Matt Dorsey attacks us on Twitter about harm reduction and the city’s priorities

Well, we got Sup. Matt Dorsey’s attention.

My piece that talked about the city’s move away from “harm reduction” strategies and toward more law enforcement in the new War on Drugs spurred a 23-part Twitter attack that starts like this:

This absurd statement in 48Hills — that abstinence-based recovery “has never worked,” and “often causes serious problems” — reflects the tired, factually vacant shibboleths of the drug-decriminalization fringe. It’s a dangerous pro-drug narrative with no basis in evidence. (1/23)

In fact, many millions of people worldwide — myself included — *do* find success in abstinence-based recovery traditions for addiction and alcoholism. And research shows that millions more benefit from Medication-Assisted Treatment (MAT) to abstain from the often deadly illicit drugs to which they’ve become addicted. (2/23)

I think Dorsey read my piece too fast, or was so determined to argue in favor of sobriety that he missed the point.

Here’s what I said:

Now Sup. Matt Dorsey wants to push all the way back to the days when the primary solution to substance use was total abstinence and sobriety—which not only has never worked, but (like telling kids the only solution to teenage pregnancy is abstinence) often causes serious problems.

Dorsey is introducing a bill that would “establish the cessation of illicit drug use and attainment of long-term recovery from substance use disorders as the primary objective of the City’s drug policy.”

It that’s the primary objective, then harm reduction gets cast aside. Safe injection sites are not in the picture.

For many, many people, abstinence programs like NA and AA have been very effective and often lifesaving. Nobody I know doubts that for a second.

What hasn’t worked, I argued, is making that approach the “primary solution.”

In this case, unless my grammar is wrong, the phrase “which has never worked” refers to the phrase “the days when the primary solution to substance abuse was total abstinence and sobriety.”

Mandatory abstinence and “cessation” is one approach, which works for many. It doesn’t work for many others.

Go back to this press conference, from 2018, where Vitka Eisen, who is the head of Healthright360, stands with state Sen. Scott Wiener, former Mayor London Breed, and others, to call on then-Gov. Jerry Brown to sign a bill that would have allowed safe-injection sites in San Francisco.

She tells her own story: As a former heroin addict, she showed up at the Haight-Ashbury Free Clinic nine times, seeking detox. Nine times, they treated her without judgement, and helped keep her alive and safe, even if she showed no interest in treatment, abstinence, or sobriety. That was a harm-reduction-first approach, and it worked: The tenth time, she decided to ask for help, and has now been sober for 30 years.

If you overdose and die, she said, you never get a second chance.

The bill that would have been very much a harm-reduction-first program, which did non emphasize the end of illicit drug use or abstinence-based recovery (although services would have been available), was vetoed twice, once by Brown and once by Gov. Gavin Newsom.

The city is continuing to move away from that approach.

I will plead guilty to being part of the “drug decriminalization fringe.” I have always believed that drug use should be treated primarily as a public health issue, not a law-enforcement issue.

When I took organic chemistry in college, the professor, A.J. Fry, told us that the oldest chemical reaction known to humans was the discovery of fire—rapid oxidation.

The second, he said, was fermentation—turning sugar into alcohol–which preceded the next, saponification (the making of soap) by many thousands of years.

“Thus demonstrating,” Professor Fry told us, “that humankind’s drive to get intoxicated is far stronger than our drive to be clean.”

I think he may have been joking a bit, but the reality is that drugs, including alcohol, have been part of the human experience for millennia, and likely will be for more millennia, if we make it that long. Some drugs that are now legal—alcohol, cannabis–were “illicit” at other points in history. Some that are now “illicit,” including heroin, opium, and cocaine, were legal at other points in history.

The line between legal, socially accepted and “illicit” is one that has always been fungible. Most people I know agree that prohibition was a huge failure, as was the criminalization of cannabis.

So the “cessation of illicit drug use” is both impossible and depends on who decides at what point which drugs are “illicit.” Not a good basis for city policy.

In 2018, more than 100 college presidents argued that the drinking age in the US should be reduced to 18. Why? Because it would allow young people to develop a relationship with alcohol that wasn’t based on binge-drinking. Making this drug “illicit” and requiring college students to abstain from it spurs more dangerous behavior, and sometimes death. It makes the situation worse, the college presidents say. They call for harm reduction, not abstinence or illegality.

My old friend Buck Bagot, who is a legendary community organizer, sent me this message:

I’m an alcoholic with 13 years sober thanks to AA. No one could make or convince me to stop drinking in the bad old days. (My experience in S.F. is that most alcoholics/addicts use both alcohol and drugs). The vast majority of us can only stop when we recognize we are substance abusers, decide to try to stop using, and usually only then with AA/NA.  Even then, way less than half of us can stay sober for one year. You can’t “make” us stop. Best to house homeless users, work with them to reduce their use, and be there with a path to recovery if and when they decide to stop using.

Again, there are many people who need, want, and thrive in sober environments, and use those programs for recovery. That’s a wonderful thing, and should be supported and available.

But I still believe prioritizing harm reduction over mandatory abstinence and “cessation” makes far more sense as public policy.

Awaiting your next Twitter storm, Matt.