The author of this book, Maia Szalavitz, was a heroin and cocaine user in the 1980s. She opens the book by recalling a conversation with an acquaintance in an East Village apartment when she was about to shoot up. This person, a girlfriend of Maia's drug-using friend, advised her about needle safety: "Don't share [...] but if you have no alternative, run bleach through the syringe at least twice, then rinse at least twice with water." Maia later recalls that the friend she was sharing a needle with contracted AIDS not long after, and was probably already infected. This small tidbit of advice, especially given back in the 1980s when information about HIV and AIDS was limited and hushed-up, and intravenous drug users likely had no idea that needle sharing put them at risk for HIV, saved her life - not in the abstract, but concretely: saved her life.

Maia's friend-of-a-friend was practicing what Maia would come to know as harm reduction. As Szalavitz puts it, "the basic idea [of harm reduction] is that, regardless of whether people continue to use illegal drugs or engage in other problematic behaviors, their lives have value." There can be a suite of activities, policies, and practices that <i>reduce the harm</i> of harmful behaviors, acknowledging that doing drugs, drinking, speeding, mountaineering, scuba diving, and any number of dangerous activities are going to happen anyways. This can be something as simple as having a designated driver to something as seemingly radical as real doctors prescribing government-subsidized cocaine and heroin for their patients (something that really happens in Liverpool, the birthplace of the harm reduction movement).

In the US and in many, many other countries, drug users have long been seen as the scum of the earth, particularly before the 2000s. The overarching, loud-blaring message was: don't use drugs. Period. If you do use drugs, you deserve all the bad things coming your way. The reality - as obvious as it seems - is that the lives of drug users have value. Their drug use is not the only thing that defines them, and there is a better way of treating them, educating them to avoid life-threatening sicknesses, and getting them on a good path - than criminalizing, demonizing, and ignoring them. Now, especially considering our heinous opioid epidemic, the US has piloted and seen the effectiveness of <a href="https://www.opensocietyfoundations.org/explainers/what-harm-reduction">programs</a> like needle exchanges, naloxone distribution, non-abstinence housing, and overdose prevention sites, as radical as they may have seemed just a few years ago. We know that harm reduction saves lives. We just need to overcome the political and reputational barriers that are preventing us from really committing to this philosophy.

Throughout the book, Szalavitz explores stories of pioneers in harm reduction, from the aforementioned doctors who prescribe heroin and cocaine to addicted patients, providing them a safe and risk-free way of obtaining their drugs and more security to get jobs and provide for their families (which, by the way, was funded under the Thatcher administration under a call for proposals for cost-effective ways to treat drug addiction), to Dan Bigg, founder of the Chicago Recovery Alliance who got naloxone, a life-saving opioid overdose reversal drug, into the hands of drug users on the streets.

There are so many stories of people who have fought uphill battles to save the lives of drug users - it has never been easy to get the general public, voters, politicians, and taxpayers, to subsidize drugs or even humanize drug users. It's very easy to just say, "Don't do drugs." But the reality and common bond between all of the activists Szalavitz highlights is that they have dedicated their lives to treating drug users as people who deserve to live.

If you're at all interested in harm reduction as a philosophy, activism, and radically effective ways to solve one of society's biggest issues, this book is for you. It's long and dense at points, but compelling the whole way through. Thank you to Hachette for the ARC via Netgalley.

I read this book as an ARC through NetGalley in exchange for an honest review.

As a Substance Use Counselor this book was very informative and challenged a lot of the perceptions of our field. Great review of the history and how Harm Reduction has changed over time and is being used presently. There were still a few points that are difficult to wrap your head around and accept based on the pervasive cultural messaging against Harm Reduction.

This is the story of the inception of the harm reduction movement. Harm reduction does not insist on eliminating addictive behaviour but minimizing it, making incremental changes which inspire larger ones over time. This is an alternative to total abstinence, which seems to be the hallmark of most recovery programs.

The focus is on the needle exchange programs that sprang up during the AIDS crisis, and then became even more needed during the opioid crisis. Also featured is the development of Narcan as an over-the-counter remedy for heroin overdoses, and how both the needle exchange and Narcan have become acceptable rather than looked at as aiding and abetting addictive behaviour.

Plenty of data and interviews with prominent pioneers in the field.

A challenging, sure to be controversial, but fascinating and important reframing of the increasingly dire drug catastrophe that looms over our world. The moral crusade of past decades demonstrably does not work; what about practicing a "radical empathy" that doesn't demonize users and use slash and burn techniques to eliminate drugs, but seeing every life as valuable and seeking to minimize harm to those lives? A question worth asking, and this book explores it thoroughly.