Resistance to harm reduction initiatives, and to legalisation or decriminalisation of drug use, stems from many impulses. Here I will discuss just one: an expectation placed upon the addicted.
They are expected to live up to a conception of autonomy, perhaps liberation, the violation of which offends the sensibilities of persons with strong views on what people should be. If someone were to function properly with the aid of certain chemicals, many would prefer to see that person do it without such help - and even to jeopardise that individual's wellbeing, along with the wellbeing of those close to that person - in hopes of creating the "right" kind of person out of him.
Leaving aside that this is akin to taking away someone's wheelchair or hearing aid in the belief that there is only one acceptable way for humans to move or to listen, this column is about expectations that our civilisation has been thrusting upon people for some two hundred years. The efforts got really brutal in the early twentieth century when prohibition of alcohol and other drugs was invoked.
The issue could be framed this way: are addicts, and other citizens, duty bound to live up to the expectations of others? If so, when? I would say that it's a duty insofar as they are expected not to rob or assault their neighbours and to be productive if they are able. If such duties have been met, they should not feel duty bound to live up to someone's idea about what "truly free" people must "really" be like.
Often, it comes down to just that. Preachy questions - is this or that type of maintenance a real solution? - presume a lot. First, the meaning of real. Second, that life is about final solutions rather than manageable realities (which in fact are much more common).
It was in the late eighteenth and early nineteenth centuries that compulsive substance use of all kinds became a major target. An emerging culture of autonomy had a lot to do with it. People were not considered free if they could not control themselves. So their lack of freedom required scrutiny, leading to the ascendency of the notion of addiction still current today. Though much good certainly came out of these inquiries in the form of legitimate attention to real life issues, there was also a great deal of preachy interloping that caused far more harm than good. Alcohol prohibition in the early twentieth century is one example of social do-gooders running amuck. This was soon reversed. Only because fewer individuals used the other newly illicit drugs were the other (equally unsound) prohibitory statutes not so obviously flawed. It took a few decades to throw them into serious question, so by the 1960s strong challenges had begun to take shape.
Rather than go through all the history and politics, I will simply ask you to consider: When someone has a problem with yelling or verbal abuse and has improved considerably, we are unlikely to ask: how long have you been off yelling completely? Most people understand that gradual reduction of such behaviour is laudable, and that one unpleasant episode last week does not invalidate the person's efforts. Could we not apply the same grassroots wisdom to cocaine and heroin? Yelling is a nastier behaviour than getting high, yet we don't put the person in jail for it.
So what led us to incarcerate people, even for the simple possession of a drug? We live in a world where people are expected to live up to many ideals. Rousseau himself envisioned a time when all person's would be "forced to be free". No matter how silly that sounds, it is happening all over the West as I write these words.
Why not let each individual decide just how "free" he or she wishes to be? Many oppose harm reduction, long-term maintenance of any kind, and all types of drug use because they believe that all addicts can, and should, do better. Leaving aside the meaning of "better", many addicts themselves might not consider it their duty to live up the expectations of certain well-meaning (though annoying and preachy) souls.
Here is a paradox our civilisation must confront: we sincerely want our citizens to be free, and have become willing to lock them up to this end. No matter how laudable the original impulse, there is such as thing as going too far with a high ideal. Our dealings with addiction starting in the early twentieth century offer an excellent example.