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Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction
From “one of the bravest, smartest writers about addiction anywhere” (Johann Hari, New York Times bestselling author)—the untold story of harm reduction, a surprisingly simple idea with enormous power
Drug overdoses now kill more Americans annually than guns, cars or breast cancer. But we have tried to solve this national crisis with policies that only made matters worse. In the name of “sending the right message,” we have maximized the spread of infectious disease, torn families apart, incarcerated millions of mostly Black and Brown people—and utterly failed to either prevent addiction or make effective treatment for it widely available.
There is another way, one that is proven to work. However, it runs counter to much of the received wisdom of our criminal and medical industrial complexes. It is called harm reduction. Developed and championed by an outcast group of people who use drugs and by former users and public health geeks, harm reduction offers guidance on how to save lives and improve health. And it provides a way of understanding behavior and culture that has relevance far beyond drugs.
In a spellbinding narrative rooted in an urgent call to action, Undoing Drugs tells the story of how a small group of committed people changed the world, illuminating the power of a great idea. It illustrates how hard it can be to take on widely accepted conventional wisdom—and what is necessary to overcome this resistance. It is also about how personal, direct human connection and kindness can inspire profound transformation. Ultimately, Undoing Drugs offers a path forward—revolutionizing not only the treatment of addiction, but also our treatment of behavioral and societal issues.
Drug overdoses now kill more Americans annually than guns, cars or breast cancer. But we have tried to solve this national crisis with policies that only made matters worse. In the name of “sending the right message,” we have maximized the spread of infectious disease, torn families apart, incarcerated millions of mostly Black and Brown people—and utterly failed to either prevent addiction or make effective treatment for it widely available.
There is another way, one that is proven to work. However, it runs counter to much of the received wisdom of our criminal and medical industrial complexes. It is called harm reduction. Developed and championed by an outcast group of people who use drugs and by former users and public health geeks, harm reduction offers guidance on how to save lives and improve health. And it provides a way of understanding behavior and culture that has relevance far beyond drugs.
In a spellbinding narrative rooted in an urgent call to action, Undoing Drugs tells the story of how a small group of committed people changed the world, illuminating the power of a great idea. It illustrates how hard it can be to take on widely accepted conventional wisdom—and what is necessary to overcome this resistance. It is also about how personal, direct human connection and kindness can inspire profound transformation. Ultimately, Undoing Drugs offers a path forward—revolutionizing not only the treatment of addiction, but also our treatment of behavioral and societal issues.
384 pages, Hardcover
Published July 27, 2021
267 people are currently reading
6033 people want to read
About the author
Maia Szalavitz
20 books264 followersMaia Szalavitz is an award-winning author and journalist who covers addiction and neuroscience. Her next book, Unbroken Brain (St. Martins, April, 2016), uses her own story of recovery from heroin and cocaine addiction to explore how reframing addiction as a developmental disorder could revolutionize prevention, treatment and policy.
She's the author or co-author of six previous books, including the bestselling The Boy Who Was Raised as a Dog (Basic, 2007) and Born for Love: Why Empathy Is Essential-- and Endangered (Morrow, 2010), both with leading child psychiatrist and trauma expert Bruce D. Perry, MD, PhD.
Her book, Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids, is the first history of systemic abuse in "tough love" programs and rehabs and helped spur Congressional hearings, GAO investigations and proposed legislation to regulate these groups. She also co-wrote the first evidence-based consumer guide to addiction treatment, Recovery Options: The Complete Guide, with Joe Volpicelli, MD, PhD. (Wiley, 2000).
Currently, she writes a bi-weekly column for VICE on drugs and addiction. From 2010 to 2013, she wrote daily for TIME.com and she continues to freelance there and for other publications including the New York Times, Scientific American Mind, Nature, New York Magazine online, Pacific Standard, Matter, Nautilus, and The Verge.
Szalavitz has won major awards from organizations like the American Psychological Association, the Drug Policy Alliance and the American College of Neuropsychopharmacology in recognition of her work in these areas.
She lives in New York with her husband and a Siamese shelter cat.
She's the author or co-author of six previous books, including the bestselling The Boy Who Was Raised as a Dog (Basic, 2007) and Born for Love: Why Empathy Is Essential-- and Endangered (Morrow, 2010), both with leading child psychiatrist and trauma expert Bruce D. Perry, MD, PhD.
Her book, Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids, is the first history of systemic abuse in "tough love" programs and rehabs and helped spur Congressional hearings, GAO investigations and proposed legislation to regulate these groups. She also co-wrote the first evidence-based consumer guide to addiction treatment, Recovery Options: The Complete Guide, with Joe Volpicelli, MD, PhD. (Wiley, 2000).
Currently, she writes a bi-weekly column for VICE on drugs and addiction. From 2010 to 2013, she wrote daily for TIME.com and she continues to freelance there and for other publications including the New York Times, Scientific American Mind, Nature, New York Magazine online, Pacific Standard, Matter, Nautilus, and The Verge.
Szalavitz has won major awards from organizations like the American Psychological Association, the Drug Policy Alliance and the American College of Neuropsychopharmacology in recognition of her work in these areas.
She lives in New York with her husband and a Siamese shelter cat.
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June 22, 2022
This review is going to be slightly different to the others here, which mostly seem to be written by people working in the substance abuse field - who are familiar with the idea of harm reduction. This book deals with this history of harm reduction, and how the concept has risen to prominence in recent years - and this is discussed very well in the other reviews.
I on the other hand knew very little about harm reduction when I read this book, and my review is going to be more about my own awakening to this topic.
To start off with the fragments I have picked up over the last few years.... First of all I read Good Cop Bad War, by Neil Woods, who worked in the police as an undercover agent, attempting to catch drug dealers. He became wholly disillusioned with the way we treat drug issues in this country, and eventually became chairman of LEAP UK, which stands for 'Law Enforcement Against Prohibition', which campaigns the decriminalization of drugs.
Then I read bits in the papers about what Portugal had done to decriminalize drugs, and their efforts to help people with substance issues, rather than prosecute them. I'd also heard that Switzerland had some good practises.
Harm reduction techniques I learnt about from this book:
Needle exchanges:
These provide sterile needles and syringes, and a place to throw away dirty equipment.
Prescribing thiamine (B1):
Heavy drinkers often have thiamine deficiency which causes a variety of problems.
Distribution of Naloxone:
This is the drug that reverses overdoses from opioids. It used only to be available in hospitals and ambulances, but in most states it can now be purchased over the counter by anyone.
Overdose prevention sites:
These are sites where people can inject illegal substances a) with sterile equipment and b) where there are people who can step in if someone overdoses.
Fentanyl test strips:
These are strips which can be used to test various drugs before people consume them, to ensure they haven't been adulterated with Fentanyl. (Fentanyl is 50 to 100% more potent than morphine, and people overdose much more quickly with Fentanyl - making it a lot more difficult to bring them round.)
Medication assisted therapy:
Meds like Acamprosate, antabuse, or Naltrexone - to help people give up or reduce their problem substances, or, in the case of the methadone or suboxone - to basically help people get off heroin, and keep them functioning on an even keel.
Nicotine patches, gums and lozenges, or in Sweden - snus - an oral form of nicotine:
All these help people who want to reduce smoking cigarettes. (Sweden now has the lowest rate of smoking in Europe, and the lowest rate of lung cancer in men.) Vaping is another great harm reduction option for smokers, although many people feel concerns about its use.
Accommodation for people who are still actively using an illegal substance, or have a problematic relationship with alcohol:
Getting accommodation makes a huge difference to these people's lives, and goes a long way towards helping people reduce or even give up their substance abuse. For instance expecting someone with a drinking problem to reduce or give up their drinking whilst sleeping rough on the streets, isn't really feasible.
The book also stresses that the philosophy of harm reduction is different to the usual goal of abstinence, (although that outcome would always be welcomed.)
"The goal of a 'war on drugs' is simply stopping substance use; In contrast, the goal of harm reduction is making people's lives healthier and better, regardless of their choice to take or not take substances..."
The book also mentions how legislation has impacted the lives of people convicted of drug related issues.
"In addition to driving mass incarceration, the legislation piled on all sorts of additional penalties. It banned people convicted of drug crimes from getting student loans. It cut them off from many welfare benefits and food stamps. It required eviction, and later laws permanently prohibited the return of anyone to public housing if they had previously used or sold drugs or even simply failed to prevent drug activity in their home. This often meant that parents could not visit their own children, even if no one had taken illegal drugs for years. It also led to homelessness for many formerly incarcerated people. Rapists and murderers could sometimes be forgiven—but not people who used or sold drugs. These laws didn’t just criminalize and stigmatize drug users: they created overwhelming obstacles to recovery at every turn by reducing opportunities for employment, education, and housing. Since the Reagan era, (there have been) literally tens of
thousands of different restrictions barring people convicted of various drug crimes."
Basically harm reduction is a movement to improve the quality of life of everyone with a substance abuse problem. "'Any positive change' could be using a clean needle, it could be getting a job, it could be going back to school or trying a new antidepressant. It could even be abstinence. But what counts as progress toward getting better is determined by the people who are trying to improve their own lives—not counsellors or cops."
For those of us not familiar with these ideas, I think they can seem very counter intuitive. For me, by far the most enlightening example of harm reduction was a video I first saw several years ago, about a home for people with chronic alcohol problems, run by The Shepherds of Good Hope, in Ottawa. I still think it is an outstanding video on this subject.
https://www.youtube.com/watch?v=3KleS...
I will end by citing some of the organisations listed in the book, which have websites which I found interesting and illuminating.
Chicago Recovery Alliance Service
https://anypositivechange.org/
Housing Works (Provides housing for people with AIDS, including for those who are using illegal substances)
https://www.housingworks.org/
Harm Reduction International
https://www.hri.global/
National Harm Reduction Coalition
https://harmreduction.org/
Drug Policy Alliance
https://drugpolicy.org/
Obviously this is a book for people with an interest in this area. I personally wanted to learn more about harm reduction, and I though it was an excellent read.
I on the other hand knew very little about harm reduction when I read this book, and my review is going to be more about my own awakening to this topic.
To start off with the fragments I have picked up over the last few years.... First of all I read Good Cop Bad War, by Neil Woods, who worked in the police as an undercover agent, attempting to catch drug dealers. He became wholly disillusioned with the way we treat drug issues in this country, and eventually became chairman of LEAP UK, which stands for 'Law Enforcement Against Prohibition', which campaigns the decriminalization of drugs.
Then I read bits in the papers about what Portugal had done to decriminalize drugs, and their efforts to help people with substance issues, rather than prosecute them. I'd also heard that Switzerland had some good practises.
Harm reduction techniques I learnt about from this book:
Needle exchanges:
These provide sterile needles and syringes, and a place to throw away dirty equipment.
Prescribing thiamine (B1):
Heavy drinkers often have thiamine deficiency which causes a variety of problems.
Distribution of Naloxone:
This is the drug that reverses overdoses from opioids. It used only to be available in hospitals and ambulances, but in most states it can now be purchased over the counter by anyone.
Overdose prevention sites:
These are sites where people can inject illegal substances a) with sterile equipment and b) where there are people who can step in if someone overdoses.
Fentanyl test strips:
These are strips which can be used to test various drugs before people consume them, to ensure they haven't been adulterated with Fentanyl. (Fentanyl is 50 to 100% more potent than morphine, and people overdose much more quickly with Fentanyl - making it a lot more difficult to bring them round.)
Medication assisted therapy:
Meds like Acamprosate, antabuse, or Naltrexone - to help people give up or reduce their problem substances, or, in the case of the methadone or suboxone - to basically help people get off heroin, and keep them functioning on an even keel.
Nicotine patches, gums and lozenges, or in Sweden - snus - an oral form of nicotine:
All these help people who want to reduce smoking cigarettes. (Sweden now has the lowest rate of smoking in Europe, and the lowest rate of lung cancer in men.) Vaping is another great harm reduction option for smokers, although many people feel concerns about its use.
Accommodation for people who are still actively using an illegal substance, or have a problematic relationship with alcohol:
Getting accommodation makes a huge difference to these people's lives, and goes a long way towards helping people reduce or even give up their substance abuse. For instance expecting someone with a drinking problem to reduce or give up their drinking whilst sleeping rough on the streets, isn't really feasible.
The book also stresses that the philosophy of harm reduction is different to the usual goal of abstinence, (although that outcome would always be welcomed.)
"The goal of a 'war on drugs' is simply stopping substance use; In contrast, the goal of harm reduction is making people's lives healthier and better, regardless of their choice to take or not take substances..."
The book also mentions how legislation has impacted the lives of people convicted of drug related issues.
"In addition to driving mass incarceration, the legislation piled on all sorts of additional penalties. It banned people convicted of drug crimes from getting student loans. It cut them off from many welfare benefits and food stamps. It required eviction, and later laws permanently prohibited the return of anyone to public housing if they had previously used or sold drugs or even simply failed to prevent drug activity in their home. This often meant that parents could not visit their own children, even if no one had taken illegal drugs for years. It also led to homelessness for many formerly incarcerated people. Rapists and murderers could sometimes be forgiven—but not people who used or sold drugs. These laws didn’t just criminalize and stigmatize drug users: they created overwhelming obstacles to recovery at every turn by reducing opportunities for employment, education, and housing. Since the Reagan era, (there have been) literally tens of
thousands of different restrictions barring people convicted of various drug crimes."
Basically harm reduction is a movement to improve the quality of life of everyone with a substance abuse problem. "'Any positive change' could be using a clean needle, it could be getting a job, it could be going back to school or trying a new antidepressant. It could even be abstinence. But what counts as progress toward getting better is determined by the people who are trying to improve their own lives—not counsellors or cops."
For those of us not familiar with these ideas, I think they can seem very counter intuitive. For me, by far the most enlightening example of harm reduction was a video I first saw several years ago, about a home for people with chronic alcohol problems, run by The Shepherds of Good Hope, in Ottawa. I still think it is an outstanding video on this subject.
https://www.youtube.com/watch?v=3KleS...
I will end by citing some of the organisations listed in the book, which have websites which I found interesting and illuminating.
Chicago Recovery Alliance Service
https://anypositivechange.org/
Housing Works (Provides housing for people with AIDS, including for those who are using illegal substances)
https://www.housingworks.org/
Harm Reduction International
https://www.hri.global/
National Harm Reduction Coalition
https://harmreduction.org/
Drug Policy Alliance
https://drugpolicy.org/
Obviously this is a book for people with an interest in this area. I personally wanted to learn more about harm reduction, and I though it was an excellent read.
July 17, 2025
4/5 stars ⭐️
This was a required reading for my graduate advanced clinical behavioral health program and I’m really glad I read it!
Undoing Drugs by Maia Szalavitz is a MUST read for anyone in the helping professions, especially those working in social services, public health, or social work. I honestly ended up really enjoying it.
The book dives deep into the history and evolution of harm reduction, breaking down how outdated and critical drug policies have harmed people, especially those already vulnerable due to systemic racism, classism, and other forms of oppression. Maia Szalavitz does a great job balancing storytelling, research, and advocacy. She challenges stigma around drug use and emphasizes the importance of treating people with dignity and compassion, not judgment.
I came away from this book having learned a lot, not just about harm reduction itself, but about how drug policy is directly tied to structural oppression in the U.S. It gave me a much broader and more critical lens on addiction, recovery, and what it truly means to support someone where they’re at.
Highly recommend this book to anyone in or entering a helping field. It’s informative, compassionate, and challenges everything society has taught people in a powerful way.
This was a required reading for my graduate advanced clinical behavioral health program and I’m really glad I read it!
Undoing Drugs by Maia Szalavitz is a MUST read for anyone in the helping professions, especially those working in social services, public health, or social work. I honestly ended up really enjoying it.
The book dives deep into the history and evolution of harm reduction, breaking down how outdated and critical drug policies have harmed people, especially those already vulnerable due to systemic racism, classism, and other forms of oppression. Maia Szalavitz does a great job balancing storytelling, research, and advocacy. She challenges stigma around drug use and emphasizes the importance of treating people with dignity and compassion, not judgment.
I came away from this book having learned a lot, not just about harm reduction itself, but about how drug policy is directly tied to structural oppression in the U.S. It gave me a much broader and more critical lens on addiction, recovery, and what it truly means to support someone where they’re at.
Highly recommend this book to anyone in or entering a helping field. It’s informative, compassionate, and challenges everything society has taught people in a powerful way.
May 30, 2025
A fascinating and emotionally compelling journalistic recounting of the harm reduction movement, in relation to the politics surrounding drug use and addiction. Tracing the consequences of the war on drugs and its opposition to harm reduction practices and initiatives, Undoing Drugs compassionately tells the stories of users, former users, and the activists researchers doctors philanthropists law practitioners who’ve shaped harm reduction into what it is today. The history of drug policy and present day drug policy and their devastating impact on families and communities is horrifying and tragic, but Szalavitz manages to bring hope and light to this entire story. From the HIV/AIDs movement to the COVID-19 pandemic, this book is a fascinating journalistic history of harm reduction activism in the face of abstinence only, “tough love”, war on drugs dehumanization of drug users. Highly recommend reading this! You will undoubtably learn a lot!!
4.5 stars because there was a little too much liberalism for my liking but many such cases
4.5 stars because there was a little too much liberalism for my liking but many such cases
September 18, 2021
I am not a book reviewer; I am a professor. I teach courses on substance use and dependence. My courses follow the arc of prevention, harm reduction, treatment and recovery while highlighting stigma and discrimination around use and criminalization of drugs and people who use them.
Before reading Undoing Drugs by Maia Szalavitz Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, I emphasized harm reduction and made it the focus of a final assignment, but I didn’t see that harm reduction is not a section to teach, it is a concept to infuse throughout the course.
Before reading this book, I struggled when teaching about treatment and recovery because I knew it was flawed, but now I understand why - what the root problems are - and I will embrace and teach the concept of 'any positive change' with alacrity. And though I had taught that enabling was not a bad thing and that tough love was, after reading the chapter on Undoing Tough Love, I can say 'this is why tough love is wrong and here is what can be done instead'. Indeed, the book is filled with 'what we can do instead moments' and I recommend it to anyone who cares about the topic of substance use and the racist unscientific drug war that casts its reach around it.
I’d add that the most impactful chapter, for me, is probably 17 -Undoing Pain Management. This chapter provides the reader with another viewpoint on the opioid crisis and how the view of doctors as over prescribers needs a closer look - Ms. Szalavitz offers that closer look - and the need to consider motivations as well as unintended consequences of 'reacting'. This chapter will be required reading for my classes.
So, I highly recommend this book while appreciating the history and the people behind the history as brought to life with the personal connections, detailed descriptions, humor, outrage and empathy of Maia Szalavitz.
Before reading Undoing Drugs by Maia Szalavitz Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, I emphasized harm reduction and made it the focus of a final assignment, but I didn’t see that harm reduction is not a section to teach, it is a concept to infuse throughout the course.
Before reading this book, I struggled when teaching about treatment and recovery because I knew it was flawed, but now I understand why - what the root problems are - and I will embrace and teach the concept of 'any positive change' with alacrity. And though I had taught that enabling was not a bad thing and that tough love was, after reading the chapter on Undoing Tough Love, I can say 'this is why tough love is wrong and here is what can be done instead'. Indeed, the book is filled with 'what we can do instead moments' and I recommend it to anyone who cares about the topic of substance use and the racist unscientific drug war that casts its reach around it.
I’d add that the most impactful chapter, for me, is probably 17 -Undoing Pain Management. This chapter provides the reader with another viewpoint on the opioid crisis and how the view of doctors as over prescribers needs a closer look - Ms. Szalavitz offers that closer look - and the need to consider motivations as well as unintended consequences of 'reacting'. This chapter will be required reading for my classes.
So, I highly recommend this book while appreciating the history and the people behind the history as brought to life with the personal connections, detailed descriptions, humor, outrage and empathy of Maia Szalavitz.
August 9, 2021
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 reduce the harm 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 programs 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.
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 reduce the harm 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 programs 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.
July 22, 2021
I recently celebrated 9 years clean from an opioid addiction that almost killed me, and not only has the epidemic been going on since before I got clean, but thousands are still dying every year. I’m always looking for thoughts, research, and opinions on what we can do about this massive issue, which is why I was honored to receive an advanced copy of this new book from Maia Szalavitz. In this book, Maia not only explains the untold story of harm reduction, but she also makes solid arguments rooted in facts for why we need to end the war on drugs and decrease the stigma that surrounds those who have an addiction.
Most people don’t know what harm reduction is, and if they do, they think of it in a very black and white way, but people are dying. Maia shares some of her personal story about how she discovered what harm reduction was, and like most of us addicts, she wanted to know why more people didn’t know about this. Reducing harm is one of the best ways we can decrease deaths from drugs as well as the spread of infectious diseases. Maia explains how harm reduction started during the HIV/AIDS epidemic and how harm reduction has changed and evolved throughout the years.
With this book, you’ll get a clear picture of organizations and people who are trying to fight for laws that make harm reduction more normalized and accessible. You’ll also learn about all of the challenges and road blocks we face as we try to advocate for harm reduction. As someone who is completely abstinent from substances I don’t always 100% agree with the author on a couple arguments she makes, but I do agree with most of what Maia wrote in this book, and she even altered my opinions on some other issues. So, if you care about the addiction epidemic and what we can do to start saving lives, you need to get a copy of this book, and hopefully this helps some awareness.
Most people don’t know what harm reduction is, and if they do, they think of it in a very black and white way, but people are dying. Maia shares some of her personal story about how she discovered what harm reduction was, and like most of us addicts, she wanted to know why more people didn’t know about this. Reducing harm is one of the best ways we can decrease deaths from drugs as well as the spread of infectious diseases. Maia explains how harm reduction started during the HIV/AIDS epidemic and how harm reduction has changed and evolved throughout the years.
With this book, you’ll get a clear picture of organizations and people who are trying to fight for laws that make harm reduction more normalized and accessible. You’ll also learn about all of the challenges and road blocks we face as we try to advocate for harm reduction. As someone who is completely abstinent from substances I don’t always 100% agree with the author on a couple arguments she makes, but I do agree with most of what Maia wrote in this book, and she even altered my opinions on some other issues. So, if you care about the addiction epidemic and what we can do to start saving lives, you need to get a copy of this book, and hopefully this helps some awareness.
August 14, 2022
WOW mind blowing!!! Anyone who is interesting in how do we change drug policies/addiction treatment in the US to be compassionate and actually help people should read this. Also I was unfamiliar w the concept of harm reduction before this book and now I think it is brilliant and applicable in so many areas.
January 15, 2022
Every day, millions of people around the world choose to engage in behaviors that involve a certain amount of risk to themselves. After weighing the potential cost versus the guaranteed reward of their actions, they decide that the risk is worth it.
And every day, those same people take for granted the common sense measures that society has long since accepted as being part of a general harm reduction strategy to keep them as safe as possible while they engage in those behaviors.
Seat belts. Oven mitts. Reflective gear. Condoms. The list goes on.
Yet if harm reduction is already such a widely accepted practice across multiple areas of life in modern society, why have we been so slow to apply its wisdom to people who use drugs?
Sterile syringes. Overdose reversal medication. Testing strips. Non-racist drug policies.
Why does your mind immediately embrace one set of strategies as common sense while recoiling at the other? Why the stigma? Where does this resistance come from?
In her new book, Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, Maia Szalavitz will help you find the answer. In this groundbreaking work, she compiles the shocking and often heartbreaking history of the modern harm reduction movement, from the HIV epidemic of the 1980's to the 2020 outbreak of the COVID-19 pandemic.
According to the latest report from the Centers for Disease Control & Prevention (CDC), over 100,000 died last year from an accidental drug overdose in America. I knew some of those people myself. You probably did, too.
But in case you haven't been paying attention, let me put it to you straight: the War on Drugs is over, and drugs have won the fight. Not only has the Drug War failed to prevent unhealthy drug use and addiction, but it has heaped untold harm upon marginalized people groups all across the world.
Black, indigenous, people of color, sexual minorities, working-class Appalachians... again, the list goes on. You can lay all the blame you want on "Big Pharma," Chinese chemists, or Mexican cartels, but the paper trail leads farther back than that, ultimately landing you on the doorstep of our very own criminal justice system.
What can we do to stop the damage now? Well, we can start by listening to the voices of those marginalized people, many of whom have been crying out in the wilderness for a very long time. Maia Szalavitz has done us all a favor by telling the story of their collective history for the very first time.
You might not agree with me just yet, nor even think it to be a desirable goal, but harm reduction is the wave of future global drug policy. Just ask Portugal, the Netherlands, or the American state of Oregon. The Drug War might remain a formidable obstacle here at the start of 2022, but signs of its impending collapse are appearing everywhere on the horizon. There is a better way forward.
So please, for the love of God, read this book. No matter how many waves of drug policy reform may yet need to break in failure, the tide is sure to win.
And every day, those same people take for granted the common sense measures that society has long since accepted as being part of a general harm reduction strategy to keep them as safe as possible while they engage in those behaviors.
Seat belts. Oven mitts. Reflective gear. Condoms. The list goes on.
Yet if harm reduction is already such a widely accepted practice across multiple areas of life in modern society, why have we been so slow to apply its wisdom to people who use drugs?
Sterile syringes. Overdose reversal medication. Testing strips. Non-racist drug policies.
Why does your mind immediately embrace one set of strategies as common sense while recoiling at the other? Why the stigma? Where does this resistance come from?
In her new book, Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, Maia Szalavitz will help you find the answer. In this groundbreaking work, she compiles the shocking and often heartbreaking history of the modern harm reduction movement, from the HIV epidemic of the 1980's to the 2020 outbreak of the COVID-19 pandemic.
According to the latest report from the Centers for Disease Control & Prevention (CDC), over 100,000 died last year from an accidental drug overdose in America. I knew some of those people myself. You probably did, too.
But in case you haven't been paying attention, let me put it to you straight: the War on Drugs is over, and drugs have won the fight. Not only has the Drug War failed to prevent unhealthy drug use and addiction, but it has heaped untold harm upon marginalized people groups all across the world.
Black, indigenous, people of color, sexual minorities, working-class Appalachians... again, the list goes on. You can lay all the blame you want on "Big Pharma," Chinese chemists, or Mexican cartels, but the paper trail leads farther back than that, ultimately landing you on the doorstep of our very own criminal justice system.
What can we do to stop the damage now? Well, we can start by listening to the voices of those marginalized people, many of whom have been crying out in the wilderness for a very long time. Maia Szalavitz has done us all a favor by telling the story of their collective history for the very first time.
You might not agree with me just yet, nor even think it to be a desirable goal, but harm reduction is the wave of future global drug policy. Just ask Portugal, the Netherlands, or the American state of Oregon. The Drug War might remain a formidable obstacle here at the start of 2022, but signs of its impending collapse are appearing everywhere on the horizon. There is a better way forward.
So please, for the love of God, read this book. No matter how many waves of drug policy reform may yet need to break in failure, the tide is sure to win.
May 19, 2022
Actually 4.5 stars, but Goodreads is dumb.
I never thought I'd see a book about harm reduction in my local, rural library. But there it was, so I borrowed it without hesitation.
Undoing Drugs didn't teach me anything new concerning the philosophy or techniques of harm reduction, but it was really cool and informative to read about its history. I'm a fan of the fact that the author, Maia Szalavitz is a former drug user who has been involved in the movement for decades. It's obvious when the person writing is just a researcher and/or interested party. I with she would have spent more time on some of the smaller towns and less "known" people, but maybe I just need to have at least one thing to complain about.
I never thought I'd see a book about harm reduction in my local, rural library. But there it was, so I borrowed it without hesitation.
Undoing Drugs didn't teach me anything new concerning the philosophy or techniques of harm reduction, but it was really cool and informative to read about its history. I'm a fan of the fact that the author, Maia Szalavitz is a former drug user who has been involved in the movement for decades. It's obvious when the person writing is just a researcher and/or interested party. I with she would have spent more time on some of the smaller towns and less "known" people, but maybe I just need to have at least one thing to complain about.
April 5, 2023
More like 3.5 ⭐️ for me this is an incredibly thorough coverage of the harm reduction and addiction subject, but it’s really dense and not particularly propelling from a reading perspective. So my desire to read was little to none. I powered through it, but I didn’t really enjoy the process.
I can recommend this though because it’s very educational especially if you’re in the market to widen your compassion and understanding of addicts as well as to learn really useful tools to further your ability to aid folks harm reduce.
I can recommend this though because it’s very educational especially if you’re in the market to widen your compassion and understanding of addicts as well as to learn really useful tools to further your ability to aid folks harm reduce.
July 9, 2023
Szalavitz is really good at interweaving stories about people in with statistics.
Harm reduction (as I believe Szalavitz mentions) is just so effing rational to me. It has always confounded me how many homeless shelters require that people are clean before they receive service. Being unhoused, in my mind, should always be the top priority. However, this book challenged me in many ways as it confronted a number of experiences I have had with babies born addicted or encountering severe neglect as I have sat with many, many kids in some of their shittiest moments. Parents too. Yet, as I read through this book I couldn't help but think about how integral economic justice and community care are to harm reduction. If we focused more of our policies on creating schools as resource hubs, mandating living wages and more we would see more opportunities for people to thrive not just survive. Even beyond that, if we had a culture shift in the way we view others and how we approach conflict and what we truly value in life. I've been questioned before about a few people in my life who are concerned about another person in our life using one substance or the other too much and my response is always that the substance use is not the problem if anything it is a symptom of something larger. There is a greater stressor that we should be focusing on.
I didn't expect to find so much of my own life in this book. It made me think about the therapists in my life who have been harm reductionists for me... those therapists are often the ones who helped me the most. When I was younger and recognizing my struggle with alcohol my therapist suggest asking for a glass of water at the bar in-between every drink. My most recent therapist worked with me on finding better coping skills and was one of the first therapeutic/medical professionals I felt comfortable talking about illegal drug use with. The nurse practitioner in charge of prescribing medication to me didn't tell me to stop smoking weed she said among many of her peers she was one of the few who recognized its value and in turn suggested I mix in a CBD only flower with my THC flower. I didn't realize that what made these interactions and what helped me make better decisions about my life and moved me away from shame (compared to some of my other experiences in therapy) is harm reduction.
Anyways, this book is a really great history of this cool fucking movement that grew from people who simply gave a fuck about other people... and it also lays out the evidence for policies that center healing and autonomy over criminalization. I do wish that Szalavitz maybe went a little bit more into some of the duality of things. Many of the people in the movement died from overdose and there are a few times where people acknowledge the harm that drugs have had on their lives which I wish there was more discussion around. I have empathy for the the people in my life who are struggling with substance use (around the harm that they experienced not making a judgment on choosing to use substances or maybe I am, I just mean understanding why the substance use is happening like it is okay to want to relieve suffering and also to want to experience joy) but also recognize that the substance use has caused or is causing a lot of harm to other people in their lives. But lots of other shit in our lives causes harm too. There were also times where Szalavitz slightly virtue signaled for lack of a better phrase or maybe its more like utilized the act of calling something "cool" and "uncool" to make a point at times.
This review is way longer than intended... but I appreciate the way this book made me think, especially about my own relationship to drugs and the conditioning that bubbles up when I think about how to approach treating substance use. I do wonder where motivational interviewing comes into play with substance use because I remember when I had to be trained in it in grad school because some of our professors were leading some of the studies being done that it felt disingenuous in some ways because you (the therapist or professional) can become the one who driving the change... although it is a big step from where addiction treatment has been. Okay I'm rambling now.......
People should read this book! Svalavitz has a lot to say and harm reduction drug policy can tell us a lot about strategies for policy making in other arenas.
Harm reduction (as I believe Szalavitz mentions) is just so effing rational to me. It has always confounded me how many homeless shelters require that people are clean before they receive service. Being unhoused, in my mind, should always be the top priority. However, this book challenged me in many ways as it confronted a number of experiences I have had with babies born addicted or encountering severe neglect as I have sat with many, many kids in some of their shittiest moments. Parents too. Yet, as I read through this book I couldn't help but think about how integral economic justice and community care are to harm reduction. If we focused more of our policies on creating schools as resource hubs, mandating living wages and more we would see more opportunities for people to thrive not just survive. Even beyond that, if we had a culture shift in the way we view others and how we approach conflict and what we truly value in life. I've been questioned before about a few people in my life who are concerned about another person in our life using one substance or the other too much and my response is always that the substance use is not the problem if anything it is a symptom of something larger. There is a greater stressor that we should be focusing on.
I didn't expect to find so much of my own life in this book. It made me think about the therapists in my life who have been harm reductionists for me... those therapists are often the ones who helped me the most. When I was younger and recognizing my struggle with alcohol my therapist suggest asking for a glass of water at the bar in-between every drink. My most recent therapist worked with me on finding better coping skills and was one of the first therapeutic/medical professionals I felt comfortable talking about illegal drug use with. The nurse practitioner in charge of prescribing medication to me didn't tell me to stop smoking weed she said among many of her peers she was one of the few who recognized its value and in turn suggested I mix in a CBD only flower with my THC flower. I didn't realize that what made these interactions and what helped me make better decisions about my life and moved me away from shame (compared to some of my other experiences in therapy) is harm reduction.
Anyways, this book is a really great history of this cool fucking movement that grew from people who simply gave a fuck about other people... and it also lays out the evidence for policies that center healing and autonomy over criminalization. I do wish that Szalavitz maybe went a little bit more into some of the duality of things. Many of the people in the movement died from overdose and there are a few times where people acknowledge the harm that drugs have had on their lives which I wish there was more discussion around. I have empathy for the the people in my life who are struggling with substance use (around the harm that they experienced not making a judgment on choosing to use substances or maybe I am, I just mean understanding why the substance use is happening like it is okay to want to relieve suffering and also to want to experience joy) but also recognize that the substance use has caused or is causing a lot of harm to other people in their lives. But lots of other shit in our lives causes harm too. There were also times where Szalavitz slightly virtue signaled for lack of a better phrase or maybe its more like utilized the act of calling something "cool" and "uncool" to make a point at times.
This review is way longer than intended... but I appreciate the way this book made me think, especially about my own relationship to drugs and the conditioning that bubbles up when I think about how to approach treating substance use. I do wonder where motivational interviewing comes into play with substance use because I remember when I had to be trained in it in grad school because some of our professors were leading some of the studies being done that it felt disingenuous in some ways because you (the therapist or professional) can become the one who driving the change... although it is a big step from where addiction treatment has been. Okay I'm rambling now.......
People should read this book! Svalavitz has a lot to say and harm reduction drug policy can tell us a lot about strategies for policy making in other arenas.
April 11, 2025
as someone who was rather precociously fixated on addiction in my adolescence, this book made me realize how little i have actually known about harm reduction. it pushed me to challenge my previous understanding of addiction recovery as necessarily abstinence based and deeply expanded my understanding of harm reduction beyond overdose reversals and access to clean needles.
“as always, we need to start with the essence of harm reduction, which is compassion and respect for the inherent dignity and value of human life. at a bare minimum, policies to change risky behavior cannot be more harmful than the behavior they seek to alter; we can’t continue to hurt people in the aid of helping them or others.”
it was interesting to notice in myself that the tenants of harm reduction are so simple and ethical when spelled out but can feel so hard to swallow when framed as potentially “enabling” addiction and drug use.
some chapters felt a little bit repetitive but i appreciated all the information that was included, especially about pain treatment. ultimately i am grateful for the opportunity to really rethink something that i have spent so much time learning and thinking about and thought i really understood.
“as always, we need to start with the essence of harm reduction, which is compassion and respect for the inherent dignity and value of human life. at a bare minimum, policies to change risky behavior cannot be more harmful than the behavior they seek to alter; we can’t continue to hurt people in the aid of helping them or others.”
it was interesting to notice in myself that the tenants of harm reduction are so simple and ethical when spelled out but can feel so hard to swallow when framed as potentially “enabling” addiction and drug use.
some chapters felt a little bit repetitive but i appreciated all the information that was included, especially about pain treatment. ultimately i am grateful for the opportunity to really rethink something that i have spent so much time learning and thinking about and thought i really understood.
September 18, 2024
Amazing history on harm reduction and drug policy in America made easy to digest and a very interesting read. Szalavitz did a wonderful job collecting personal histories to depict a wide array of how people can be affected by addiction or harmful drug policy. No previous knowledge on drugs or addiction required, and if you have previous knowledge she helps you question where that knowledge came from and what agenda it might serve. I would encourage anyone to read this book regardless of if they work in these fields or not.
August 15, 2024
Before starting this book, I sheepishly thought I wouldn’t learn much, that it would only cover the basics of what I already know about harm reduction. I was very much wrong! There is A LOT to learn here; I recommend strongly to anyone who is vaguely interested in learning more about the history and present day reality of this movement. It was surreal to be in the same neighborhood that’s described as the first area in New York to start a needle exchange. How things have changed, for the better and the worse.
I feel more equipped with sound arguments against the Reagan-dosed opposers to harm reduction practices now.
I feel more equipped with sound arguments against the Reagan-dosed opposers to harm reduction practices now.
August 1, 2022
This extensive history of harm reduction was thorough and illuminating. The author actively discusses the racism inherent in the war on drugs, the unscientific reasonings behind drug policies, and the quantifiable impacts that harm reduction has had on people’s lives.
May 20, 2023
Takeaways:
- Harm reduction is a great example of perfection being the enemy of good. We look for best case scenario when settling for good instead still saves lives.
- I like the idea of recovery as “any positive change” and not a blanket “complete sobriety”
- If you don’t deeply care about someone with chemical dependency, you should not be in charge of policy making for them
- Naloxone needs to be widely available and non prescription - “dead addicts don’t recover”
- Harm reduction is a great example of perfection being the enemy of good. We look for best case scenario when settling for good instead still saves lives.
- I like the idea of recovery as “any positive change” and not a blanket “complete sobriety”
- If you don’t deeply care about someone with chemical dependency, you should not be in charge of policy making for them
- Naloxone needs to be widely available and non prescription - “dead addicts don’t recover”
February 11, 2025
Had to read this book for class but actually really really enjoyed it and highly recommend to anybody in social work/public health or just interested in harm reduction/substance use
April 26, 2023
An incredibly researched book, outlining the full history of harm reduction practices (mostly in the US, but some international). I will note this is a frustrating read because it highlights how many lives have been unnecessarily lost due to systemic stigma towards substance use. Took me a long time to get through the book given the clinical and political nature…not exactly a fun beach read. Plus, when you handle such things at work, it can be hard to convince yourself to dive into these heavy topics on evenings and weekends.
April 30, 2022
Absolutely loved this book. I work professionally with folks strongly affected by substance use - mostly chaotic, street use. Harm reduction is absolutely a passion and philosophy of mine in my work and personal life, and I learned so much about the history of its emergence and development in this book. Considering most everyone's lives are affected by substance use in some way by themselves or a loved one, I think this is a necessary read to best understand a different way of looking at substance use that is actually scientific - one that empowers people instead of shaming, reduces harm/trauma instead of inducing it, saves lives instead of costing them, fosters a variety of pathways to recovery instead of one all/nothing track, and much more!
July 30, 2022
5/5 stars. So well done.
Things I really liked:
- Szalavitz continually interrogates the tension between users/ former users/ non-users in the harm reduction workplace. It isn't just a chapter or footnote, but continual discussion with the input and perspective of both active and former users.
- Even as a white author, Szalavitz does not shy away from discussing race. This shouldn't be unusual, but honestly it's hard to find a white author who acknowledges the racial aspect of literally *everything* instead of trying to shirk the topic.
- Light on author's personal opinions and story, heavy on interview data, research, and very well cited. Tons of opportunities for further reading.
Some notes: I read this at a *really* weird time, watching close friends navigate a local harm reduction space to access medical & detox services. A lot of what I saw with them tracked so closely to what I was reading. It took me a long while to get through this book, even though typically this is something I'd devour in a few days. I guess because this stuff is really exhausting.
Things I really liked:
- Szalavitz continually interrogates the tension between users/ former users/ non-users in the harm reduction workplace. It isn't just a chapter or footnote, but continual discussion with the input and perspective of both active and former users.
- Even as a white author, Szalavitz does not shy away from discussing race. This shouldn't be unusual, but honestly it's hard to find a white author who acknowledges the racial aspect of literally *everything* instead of trying to shirk the topic.
- Light on author's personal opinions and story, heavy on interview data, research, and very well cited. Tons of opportunities for further reading.
Some notes: I read this at a *really* weird time, watching close friends navigate a local harm reduction space to access medical & detox services. A lot of what I saw with them tracked so closely to what I was reading. It took me a long while to get through this book, even though typically this is something I'd devour in a few days. I guess because this stuff is really exhausting.
November 8, 2022
As someone who lived a small chapter of the story told in this book, I was keen to finally have the time to sit down and read Maia Szalavitz's account of harm reduction (in the U.S.) from cover to cover. A fantastic writer, Szalavitz draws on her own decades-long engagement with harm reduction as an independent journalist, a fellow-traveler of the movement, and as a person in recovery. The book offers detailed accounts of harm reduction's many key episodes, mapping the movement and personal connections that become the material of any transformative struggle. At its heart, Undoing Drugs is an account of the movement to resist the racist War on Drugs. The book rightly situations that resistance at the center of any narrative about the movement and any definition of harm reduction. It can't be overstated how important that intervention is at a moment when the Democratic Party has sought to recruit harm reduction into the state control of working-class and poor people, claiming that there is no contradiction between harm reduction and the fundamentally racist war on drugs.
With each chapter in the book dedicated to a different moment in the history of U.S. harm reduction and its colorful and passionate protagonists, the book introduces us to a remarkable cast of characters. It's a remarkable experience to read accounts of events that I either knew about at the time or was a participant. But more exciting was to hear more details and connections, making the familiar unfamiliar to me. The effect of this was often deeply moving such as the account of the ACT UP court battle to defend a group of needle exchange activists in the early '90s -- a legal battle that would have consequences for emboldening harm reductionists across the country, including us in Los Angeles.
But reading such an important book is also an opportunity to critique the way the story is told. Such a critique is by no means a call to reject or diminish the book's importance. The opposite. Any critique of a narrative is a way to ensure that the story get told again, expansively, and sharply in relationship to the current conjuncture (as mentioned above).
For one, reading Undoing Drugs raises the question of the political orientation of the person telling the story. What becomes clear to me in reading Undoing Drugs, is that the author has subtly adopted a political strategy for how one can fight against the war on drugs, that is, to highlight to role of often middle-class, professional, and connected people in weaving together a movement that becomes legible to politicians, public health officials, public health researchers, major funders, and even to a mostly white middle-America. Such an orientation is not the automatic position from which to tell a story. Furthermore, it is an orientation that can lead to profound distortions. One of the major distortions is the way harm reduction is seen as the work of activists and people with institutional connections.
For many of us in the movement, harm reduction was and continues to be the practices of extremely poor, mostly BIPOC, homeless people and sex workers who use drugs. Harm reduction is the practice of people creating a resistant form of community care in the very spaces that are extremely criminalized and policed. This, however, is not the story that Undoing Drugs tells. For that story, we need different texts like the recently published, Saving Our Own Lives from Shira Hassan, a text that explicitly counters the white liberal orientation of Undoing Drugs. The white liberal orientation consistently centers the do-goodism of people who have no larger political analysis of capitalism, no understanding of the intersection of racism and capitalism, and no larger anti-imperialist context. Why does that matter?
For one, if an understanding of the war on drugs is located in the larger context of racial capitalism, then we end up tell a very different story about how harm reduction begins, where it begins, and with whom. Locating harm reduction within a critical analysis of racial capitalism, underscore the connections between harm reduction the anti-racism and anti-capitalism of '70s revolutionary movements like the Black Panthers and Young Lords. That connection is embodied in community histories and the names of radical health organizers who began in the movement and have continued as self-avowed harm reductionists.
What happens when your political orientation in telling the story of harm reduction is fundamentally liberal; a belief that harm caused by the state can be merely corrected through policy reform with no attention to material basis of the state's actions. Thus, the protagonists that the book focusses on are reformers, mostly white middle class individuals who do the "real" political work of affecting policy. There's no space for the autonomous political capacity of poor people, but only the small adjustments that do not transform the larger conditions of class conflict in which the war on drugs is but a tactic.
Where we start a story matters. By minimizing the role of the capitalist state in regards to the social control of poor people, specifically poor POC, the narrative of harm reduction excludes the earlier struggles of revolutionary movements to resist the role of the state in using drugs to control people. Thus, there's no mention in Undoing Drugs of "the people's detox" movement as a preamble to harm reduction before white people responded o the war on drugs. thus, the whole narrative obscures the underlying theme of social control that links both imperialism and later the war on drugs. Both popular (like acupuncture) treatment and harm reduction as oriented towards police abolition.
This points to another fundamental absence; what is the material basis of the war on drugs? Later in the book, Szalavitz rightly credits Michelle Alexander's book, The New Jim Crow, as laying out the analysis that links the racist carceral system and the war on drugs. That analysis makes clear how harm reduction has always been a movement towards abolition. But what is the material basis of mass incarceration? What is the larger arc of capitalist crisis that makes the war on drugs a necessary strategy? What is the link between rising poverty, historic rates of wealth accumulation, and the neoliberalization of urban space under real estate capital? While Szalavitz's book is not one of political analysis, it's necessary to have some larger context.
But probably one of the more egregious errors in Undoing Drugs is the continual confusion between the terms decriminalization and legalization. The interchangeable use of these terms creates a number of problems in Szalavitz's narrative such as the term "full legalization" of marijuana. Here is where the analysis from the struggles to decriminalize sex work have been enormously helpful in how we talk about the law and illicit drugs or even the law and houselessness. Legalization means that there are still in place structures of control that make drugs, sex work, and homelessness legal under state-defined conditions. In contrast, decriminalization begins from the place that drugs, sex work and homelessness are inherently not criminalized. From there we can have public discussions about health access, treatment, worker rights, and housing with dignity.
There is also a tendency in Undoing Drugs for Szalavitz to oversell programs and policies without any in-depth critical analysis of what those programs look like on the ground. For example, it's dangerous to holds up Law-Enforcement Assisted Diversion (LEAD) programs as part of harm reduction or decriminalization, when, in practice they're part of a legalization framework where there are still harmful forms of control by the state. Szalavitz acknowledges that the programs aren't perfect. But it's important to explain those perfections, particularly at this moment of appropriation. The social controls and surveillance systems that are often aspects of diversion programs can be part and parcel to the reality that the services offered in diversion programs are still dominated by scarcity. Thus, community members experience these programs as an extension of carceral logics and not the necessary conditions of personal and community autonomy. Since Szalavitz describes diversion as a harm reduction reform of policing with regards to drug use and sex work, I would strongly suggest readers look at a book like Revolting Prostitutes or statements issued by the Philadelphia-based Sex Worker political group Project Safe for rigorous critiques of such programs from a human rights and abolition point of view.
All of which to say, Szalavitz's book is welcome for the story it tells. We can then critically engage the political strategy inherent in the way the story gets constructed, asking how harm reduction has and can continue to serve poor people power in destroying the institutions and practices that cause so much harm in our lives and our communities.
With each chapter in the book dedicated to a different moment in the history of U.S. harm reduction and its colorful and passionate protagonists, the book introduces us to a remarkable cast of characters. It's a remarkable experience to read accounts of events that I either knew about at the time or was a participant. But more exciting was to hear more details and connections, making the familiar unfamiliar to me. The effect of this was often deeply moving such as the account of the ACT UP court battle to defend a group of needle exchange activists in the early '90s -- a legal battle that would have consequences for emboldening harm reductionists across the country, including us in Los Angeles.
But reading such an important book is also an opportunity to critique the way the story is told. Such a critique is by no means a call to reject or diminish the book's importance. The opposite. Any critique of a narrative is a way to ensure that the story get told again, expansively, and sharply in relationship to the current conjuncture (as mentioned above).
For one, reading Undoing Drugs raises the question of the political orientation of the person telling the story. What becomes clear to me in reading Undoing Drugs, is that the author has subtly adopted a political strategy for how one can fight against the war on drugs, that is, to highlight to role of often middle-class, professional, and connected people in weaving together a movement that becomes legible to politicians, public health officials, public health researchers, major funders, and even to a mostly white middle-America. Such an orientation is not the automatic position from which to tell a story. Furthermore, it is an orientation that can lead to profound distortions. One of the major distortions is the way harm reduction is seen as the work of activists and people with institutional connections.
For many of us in the movement, harm reduction was and continues to be the practices of extremely poor, mostly BIPOC, homeless people and sex workers who use drugs. Harm reduction is the practice of people creating a resistant form of community care in the very spaces that are extremely criminalized and policed. This, however, is not the story that Undoing Drugs tells. For that story, we need different texts like the recently published, Saving Our Own Lives from Shira Hassan, a text that explicitly counters the white liberal orientation of Undoing Drugs. The white liberal orientation consistently centers the do-goodism of people who have no larger political analysis of capitalism, no understanding of the intersection of racism and capitalism, and no larger anti-imperialist context. Why does that matter?
For one, if an understanding of the war on drugs is located in the larger context of racial capitalism, then we end up tell a very different story about how harm reduction begins, where it begins, and with whom. Locating harm reduction within a critical analysis of racial capitalism, underscore the connections between harm reduction the anti-racism and anti-capitalism of '70s revolutionary movements like the Black Panthers and Young Lords. That connection is embodied in community histories and the names of radical health organizers who began in the movement and have continued as self-avowed harm reductionists.
What happens when your political orientation in telling the story of harm reduction is fundamentally liberal; a belief that harm caused by the state can be merely corrected through policy reform with no attention to material basis of the state's actions. Thus, the protagonists that the book focusses on are reformers, mostly white middle class individuals who do the "real" political work of affecting policy. There's no space for the autonomous political capacity of poor people, but only the small adjustments that do not transform the larger conditions of class conflict in which the war on drugs is but a tactic.
Where we start a story matters. By minimizing the role of the capitalist state in regards to the social control of poor people, specifically poor POC, the narrative of harm reduction excludes the earlier struggles of revolutionary movements to resist the role of the state in using drugs to control people. Thus, there's no mention in Undoing Drugs of "the people's detox" movement as a preamble to harm reduction before white people responded o the war on drugs. thus, the whole narrative obscures the underlying theme of social control that links both imperialism and later the war on drugs. Both popular (like acupuncture) treatment and harm reduction as oriented towards police abolition.
This points to another fundamental absence; what is the material basis of the war on drugs? Later in the book, Szalavitz rightly credits Michelle Alexander's book, The New Jim Crow, as laying out the analysis that links the racist carceral system and the war on drugs. That analysis makes clear how harm reduction has always been a movement towards abolition. But what is the material basis of mass incarceration? What is the larger arc of capitalist crisis that makes the war on drugs a necessary strategy? What is the link between rising poverty, historic rates of wealth accumulation, and the neoliberalization of urban space under real estate capital? While Szalavitz's book is not one of political analysis, it's necessary to have some larger context.
But probably one of the more egregious errors in Undoing Drugs is the continual confusion between the terms decriminalization and legalization. The interchangeable use of these terms creates a number of problems in Szalavitz's narrative such as the term "full legalization" of marijuana. Here is where the analysis from the struggles to decriminalize sex work have been enormously helpful in how we talk about the law and illicit drugs or even the law and houselessness. Legalization means that there are still in place structures of control that make drugs, sex work, and homelessness legal under state-defined conditions. In contrast, decriminalization begins from the place that drugs, sex work and homelessness are inherently not criminalized. From there we can have public discussions about health access, treatment, worker rights, and housing with dignity.
There is also a tendency in Undoing Drugs for Szalavitz to oversell programs and policies without any in-depth critical analysis of what those programs look like on the ground. For example, it's dangerous to holds up Law-Enforcement Assisted Diversion (LEAD) programs as part of harm reduction or decriminalization, when, in practice they're part of a legalization framework where there are still harmful forms of control by the state. Szalavitz acknowledges that the programs aren't perfect. But it's important to explain those perfections, particularly at this moment of appropriation. The social controls and surveillance systems that are often aspects of diversion programs can be part and parcel to the reality that the services offered in diversion programs are still dominated by scarcity. Thus, community members experience these programs as an extension of carceral logics and not the necessary conditions of personal and community autonomy. Since Szalavitz describes diversion as a harm reduction reform of policing with regards to drug use and sex work, I would strongly suggest readers look at a book like Revolting Prostitutes or statements issued by the Philadelphia-based Sex Worker political group Project Safe for rigorous critiques of such programs from a human rights and abolition point of view.
All of which to say, Szalavitz's book is welcome for the story it tells. We can then critically engage the political strategy inherent in the way the story gets constructed, asking how harm reduction has and can continue to serve poor people power in destroying the institutions and practices that cause so much harm in our lives and our communities.
July 8, 2024
This was seriously great! Szalavitz perfectly balanced a compassionate approach to the humanity of drug users with very thorough reporting on the history of harm reduction implementation. I’ve read a bit about assorted harm reduction policies in other places but it was really nice to have their evolution & history laid out chronologically and in context of other movements. There were definitely sections that reframed arguments that I had never thought critically about before in really interesting ways.
Sections of this were pretty hard to read due to things hitting close to home (losing family through overdose) so check warnings and be kind to yourself while reading.
Sections of this were pretty hard to read due to things hitting close to home (losing family through overdose) so check warnings and be kind to yourself while reading.
June 1, 2022
Szalavitz explains the history of harm reduction in a beautifully simple manner that anyone can understand. As she says, there was no text detailing the history of harm reduction in the states before this, and so I am extremely grateful for all the work that went in to compile the stories in this book. Her unique insight as a past drug user and as a reporter when harm reduction was becoming more well known is so valuable; no one else could have written this book.
December 27, 2023
This should be required reading for anyone working in the substance use field. The author did a great job of highlighting the intersections that make this field so complex. We need better drug policy, we need to listen to the people impacted the most by current policies, we need more funding for research, and we need to provide people with better access to life-saving resources and knowledge. It’s a matter of life and death.
October 11, 2024
A great history of addition and the development of harm reduction in America’s and the world’s history. It doesn’t seem like America is going great in the realm of harm reduction, but we are doing better than we ever have been. We just need (this a a lot more progressive ideas) US versions of Vancouvers Insite and Onsite programs and to throw away our backwards laws and racist mandatory minimum sentences. So, we are better than we were in the 90’s but we still have a lot of work to do.
May 6, 2024
Her take on the opioid crisis was groundbreaking for me. It makes sense, it’s just very different from every other perspective I’ve heard.
The rest of the book is interesting but a little too long imo.
The rest of the book is interesting but a little too long imo.
December 30, 2021
really interesting and well-done.
December 3, 2024
For class but it was tea 😜
April 19, 2024
As a Canadian Harm Reductionist who only started working in this field in 2022, I’ve been consuming everything I can about this topic. Undoing Drugs provided me the American harm reduction history I didn’t know I need, from the early days of the AIDS crisis, the roots of housing first, to the current day drug policy changes this book offers an intimate perspective from the front lines. I laughed and cried during this book as I learned the stories of the very first harm reductionists who paved the way for my work today.
August 12, 2022
Let me start by saying I may be a little biased because I work in the addiction recovery field, in a hospital more specifically, so I'm very much in the trenches. As a person who had over a decade of abstinence based recovery when I started this job, harm reduction was difficult for me to wrap my head around. I could look at statistics for needle exchanges, legalization, and Medication Assisted Treatment (MAT) and see that there were definitely some benefits, but working with people still very much ambivalent or not ready to make a change was tough for me to handle. I wasted a lot of time and energy wondering why someone wasn't ready to stop, or even make slight changes, and what the point of my role as a peer was in helping them when they obviously weren't committed to recovery was supposed to look like. I hadn't yet come to the understanding that recovery is "any positive change", and that just because I myself am uncomfortable with how someone is leading their life (or, now, advocating on the behalf of people to mostly clinicians), doesn't mean that I should force or impose my own views on what recovery should look like onto them.
Szalavitz does a really good job of presenting a lot of the concepts, ideas, and questions that I came to through conversations with people more experienced in harm reduction than I was at the time. She does a really great job of collecting the disparate threads of history of a mostly decentralized movement, whose scope and priorities have shifted and expanded over the years, and built a very easily digestible and understandable history of the movement in the process. Most other authors would create something that might crumble under the weight of it's own scope, but she really excels in collecting history, research, and philosophy here, and it makes a very compelling argument. If this book continues to be updated and expanded I would love to see more on how the term "harm reduction" has been expanded to other political and social spheres as is touched on very late in the book- primarily in terms of the 2020 election, and how that is being felt as co-opting and cheapening the term and concept.
Szalavitz does a really good job of presenting a lot of the concepts, ideas, and questions that I came to through conversations with people more experienced in harm reduction than I was at the time. She does a really great job of collecting the disparate threads of history of a mostly decentralized movement, whose scope and priorities have shifted and expanded over the years, and built a very easily digestible and understandable history of the movement in the process. Most other authors would create something that might crumble under the weight of it's own scope, but she really excels in collecting history, research, and philosophy here, and it makes a very compelling argument. If this book continues to be updated and expanded I would love to see more on how the term "harm reduction" has been expanded to other political and social spheres as is touched on very late in the book- primarily in terms of the 2020 election, and how that is being felt as co-opting and cheapening the term and concept.
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