I was doing my Duolingo yesterday and came upon a story that illustrates the problem with Harm Reduction. Eddy was making dinner and talking to Junior about one of Junior’s books that Eddy was reading.  Junior then said he’d tell Eddy the ending (spoiler) if Eddy didn’t let him eat ice cream before dinner.  Eddy, not wanting to have the ending ruined by Junior, agreed to let Junior have the ice cream despite knowing that it wasn’t a good idea for Junior’s health.  Was this harm reduction (Eddy avoiding a negative outcome) or extortion (Junior getting his way by threatening a negative outcome)?

Harm Reduction or Extortion?

Arguably since the negative outcome was really to Eddy, not so much to Junior, it’s really extortion.  Harm Reduction would be about minimizing the harm to Junior.  However, so long as anyone other than Junior is involved, the line between harm reduction and extortion blurs.  There will always be something that someone can do that is more harmful to themselves than the option they want, and by threatening to go the more harmful route they hope to cow others into going along with a fundamentally bad decision.  This is a slippery slope with no bottom. 

hand of man soars on the smoke - The Problem with Harm Reduction

Harm Reduction Concept

Here’s another example, this time from real life.  In 2018, remember back then, prior to the Pandemic, there was EVALI – the life-threatening illness caused by Vitamin E added to vape pens.  Before it became clear what the cause of this disaster was, the Governor of Massachusetts issued a temporary ban on all “vaporizers”. Sure, this could have been done with more finesse so that flower machines didn’t get lumped in with vape pens, but the idea that the medical and scientific folk needed some time to sort out that was going on, was reasonable.  He wasn’t banning these devices forever (though I would argue based on subsequent data, vape pens probably should be taken off the market – see my article on vape pens) but rather just until the problem was sorted out. 

Immediately the internet erupted with libertarian cries of anguish over taking away their right to make their own decisions.  Further, the argument was put forward that banning them didn’t make sense because people would then “have to” go buy such devices “on the streets” where they admitted it would be unsafe. 

Here we have a temporary intervention by the government to ensure public safety in a time of crisis of unknown cause and people are complaining, fine, but threatening to do something evidently more unsafe to prove their point?  Their argument is that the harm reduction concept would prevent such a ban so that they wouldn’t have to get the less safe option.

The Personal Responsibility and Flawedness of the “Harm Reduction” Model

When does personal responsibility factor in?  If the government is telling you that these devices are unsafe, and thousands of people are dying in hospitals across the national, at some point aren’t you reasonably expected to listen?

Fundamentally the harm reduction model is flawed.  It’s flawed because someone can always threaten to do something more stupid and injurious to get their way.  At what point do we call it extortion?

Further, many harm reduction arguments hinge on a false dichotomy.  “If you ban legal vapes, then we’ll buy illegal vapes” demonstrates the idea that there are only two possible choices: legal unsafe vapes and illegal even more unsafe vapes.  However, it overlooks other options like not using any vape.

broken cigarette close up - The Problem with Harm Reduction

Why is it so important to use data in the concept of harm reduction?

Ultimately, the concept of harm reduction can only work if it is applied using data.  A fine example of how this should, and didn’t, work can be seen in the nicotine vape world.  There are great data to show that, when used properly in the context of a smoking cessation program, nicotine vapes can help people overcome nicotine dependence and stop smoking tobacco.

However, this has been generalized to any nicotine vaporization, at any dose and frequency, while overlooking the intended goal of ceasing to use any nicotine-containing products.  Holy wars have been waged online, largely supported by the vaping industry, proclaiming that any restrictions on nicotine vaping will drive people back to smoking tobacco.

This, of course, is great for the vaping industry but once again overlooks the third option (the intended option) of not using any nicotine after the dependence has been overcome.  It also overlooks that reality, supported by data, that nicotine, itself, is not benign – leading to atherosclerosis, hypertension, cardiac strain, and stroke.  Worse, the self-medicating nicotine user often uses significantly more nicotine than they would if they were smoking.  While the balance of harm is still in favor of nicotine vaporization rather than smoking, it is not reasonable to maintain this false idea that it must be one or the other, instead of stopping altogether as reason and medical data would dictate.

The idea that we should choose and encourage others to choose the lesser of two evils is fine, so long as we provide those options based on data, not end-user preferences, and if we avoid the idea that there are no other, even safer ideas.  Harm reduction must be a pathway to least harm, not just to lesser harm.

Consult with a Qualified Boston Medical Marijuana Expert Today

Those considering using THC, CBD, or any type of medicine found in cannabis to help manage their condition should consider speaking to a trained medical expert who is knowledgeable about using cannabis therapeutically. Massachusetts medical marijuana doctor Jordan Tishler, M.D. sits on the faculty of Harvard Medical School and has years of experience helping patients treat pain and other ailments using cannabis. He and the team at InhaleMD stand ready to assist patients in determining whether medical marijuana is right for them. For more information, or to set up a virtual consultation with the team at InhaleMD, call us at (617) 477-8886 today.

Now Offering Virtual Telemedicine Consultations

Now Offering Virtual TeleMedicine Consultations

Due to COVID-19, and for the foreseeable future, all of our appointments are being done by telemedicine. As it turns out, this has been wonderfully successful — patients love not having to take time away from work, fight traffic, or worry about parking. For us, telemedicine is like doing old-fashioned home visits — we get to see people in their own environments. What started out as an adaptation to the current crisis has transformed into a better way of providing healthcare.

Telemedicine, using Zoom, is easy to do with just a few clicks. It's also safe and secure.

Schedule a Telemedicine Visit