Daily Intel has a piece today on how NYPD officers are (theoretically) going to start carrying naloxone, the heroin anti-overdose medication, in an effort to stem the rising tide of opiate-related deaths in that city. Predictably, naloxone is a controversial treatment, particularly in this context; the rationale against it seems to be that if heroin users *know* that they can just overdose whenever they want and not die, they'll have no incentive to stop using. In that sense, it's reminiscent of the Bush-era PEPFAR campaigns that emphasized abstinence over condom usage, with the logic being that if people know how AIDS is passed on but you don't give them protection, then they just won't have the unprotected sex. Harm prevention vs. harm reduction.

Unsurprisingly, those AIDS programs didn't really work, and forsaking naloxone probably won't either. Now, I love behavior change and its related communications - there's a reason I've focused so much of my academic and professional career in that area - but, unfortunately, difficult problems generally require systemic, multi-pronged solutions. And while we should be working on the structural issues and individual choices that lead to problems as aggressively miserable as heroin addiction, in the meantime we have some people who are dying on our hands.

This is a domestic issue, of course, but the treatment of harm reduction vs. harm prevention as a binary instead of as a compliment has substantial relevance for the development world as well. No one is going to argue that an educational radio program is an adequate substitute for a well-run and well-resourced school, but building institutions takes time, and there are kids who need an education in the world we live in now. Not to state the obvious or anything, but the trick is figuring out how to balance the two approaches - not making ourselves choose only one.


(Another example of the need for a systemic approach to social change: this Onion article. I know, two in one day. With me, this is what you get.)