latin root tox-, which means “poison” (the same root as the English word “toxic”). In Spanish, a drug user can be called a “contaminado”, or contaminated person.
Although it is possible that this results from European cultural influence, a more likely explanation is that people subconsciously connect drugs and contamination, and language evolves accordingly. The connection is intuitive; drugs enter your body and change your state of mind – often for the worse. To be fair, not all drugs are viewed in this way. For example, alcohol is does not carry such a stigma in Western countries, and some cultures have used hallucinogenic drugs for religious purposes. However, drug use and uncleanliness are often conflated, and this appears to be a natural mental link.
Within this framework, the moral opposition to harm reduction techniques is completely understandable. The primary harm is the drugs, which are contaminating the bodies of users, so any effort to make drug use easier or safer is missing the point. In this view, the only morally acceptable outcome is for people not to ‘contaminate’ themselves. This could be achieved at a societal level through a mix of abstinence, prevention, and enforcement, policies that ensure the government is not complicit in the corruption of its citizens. The idea of government-funded medical professionals literally injecting narcotics into the arms of citizens is, in this view, completely backwards. The state would be enabling the descent of its citizens into corruption and moral perversion.
Evidence from social media suggests that the sanctity/degradation value was active in the debates around BC’s effort at drug decriminalization. For example, note this set of comments on this CBC News article on the topic:
Rampant use of narcotics and drugs is symbolic of a failing societal structure. Lets fix the cause….. not feed the symptom. – net 37 likes
REPLY: true. Crumbling infrastructure. Loss of personal connections. Celebrating degeneracy. And encouraging mind rotting drug use. It appears that the “slippery slope” people were right. Legalize marijuana, and now there are more marijuana stores than Tim Horton’s in every city in Canada. We see where this path leads. Society in decay. – net 8 likes
This is a distilled expression of a violation of the sanctity/degradation value, as these comments retain many of its hallmarks: concerns about degeneracy, societal breakdown, and a general lack of moral substance. These themes appear to be morally resonant with a wide subset of the population who oppose harm reduction policies.
There is another value at play in the opposition to harm reduction: the authority/subversion value. Many harm reduction efforts, such as safe consumption sites, are effectively a limited decriminalization of drug use, a “mulligan” for drug users to consume illicit substances under certain conditions. This appears to many to be morally perverse, as evidenced by these comments on BC decriminalization:
This is what happens when you elect the inmates to run the asylum. What next? No arrests for holdups that net under $100? Or assaults where the victim doesn’t require hospitalization? – Globe and Mail, 40 likes
Decriminalizing drug possession is rewarding the person that broke into your car for a phone charger or sold your bike out of your yard and sold it for the drugs. Stop blaming inanimate objects and start making people responsible for their actions/choices – CBC, 42 likes
Under the authority/subversion value, people have a responsibility to follow the law, and the police have a responsibility to enforce it. Harm reduction can be viewed as both sides of this bargain failing to honor it. Drug users aren’t respecting rightful authority, and the police aren’t upholding the law. It’s no surprise that people find this outrageous.
But if drug decriminalization makes the use of narcotics legal, what’s the problem? Doesn’t that just solve the issue, since no laws are being broken? While this may be technically true, it isn’t morally resonant. Fundamentally, harm reduction operates on the assumption that eliminating drug use is impossible, so the best outcome is to manage its negative effects. This is hardly a full-throated defence of drug legalization. Rather, people with this moral view could interpret harm reduction policies as the waving of a white flag. The state, in all its power and authority, would prefer to surrender than continue the fight against harmful substances, a dereliction of duty under the authority/subversion value. In addition, simply changing the laws on paper will not alter societal expectation. Sure, drugs may be technically legal, but people will continue to think about narcotics in much the same way: as destructive and immoral substances.
But What about the Liberty/Oppression Value?
Unfortunately, the scientific article that traced the moral reactions of needle exchanges did not explore the liberty/oppression value (i.e. freedom is a moral good). However, it is likely that the impact would be mixed. On one hand, drug use is primarily a personal matter, and the liberty/oppression value elevates free will as a moral good. If people want to use drugs, let them. No wonder the Libertarian Party of Canada pledged to reduce punishments for drug use in their 2021 platform. On the other hand, people who are high in the liberty/oppression value may view harm reduction policies as government efforts to cover for people’s poor decisions, which could violate libertarian ideals of personal responsibility. On balance, it’s probably fair to assume that efforts like drug decriminalization would harmonize with the liberty/oppression value – but other harm reduction efforts would not.
Conclusion
A robust values analysis shows that harm reduction efforts are morally fraught. There is more to morality than saving lives or reducing pain and suffering. People are also concerned with fairness, purity, equality before the law. Without understanding the full range of moral values that people feel, policymakers cannot fully comprehend why harm reduction remains controversial. Next week, I will look into the implications of these insights for policy.