The ethics of drug injecting rooms

Should we allow people to use illicit drugs if it means that we can reduce the harm they cause? Or is doing so just promoting bad behaviour?

Illicit drug use costs the Australian economy billions of dollars each year, not to mention the associated social and health costs that it imposes on individuals and communities. For the last several decades, the policy focus has been on reducing illicit drug use, including making it illegal to possess and consume many drugs. 

Yet Australia’s response to illicit drug use is becoming increasingly aligned with the approach called ‘harm reduction,’ which includes initiatives like supervised injecting rooms and drug checking services, like pill testing.  

Harm reduction initiatives effectively suspend the illegality of drug possession in certain spaces to prioritise the safety and wellbeing of people who use drugs. Supervised injecting rooms allow people to bring in their illicit drugs, acquire clean injecting equipment and receive guidance from medical professionals. Similarly, pill testing creates a space for festival-goers to learn about the contents and potency of their drugs, tacitly accepting that they will be consumed. 

Harm reduction is best understood in contrast with an abstinence-based approach, which has the goal of ceasing drug use altogether. Harm reduction does not enforce abstinence, instead focusing on reducing the adverse events that can result from unsafe drug use such as overdose, death and disease. 

Yet there is a great deal of debate around the ethics of harm reduction, with some people seeing it as being the obvious way to minimise the impact of drug use and to help addicts battle dependence, while those who favour abstinence often consider it to be unethical in principle.

Much of the debate is muddied by the fact that those who embrace one ethical perspective often fail to understand the issue from the other perspective, resulting in both sides talking past each other. In order for us to make an informed and ethical choice about harm reduction, it’s important to understand both perspectives. 

The ethics of drug use

Deontology and consequentialism are two moral theories that inform the various views around drug use. Deontology focuses on what kinds of acts are right or wrong, judging them according to moral norms or whether they accord with things like duties and human rights.

Immanuel Kant famously argued that we should only act in ways that we would wish to become universal laws. Accordingly, if you think it’s okay to take drugs in one context, then you’re effectively endorsing drug use for everyone. So a deontologist might argue that people should not be allowed to use illicit drugs in supervised injecting rooms, because we would not want to allow drug use in all spaces. 

An abstinence-based approach embodies this reasoning in its focus on stopping illicit drug use through treatment and incarceration. It can also explain the concern that condoning drug use in certain spaces sends a bad message to the wider community, as argued by John Barilaro in the Sydney Morning Herald: 

“…it’d be your taxpayer dollars spent funding a pill-testing regime designed to give your loved ones and their friends the green light to take an illicit substance at a music festival, but not anywhere else. If we’re to tackle the scourge of drugs in our regional towns and cities, we need one consistent message.” 

However, deontology can also be inflexible when it comes to dealing with different circumstances or contexts. Abstinence-based approaches can apply the same norms to long-term drug uses as it does to teenagers who have not yet engaged in illicit drug use. With still high rates of morbidity and mortality for the former group, some may prefer an alternative approach that highlights this context and these consequences in its moral reasoning.  

Harms and benefits

Enter consequentialism, which judges good and bad in terms of the outcomes of our actions. Harm reduction is strongly informed by consequentialism in asserting that the safety and wellbeing of people who use drugs are of primary concern. Whether drug use should be allowed in a particular space is answered by whether things like death, overdose and disease are expected to increase or decrease as a result. This is why scientific evaluations play an important role in harm reduction advocacy. As Stephen Bright argued in The Conversation: 

“…safe injecting facilities around the world: ’have been found to reduce the number of fatal and non-fatal drug overdoses and the spread of blood borne viral infections (including HIV and hepatitis B and C) both among people who inject drugs and in the wider community.’”

This approach also considers other potential societal harms, such as public injections and improper disposal of needles, as well as burden on the health system, crime and satisfaction in the surrounding community.  

This focus on consequences can also lead to the moral endorsement of some counter-intuitive initiatives. Because a consequentialist perspective will look at a wide range of the outcomes associated with a program, including the cost and harms caused by criminalisation, such as policing and incarceration, it can also conclude that some dangerous drugs should be decriminalised or legalised, if doing so would reduce their overall harm.

While a useful way to begin thinking about Australia’s approach to drug use, there is of course nuance worth noting. A deontological abstinence-based approach assumes that establishing a drug-free society is even possible, which is highly contested by harm reduction advocates. Disagreement on this possibility seems to reflect intuitive beliefs about people and about drugs. This is perhaps part of why discussions surrounding harm reduction initiatives often become so polarised. Nevertheless, these two moral theories can help us begin to understand how people view quite different dimensions of drug treatment and policy as ethically important.