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iAUDIT - In February 1929, Al Capone sent his gunmen to a Chicago garage, where they murdered seven members of a rival mobster’s gang. What is now known as the St. Valentine’s Day Massacre so shocked the nation that the FBI was finally forced to recognize the threat of organized crime, and the corrupt Mayor of Chicago, Big Bill Thompson, was voted out of office in favor of reformer Anton Cermak. In modern-day Los Angeles, the equivalent of a St. Valentine’s Day Massacre happens on our streets every night, and it barely makes the news. Worse, homeless advocates and government leaders know why people are dying on the streets and in lonely hotel rooms but do nothing.
The source of many of these deaths is a misguided program called Harm Reduction. In Los Angeles and elsewhere, it is a component of No Barrier Housing First, the homelessness “solution” used by government agencies. Harm Reduction is a public health policy intended to reduce deaths and serious injuries from illicit drug use by making it safer to use some drugs without fear of arrest. It began as a response to the AIDS epidemic, by encouraging people who used injectable drugs to exchange their communal needles for new, sterile single-use needles. In that context, Harm Reduction has been credited with saving thousands of lives. Although there is no single accepted definition of a Harm Reduction program, typically it includes needle or other paraphernalia exchanges, the availability of anti-overdose drugs like Narcan, condoms, sterilization kits, and the offer of abuse recovery programs. Unfortunately, like Housing First, Harm Reduction has strayed far from its benevolent origins.
In some European countries, needle exchange programs evolved into “safe sites” where people could use drugs under supervision of medically trained personnel who can respond to overdoses and ensure clients use clean paraphernalia. However, these countries have robust socialized medical and mental care services, and actively offer recovery services. When cities in the U.S. tried to emulate European safe sites, the “offer” of recovery services faded into the background, so clients didn’t feel threatened, or more often, due to a lack of trained personnel. Some local governments, like LA County’s Public Health Department, have Harm Reduction field outreach teams, to distribute safety kits to the unsheltered homeless.
Members of the Santa Monica Coalition, a non-profit community advocacy group, filed a series of reports on the Harm Reduction outreach team’s activities in their city. “Outreach” consisted mainly of passing out kits with clean needles, clean smoking pipes, Narcan, condoms and sterile wipes, with no mention of the availability of recovery services. A few homeless people told Coalition members they used one of the two needles in the kit and sold the other for drugs. Rather than reducing overdoses or open-air drug use, the outreach program has just made it worse. In an effort to save their businesses, members of Santa Monica’s downtown Business Improvement District recently voted to bill themselves $1.7 million for professional security services to protect against violent street people, many of whom are chronic drug abusers. The Coalition reports at least four unhoused people in Santa Monica die from overdoses each night.
The negative effects of Harm Reduction are most visible in San Francisco, where Governor Newsom recently assigned Highway Patrol and National Guard personnel to assist local police with interdicting fentanyl suppliers. For several years, San Francisco enthusiastically embraced Harm Reduction. During the COVID pandemic San Francisco ordered local hotels to house unsheltered homeless without regard to their substance abuse or mental history. According to a report by the Hoover Institute, the result was “Hotel residents have threatened to kill hotel staff, chased them with metal pipes, and lit fires inside hotel rooms. Tenants attack each other, including one person who sprayed pesticide into their neighbor’s eyes on at least two occasions. One tenant slashed another’s face with a knife. Other tenants have been threatened by guns and crowbars.” The Hoover Institute report found that, of 515 people in a No Barrier Housing First program, at least 166 died by drug overdose in city-provided hotel rooms, or 14 percent of all confirmed overdose deaths in the city in 2020 and 2021.To date, hotels have collected about $33 million from the city in repair costs for damage incurred housing the homeless, including a $19.5 million payment to just one hotel. A safe use site in the Tenderloin District was known for being little more than a place where people could use their drug of choice without fear of arrest. Under intense pressure from residents, San Francisco closed the Tenderloin site in late 2022, while Governor Newsom vetoed a statewide safe site law. Incredibly, San Francisco’s Board of Supervisors has recently taken up consideration of privately-run safe sites, despite the disastrous experience in the Tenderloin.
In Los Angeles, the pairing of Harm Reduction with No Barrier Housing First has resulted in chaotic situations on the streets and in transitional and permanent housing. Placing active drug users in the same housing with those in recovery, endangers their efforts to stay clean, as described in the January 2022 edition of The Hill. Properties managed by the Skid Row Housing Trust are especially infamous for the number of overdose deaths in its hotels. In a case of cruel irony only the most oblivious would miss, the County pays for outreach teams to distribute paraphernalia that makes it easier to abuse street drugs, and pays others to counteract the medical emergencies those drugs create. It is no wonder the Rev. Andy Bales of Union Rescue Mission refers to Harm Reduction as “Harm Creation”.
The result of Harm Reduction and our failed Housing First efforts is an average of six deaths on City streets every night, plus an unknown number who die alone in hotel rooms. That’s at least 2,190 people per year, 5.7 times L.A.’s 2022 murder rate. A number that would shock even Scarface Al Capone.
How has a program that’s supposed to save lives kill people with near-industrial efficiency? Part of the answer lies in the Harm Reduction’s origins. Forty years ago, it was designed to prevent deaths from AIDS by stopping needle sharing. More modern drugs like fentanyl are far more powerful and addictive than anything available in the 1980’s, and they are easier to obtain. Like Housing First, Harm Reduction is a tool that has not been updated to meet changing conditions. The new drugs have such severe side effects as they wear off, users want another dose immediately. The extreme ups and downs of fentanyl and methamphetamine often mimic mental psychosis, which is why the general public believes many of the unhoused have mental problems.
Harm Reduction assumes a substance abuser can make rational decisions about his or her drug use and treatment. However, when in the grip of a drug with powerful high/low cycles, it is highly unlikely someone can make life-changing decisions in their own best interests. That’s one of the reasons safe sites become little more than places for congregant drug abuse; the need for another dose and a space where one can take another hit in relative safety outweighs all other concerns.
The statistics behind overdose deaths tell us we need to take another path. In only 15 months, a Metro transit worker used the anti-overdose drug naloxone 21 times to revive overdose victims. The transit worker’s experience is indicative of how widespread the fentanyl epidemic is. According to the L.A. County Department of Public Health: “Drug overdose was…the leading cause of death for people experiencing homelessness, accounting for 37% of all deaths among unhoused individuals in 2020 and 2021 combined —about two deaths per day on average, [other studies put the number higher]. Drug overdose was also the largest driver of the overall increase in mortality for people experiencing homelessness, with the overdose mortality rate doubling from 2019 to 2021”. Despite the appallingly high mortality numbers, the Department continues its lackadaisical approach to Harm Reduction, concentrating on distributing drug paraphernalia while doing little or no recovery outreach.
Despite skyrocketing opioid and methamphetamine abuse, and their deadly effects on the unhoused, Housing First advocates continue to insist homelessness is purely a problem of affordable housing. They deny any relationship between substance abuse and being homeless, other than claiming that such problems are the result of, rather than the cause of, homelessness, while offering scant empirical proof. The recent UCSF/Benioff survey on homelessness revealed 65 percent of unhoused people reported regular use of illicit drugs at some point in their lives, not after they became homeless. In any case, the appalling numbers speak for themselves; the number of the chronically homeless, who often have substance abuse problems, is increasing disproportionately to the growing population of all homeless people. As State Senator Susan Talamantes Eggman said, “We see real examples of people dying every single day, and they’re dying with their rights on. I think we need to step back a little bit and look at the larger public health issue. It’s a danger for everybody to be living around needles or have people burrowing under freeways.”
Substance abuse is rightfully viewed as a medical disease. Addicts are in the grip of a seemingly endless cycle of highs and lows, euphoria and despair. They need medical interventions, not just arrests. Unlike other epidemics, however, public health authorities appear to be making the crisis worse, by using outdated and unrealistic service models. The crisis is not intractable. 50 years ago, nobody could have imagined cigarette smoking would sharply decline, based not on arrest and enforcement, but on education and deterrence. There is no single method that will reduce the fentanyl and methamphetamine epidemic; it will take medical interventions, law enforcement, and mental health services. Making it easier for addicts to use drugs in public spaces is a gross misuse of public funds and achieves nothing but perpetuating a destructive cycle of addiction, sickness, and death.
(Tim Campbell is a resident of Westchester who spent a career in the public service and managed a municipal performance audit program. He focuses on outcomes instead of process. He is a regular contributor to CityWatch.)
