Harm Reduction Is an Ethical Approach to the Opioid Crisis

We have an obligation to help even those who seem intent on hurting themselves.

If someone is badly injured in a motorcycle accident and rushed to the emergency department, she’s not refused treatment because of her foolish behavior. That’s the metaphor Travis Rieder uses in arguing in USA Today that those with drug addiction problems should be treated with compassion and that compassion includes accepting that some people don’t want to change. If they don’t want to change, then society must do everything it can to reduce their chance of harming themselves until they're ready to change.

Rieder, a faculty member at the Johns Hopkins Berman Institute of Bioethics, has been there, done that. When he was in a motorcycle accident, opioids saved him from a world of hurt. Then, he suffered from withdrawal symptoms. He points out that “I learned something important both when I gratefully took high doses of the drugs to quell the pain, and when I tried to quit and went through hellish withdrawal: People take drugs for reasons.”

There’s a lot of evidence that needle exchanges, naloxone, safe injection sites and “virtually all harm reduction approaches have positive side effects, like saving money in the long run and keeping used needles off the street.”

But an ethical case for harm reduction must be made.

“If we see people who use drugs as people we know and love, people who deserve respect and health care, we can save many of them,” Rieder writes. “But we have to replace our instinct to punish what we see as bad behavior with an instinct to care. This is not a discussion about evidence. It’s about ethics and the dignity of human beings—about what each of us deserves.”