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We work within a philosophy that supports the idea of drug user autonomy. We challenge ideas that say drug users are incapable of critical thought about the risks and harms of their drug use. We challenge the belief that drug users are failed humans. We challenge stigma. And we challenge the system of cultural entitlement that allows drug users to be dismissed solely on the basis of their drug use, without consideration of other present factors, such as systemic racism and poverty. But we also tend to use a model for understanding drug use that identifies a point at which drug users may lose critical capacity, may lose their autonomy in relation to their drug use. A point at which it is no longer the person who is acting, but a disease, or some other, somehow impersonal force.(Since when is disease really impersonal?) In my own personal experience, both as a user and as a person living among active users, this is actually a natural part of my understanding of what is going on. Maybe it is part of the system of stigma that I want to separate Joe from Joe on drugs. But I do. Not in all cases, but I do.

I think this is where it gets really difficult. We see our co-workers use; we see them – ourselves – high on the job, sometimes genuinely incapable of doing their work. And that incapacity doesn’t begin or end with work. No matter how much we want to impersonalize the workspace, the user is living a life outside of that workspace where their drug use is also having an impact on their ability to raise children, manage parole, stay housed, etc. Taken within this context, the idea that the workspace is impersonal is not only incredibly dangerous and harmful, but also political. Is it also harmful to depersonalize the drug use? “It’s not Joe, it’s his disease.” Who draws the line? It’s a line that negates the autonomy of the user. It’s still a line I draw, sometimes, with pain and confusion.

I give this analysis because this is how I approach the question of “drug use in the harm reduction workspace.” It’s not happening in an impersonal vacuum. It’s happening in my life, everyday. In my real, highly personal life. I need help to understand the functions of the hierarchies, the functions of the impersonalization, the functions of differentiating between user autonomy and user incapacity because of what is happening in front of me, everyday, to people I know, love and admire. I see executive directors and supervisors blamed and accused for not supporting the users, I see users blamed and accused for not being forthcoming about their needs or incapacities. I see users asking the harm reduction community as a whole, “How come no one said anything when I picked up and nearly died?” And I see users in a state of total meltdown angrily rejecting the suggestion that their drug use may be part of their meltdown.

It just doesn’t look impersonal to me. It looks super, super personal. I am dissatisfied by the presence of hierarchy, and it’s cautious, legalistic structures of responsibility and blame. What I see are people whose lives are going down the toilet. It is impossible to predict who is going to die next. And it is very hard to tell where to set my boundaries, when often where I set them may be the difference between life and death. If not life and death, then the difference between dignified well being and humiliating destitution within struggling and oppressed communities.

Drug users are often living in a state of continual repeated trauma; we are battling with, or conceding to, continual deep personal loss. And we experience that loss and that trauma not just as individuals but also as members of families and communities. But what about when that loss is someone else’s, not my own? I have seen loss happen to others again and again. I have watched people fall apart, struggle, suffer and sometimes die, again and again. That is a trauma too. And I struggle to judge which matters more – doing triage in a world of competing traumas. This is what the people in harm reduction agencies often face. Each trauma is supposed to stand alone, and be addressed on its own terms. But that isn’t possible in this world, at this time.

—

Donald Grove, Impersonality and Drug Use in the Harm Reduction Workplace, Harm Reduction Communication #17, Fall 2012

http://harmreduction.org/publication-type/newsletter/communication-issue-seventeen/

I have been thinking about this a lot lately, about the difficulty of drawing the line between drug use and chaotic drug use without further stigmatizing drug users. For me, and for most of the people I used to get high with, quitting was important for us to be able to have both the kind of personal relationships and the fulfilling jobs that we wanted (with the caveat that if there is no room in your work life for your life and experiences, and you are constantly biting your tongue when people talk shit about drug users, it does make it a lot less fulfilling).