Maia Szalavitz, a prominent neuroscience journalist and progressive drug reform champion who has written for the New York Times, Washington Post, Huffington Post, Salon and other publications, is the author, among other books, of Undoing Drugs (2021), a stirring history of the harm reduction movement. 

A former cocaine and heroin addict, Szalavitz is one of the country’s foremost journalistic critics of the war on Drugs era, and she remains a fierce proponent of non-punitive approaches to addressing addiction. We invited her on to this latest BCB episode to make her case that harm reduction remains the right way to handle the spread of fentanyl addiction, homelessness and open air drug markets in cities like Seattle, San Francisco and Philadelphia. 

Szalavitz forcefully argues the War on Drugs never really ended, and that efforts to criminalize drug use have always been shaped more by politics, race, and social control than by science. She argues that American drug laws have historically targeted marginalized groups such as Black Americans, immigrants, and the poor, while legal substances like alcohol and tobacco remained socially accepted despite causing greater harm. She further contends that criminalization has failed by virtually every measurable standard, citing America's simultaneously high incarceration rates and overdose rates.

The earlier part of our discussion focuses on the emergence of the harm reduction movement during the HIV/AIDS crisis in the 1980s. Szalavitz recounts how activists in the Netherlands, Britain, and eventually New York pioneered needle exchange programs to prevent HIV transmission among injection drug users. She argues that these efforts demonstrated that treating drug users with dignity and providing clean syringes dramatically reduced disease transmission without increasing drug use.

Later in our conversation, we press Szalavitz on what we see as the limits of the harm reduction ethos in its present, expansive form, questioning policies common in blue cities like handing out foil and pipes to drug users, and suggesting that the current fentanyl crisis may require stronger interventions than previous waves of heroin use. We point to the enormous suffering created by today's open-air drug scenes and the social harm addiction creates in impacted communities, asking whether there is a place for greater "friction" or limited coercion in public policy.

Szalavitz rejects that premise, maintaining that evidence consistently shows voluntary treatment, housing-first policies, medication-assisted treatment (methadone and buprenorphine), supervised consumption sites, syringe exchanges, and social services outperform coercive approaches. She repeatedly emphasizes that there is little evidence that harm reduction increases drug use, while she contends that substantial evidence shows it keeps people alive long enough to eventually seek treatment.

OUTSIDE SOURCES:

Maia Szalavitz, Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, Balance (2021). 

Maia Szalavitz, Unbroken Brain: A Revolutionary New Way of Understanding Addiction, St. Martin's Press (2016). 

Bruce D. Perry and Maia Szalavitz, The Boy Who Was Raised as a Dog: And Other Stories form a Child Psychiatrist's Notebook, Basic Books (2007). 

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