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“Undoing Drugs”—Maia Szalavitz’s Profound History of Harm Reduction

In 1986, HIV/AIDS was burning through New York. The city’s gay population was devastated, and, though it was talked about much less, so were its quarter million injection drug users. Maia Szalavitz tried not to share needles. But syringes were scarce, and she was addicted to drugs, shooting cocaine and heroin daily. Facing 15-years-to-life on a trafficking charge, she often found it more important to dampen her anxiety, and turn the dial down on a world that didn’t always feel comfortable to her.

Then Szalavitz met an outreach worker from San Francisco who was in Manhattan visiting a mutual friend. Though she wouldn’t learn her name for many, many years, Maureen Gammon changed Szalavitz’s life. Gammon didn’t convince her to stop using drugs. She taught her to use drugs in ways that would do less harm.

“I was not ready to quit, at that point. And in New York, 50 to 60 percent of injectors were already infected,” Szalavitz told Filter. “And then, though I didn’t know what it was called, at the time, somebody taught me to use bleach to clean my needles. And it saved my life.”

She was relieved and empowered. But she wasn’t happy.

That was Szalavitz’s introduction to harm reduction. Thirty-five years later, as an acclaimed journalist and author, she’s written the first history of the activist movement that is finally beginning to break into the mainstream. Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction hits bookstores July 27.

Ahead of its release, Szalavitz shared how she felt after that chance encounter with Gammon. She was relieved and empowered. But she wasn’t happy.

“When I learned about bleach, I was completely outraged,” she said. “The fact that something as common as household bleach could save you from a disease that was then almost 100-percent deadly, and nobody was even mentioning this, because they were afraid that mentioning it would encourage us to use drugs—as if we weren’t already using drugs. It was outrageous to me.”

She began to spread the word. From that day forward, whenever Szalavitz found herself in a public bathroom where she guessed people were injecting drugs, she left a message for them. “Use bleach,” she scrawled on every wall.


A Trip Through Harm Reduction History


In an alley adjacent to San Francisco’s “unlikely punk palace,” Mabuhay Gardens, drug users in the know kept a syringe hidden behind a brick, sharing it among an untold number of people on account of how hard it was to find clean needles in 1981.

Not far away, at the Haight Ashbury Free Clinic, epidemiologists tested one liquid after another, looking for a substance that would work quickly to kill HIV/AIDS and that was also cheap and widely available (eventually deciding on bleach, as Szalavitz would learn a few years later).

Meanwhile, in the port city of Rotterdam, the Netherlands, a group of Dutch heroin users established the very first “Junkiebond,” a group that American “junkies” would later replicate and call a drug users union.

On the East Coast, in a Brooklyn courtroom, the “Needle Eight” gave harm reduction its earliest day in court. Police had arrested the ACT UP activists for distributing clean syringes. On the stand, they delivered a fierce (and scientific) defense of their activities.

And to the north, in Canada, members of the Vancouver Area Network of Drug Users (VANDU) marched in the streets to demand authorities open the continent’s first sanctioned safe consumption site in response to an epidemic of overdose deaths that swept through the city in the 1990s.

Readers of Undoing Drugs meet an eclectic (and large) cast of characters. Edith Springer, the “goddess of harm reduction,” likely did more than anybody else to spread the word of harm reduction in its earliest days. Heather Edny was one of the first harm reduction advocates to speak openly about their own drug use. Keith Cylar brought the concept of harm reduction to housing, pioneering the collection of social policies that today we call housing first. Dan Bigg freed naloxone (Narcan) from emergency rooms and ambulances to make it available at needle exchanges and on the street. And Louise Vincent, a co-leader of America’s first national drug user union, demanded a voice at the federal level.

“We have the worst overdose crisis in the history of the United States. And we are not dealing with it well, because we haven’t learned the lessons of harm reduction.”

The story is one of empowerment, where a spirited collection of outcasts—many of them drug users themselves, as Szalavitz highlights—built a movement and then an entirely new paradigm for addiction.

Though Undoing Drugs deals mostly with the past, there is an unavoidable contemporary context: In 2020, an estimated 93,300 people died of an overdose in the US, up from 63,600 five years earlier.

“We have the worst overdose crisis in the history of the United States. And we are not dealing with it well, because we haven’t learned the lessons of harm reduction,” Szalavitz said. “Harm reduction has enormously advanced the rhetoric around what we should do, and the understanding that criminalization is a problem. But in terms of getting politicians to put that into actual action, that has been slower.”

Undoing Drugs covers a lot of ground, though not as much as Szalavitz would have liked.

“This is, basically, the first ever history of harm reduction, which meant primary sources, which meant interviewing hundreds of people,” she said. “And doing that in a context where a lot of people were criminalized and were not able to be open about their own drug use.”

“This book could have been 10,000 pages, and I easily could have done thousands of interviews. There’s an enormous amount that I had to leave out,” she continued. “I feel guilty about everyone who ended up in the footnotes or who I was not able to mention … It kills me. It was really torture.”

Despite Szalavitz’s misgivings, the book more than succeeds in its overarching purpose. Undoing Drugs leaves readers with a deep understanding of what activists are fighting for.

“Harm reduction is the idea in drug policy that we should stop people from getting hurt, rather than stop them from getting high,” Szalavitz said.

“The main goal should be, let’s make everything safer and less harmful. And that is in conflict with the War on Drugs, which makes things more dangerous and deadly. My book traces the movement to put harm reduction first, from its birth in the 1980s, to its current status as a genuine threat to worldwide prohibition.”


Image of book cover courtesy of Hachette Books


This article was originally published by Filter, an online magazine covering drug use, drug policy and human rights through a harm reduction lens. Follow Filter on Facebook or Twitter, or sign up for its newsletter.

*Travis Lupick is a journalist based in Vancouver and the author of “Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle with Addiction” (Arsenal Pulp Press, June 2018).

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