housing is harm reduction

thank you for coming to my ted talk

Over the course of my life and career I have done lots of harm reduction work (in both conventional and unconventional ways).  While the focus of so much harm reduction programming surrounds supporting people who use drugs to do so safely and autonomously, I’ve spent almost an equal amount of time focusing on one other thing: helping people with housing.

The majority of clients I see on a daily basis are experiencing homelessness.  They sleep outside or on public transit, and a small portion of them bounce between the few open shelter beds our city offers.  We see hundreds of people monthly and most of them are living this way.  It’s become very clear to me over my career that housing is undeniably a part of harm reduction work.

When people talk about harm reduction, they think primarily of needle exchanges and Narcan distribution.  Both of these things are deeply important, but reducing this work to just that is doing a disservice to ourselves and our communities.  The definition of harm reduction that I hold closest to my heart comes from Shira Hassan, author, harm reductionist, and amazing human.  She speaks of liberatory harm reduction as “a philosophy and set of empowerment-based practices that teaches us how to accompany each other as we transform the root causes of harm in our lives.”

When harm reduction practice is framed in this way, as a way to transform the root causes of harm in our lives, it’s no wonder housing comes up as a very prominent and prevalent issue.  If we go back further to examine what systemic issues are hurting people, we will often come back to a lack of safe, stable housing.  Without housing (real housing, not shelters or transitional spaces or tiny villages inside of warehouses), stability is impossible.  Without stability, how could a person even begin to address their mental health concerns, find financial stability, or change their relationship with their substance use?  Spoiler alert: they can’t.

There is a myth that people who are homeless and use drugs are homeless because they use drugs (even the mayor of Minneapolis spreads this false information, and he has come into my instagram DMs to argue with me about it), but that is not true.  Drug use is often a way to cope with homelessness; it’s a skill people use to deal with the unending stress of having no safe and stable place to land.

The same can be said for a variety of other skills used to cope, like sex work or stealing or self-harm or staying with an abusive partner; to look at things through a harm reduction lens we need to understand that people are using every tool in their toolbox to survive.  Instead of viewing these coping skills as causes of homelessness, we need to view our insane and impossible housing systems as one of the things pushing people to rely on these often stigmatized coping skills.

I have met hundreds and hundreds of people who are unhoused that use drugs or do sex work or self-harm, and do you know what I have never heard a single person say? 

“If I had never started using drugs/doing sex work/self-harming, I wouldn’t be homeless right now.”

But do you know what I DO hear?

“I want to stop using drugs, but it’s so cold and it’s the only way I can get through the night.”

“I can’t handle being homeless anymore- cutting is the only way I can cope without killing myself.”

“I need help with my mental health but I don’t have transportation or a phone or health insurance.”

“I have been relying on meth to keep me awake all night so no one steals my bags on the train.”

“I need somewhere safe to sleep- if that means sex work I will do it.”

one of my favorite quotes ever, by Dominique Morgan

As we are walking alongside one another and working to address the root causes of people’s hurt, we also have a responsibility to support their right to cope in whatever ways they want and need to, even if those ways feel unconventional or taboo. Even though I believe we are moving towards a better, more just world, hurt will always be there. Where there is hurt there are coping skills.

I want to be careful not to be reductive here- not every person who uses drugs or does sex work does it for the same reason. Some people do it because they enjoy it and think it’s fun, and having space for that is part of harm reduction too!  I simply want to highlight the intersections of harm reduction work and housing work, because I believe the two to be so deeply intertwined.

Harm reduction means giving people full autonomy to make the choices that they believe are best for them and working together to address any underlying causes of harm; there is no question that addressing the housing crisis is an essential piece of the puzzle.