By Kevin D. Williamson
Friday, September 06, 2019
The drug warriors in the Trump administration are doing
everything they can think of to stop a nonprofit group in Philadelphia from
opening a “safe consumption site” in the city’s horrifying Kensington
neighborhood, a place for heroin users to shoot up under medical supervision,
with clean needles and counter-overdose drugs close at hand. The matter is
under litigation in federal court.
Philadelphia has a rough reputation, but, as with many
similar American cities, you could visit there, see the sights, walk the
streets, and never see anything that seemed especially amiss, only the usual
panhandling and low-level urban disorder that you might see in any city. You
can go hear Yannick Nézet-Séguin conducting one of the world’s great
orchestras, try Jon Chicon’s menu at Lacroix and learn what fourme d’Ambert
is, stroll around Rittenhouse Square, and think that you are in one of the
country’s great urban oases — which you are. Philadelphia is a splendid city
with an incompetent ruling class and a couple of very, very bad neighborhoods.
One of those is Kensington, which tourists may visit for
one of two reasons: either to see where Rocky lived or to engage in illicit
commerce. Kensington was in Rocky Balboa’s time a poor but safe working-class
neighborhood. It has since devolved into an unlivable ghetto, with open drug
sales, street-corner prostitution, and the other flashing neon signs of urban
alarum. It is a near neighbor to Fishtown, a neighborhood made famous by
Charles Murray’s use of it as the downward-bound counterpoint to Belmont in his
famous treatment of America’s divergent classes. But Fishtown, thanks in part
to the miracle of real-estate markets, experienced a dramatic turnaround in the
early part of this century. Peter Lane Taylor of Forbes describes the
scene:
Every Friday afternoon at 5:30 pm
the doors of “the El”—one of America’s oldest elevated subways—swoosh open at
Girard and Berks Street stations, unleashing a stampede of Millennials,
yuppies, hipsters, entrepreneurs, and empty nesters onto Front Street.
As fast as the doors close, they
scatter east down a maze of narrow streets swirling with trash, bumping shoulders
with the occasional heroin addict and scrappers pushing shopping carts piled
high with salvaged sheet metal. Nobody blinks.
A half dozen blocks away from their
newly-built, half-million dollar townhomes, the lines twist out the doors at
Pizzeria Beddia and Frankford Hall, two of Philadelphia’s hottest foodie spots.
Across the street, Johnny Brenda’s is already packed—hosting as they have for
over a decade one of America’s hottest indie rock bands. Mothers pushing
strollers window shop past Lululemon along Frankford Avenue’s buzzing retail
corridor fronted with wine bars, coffee shops, couture boutiques, yoga studios,
a vintage motorcycle joint, and an Argentinian tango dance school.
Visually the dichotomies are
jarring. Culturally the contradictions are even more confusing. Yet when the El
disgorges its “New Fish” every afternoon it epitomizes the driving forces
behind Fishtown’s warp-speed transformation, and the demographics fueling
America’s new urban revolution.
Rising real-estate prices have driven some of that
gentrification into Kensington. There is the usual tension between relatively
rich new neighbors and relatively poor incumbents, between absentee real-estate
investors and longtime homeowners, between new businesses and neighborhood
fixtures, all of it heightened by the municipal insanity that is as much a part
of Philadelphia’s local culture as Tastykake. The conflict is economic and
social, racial, and cultural. There are disputes about noise and public spaces
— and at the extreme end of the spectrum is the question of what to do about
all the junkies.
On a per capita basis, Philadelphia experiences more
opioid-overdose deaths than any other major city in the United States — about
three deaths per day in recent years. More than 1,000 Philadelphians died of
accidental overdoses in 2018 — three times the murder rate in a city with a hell
of a lot of murders.
In cities from Houston to New Orleans to Birmingham, one
of the few strategies for reducing the harm of heroin use is, not to put too
fine a point on it, helping junkies pre-plan their overdoses. In New
Orleans, the authorities began experimenting with giving addicts and their
families prescriptions for Narcan (naloxone), an anti-intoxicant used to
reverse the effects of opiate overdose, on the theory that they were likely to
need it sooner or later, and that in the event of an actual overdose there
would be little time to contact emergency medical personnel. They did this at a
time when the city’s emergency rooms were seeing as many overdose deaths in a
month as Philadelphia sees in a couple of days.
There is some evidence that safe-consumption sites reduce
harm. The most significant metric is that none of them has been the site of an
overdose death. (That figure comes from experience abroad; there are no
safe-consumption sites currently operating in the United States with legal sanction.)
Heroin addicts tend not to be very future-directed thinkers, but most of them
are not actively suicidal, either. They will use clean needles when clean
needles are available, and clean needles reduce the transmission of HIV and
hepatitis C. A study of injection-drug users at a safe-consumption site in
Vancouver found that 11.2 percent of those frequenting the facility eventually
made use of on-site detox services, and that they were more likely to try
medication-assisted treatment.
The Trump administration disputes that these sites
significantly reduce harm and insists that they are illegal, conflicting with
the “crack-house law” that prohibits the maintenance of a property for the
purpose of selling or using illegal drugs. The evidence on harm-reduction is
indeed modest, but modest as it is, it is not on the administration’s side. And
the invocation of an anti-trafficking statute to block medical services and
humanitarian treatment for drug users is legally questionable — and morally
reprehensible.
Many conservatives, including William F. Buckley Jr. and
the editors of National Review, concluded a generation ago that “the war
on drugs is lost,” that the strategy most likely to actually improve the lives
of America’s addicts — and, not to be forgotten, their neighbors — would be
based on a public-health model rather than a law-enforcement model, that
harm-reduction and treatment should be our priorities. Thirty years ago, WFB
wrote:
A conservative should evaluate the
practicality of a legal constriction, as for instance in those states whose
statute books continue to outlaw sodomy, which interdiction is unenforceable,
making the law nothing more than print-on-paper. I came to the conclusion that
the so-called war against drugs was not working, that it would not work absent
a change in the structure of the civil rights to which we are accustomed and to
which we cling as a valuable part of our patrimony. And that therefore if that
war against drugs is not working, we should look into what effects the war has,
a canvass of the casualties consequent on its failure to work. . . .
. . . Pursuing utilitarian
analysis, we ask: What are the relative costs, on the one hand, of medical and
psychological treatment for addicts and, on the other, of incarceration for
drug offenses? It transpires that treatment is seven times more cost-effective.
By this is meant that one dollar spent on the treatment of an addict reduces
the probability of continued addiction seven times more than one dollar spent on
incarceration. Looked at another way: Treatment is not now available for almost
half of those who would benefit from it. Yet we are willing to build more and
more jails in which to isolate drug users even though at one-seventh the cost
of building and maintaining jail space and pursuing, detaining, and prosecuting
the drug user, we could subsidize commensurately effective medical care and
psychological treatment.
I have spared you, even as I spared
myself, an arithmetical consummation of my inquiry, but the data here cited
instruct us that the cost of the drug war is many times more painful, in all
its manifestations, than would be the licensing of drugs combined with
intensive education of non-users and intensive education designed to warn those
who experiment with drugs. We have seen a substantial reduction in the use of
tobacco over the last 30 years, and this is not because tobacco became illegal
but because a sentient community began, in substantial numbers, to apprehend
the high cost of tobacco to human health, even as, we can assume, a growing
number of Americans desist from practicing unsafe sex and using polluted
needles in this age of AIDS.
But this line of thinking has not penetrated very far
into Republican circles. During National Review’s recently concluded
seminar at sea, I had the opportunity to speak briefly with former attorney
general Jeff Sessions about this question; he is an intelligent and gracious
man, and looked at me as though I were utterly insane to suggest that
we’d be materially better off with heroin manufactured under the exacting
conditions of an American pharmaceutical factory than with junk cooked up by
criminals in a jungle shed. It is a sobering thought. But I cannot see how it
would be otherwise.
Likewise, we would be better off with heroin users
employing clean needles and having access to anti-overdose measures. We should
not give in to “romancing opiates,” as Theodore Dalrymple puts it. And we
libertarians should consider the limited success of marijuana legalization in
places such as Colorado when we calculate how much harm-reduction our programs
are likely to achieve. The answer is: not very much, probably, but making
things marginally better is a much more intelligent choice than making things
marginally worse.
To support the de-emphasis of prohibition in favor of
treatment — or to endorse, as I do, the outright legalization of most
recreational drugs — is not to make a declaration of moral indifference to the
question. It is simply to acknowledge the reality that passing a law against x
does not necessarily relieve the world of x, whether x is
marijuana or heroin or irresponsible banking practices. Drug use is going to
continue to do harm to our society and to our neighbors and families. We cannot
magic that harm away — nor can we jackboot it away. What we can do is exert
some influence on the nature and extent of that harm, and channel it into more
predictable avenues.
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