What if the First Person to Respond to Drug Use Isn't a Cop, But a Health Worker?

My dentist recently asked me how much coffee I drink.

The question came after she spent several minutes peering into my mouth and making the kinds of small observations that medical professionals somehow turn into entire biographies. There were stains on my teeth. My enamel showed signs of wear. Did I drink a lot of coffee? Did I grind my teeth while I slept?

I mrffrfrhrherhurrred the only way I can while there is equipment in my mouth.

The coffee, certainly. The stress, probably. The teeth grinding, almost definitely. I have the mandibular tori to prove it.

Her recommendation was simple enough. I should cut back on the caffeine.

The thing is, she didn't actually give me a plan for cutting down on coffee. There was no caffeine cessation program. No support group. No referral. No follow-up appointment dedicated entirely to reducing the abuse of my never-washed French Press.

She simply identified the harm, explained the likely causes, and suggested ways of reducing further damage. I got a silicone mouth guard to wear during sleep. Then I went on with my day. The mouth guard is in the fridge, forgotten.

What stayed with me wasn't the advice. It was how unremarkable the entire interaction felt. She didn't panic. I didn't feel judged.

Nobody treated me like I had confessed to a character flaw. Nobody wondered whether I deserved punishment for my dependence on a stimulant.

Coffee occupies a peculiar place in modern life. We joke about needing it before we can function. I literally wake up to withdrawal headaches that will end after my first sip. We proudly announce how many cups we've had. Entire personality types seem to have formed around caffeine consumption. Somewhere along the way, dependence became relatable. Not desirable, necessarily. Just understandable.

I recently participated in the Project ACCEPT sessions with Dr. RJ Naguit. I found myself wondering how differently the conversation might have unfolded if the substance responsible for the damage had not been coffee.

I could have had the same stains and enamel deterioration. I rely on a stimulant to get through the day. Only this time, the stimulant is methamphetamine.

Suddenly the conversation feels heavier. Not because the damage is necessarily different, but because our feelings about the substance are. The dentist is no longer discussing enamel. She is discussing crime. There are systems in place to punish me if my dentist extracts the reasons why my teeth are stained and worn out, and word gets out, say via the clinic waiting room.

Even before the possibility of punitive action, I am no longer someone with a health concern. I have become someone with a moral problem.

When illicit drugs are involved, rarely are they asked why they need stimulants every day.

They might not be asked what happens if they stop.

They aren't asked what kind of life requires chemical assistance just to remain upright inside it. Escapist behavior stems from material conditions that require escape, but we think escapism is a bad word.

They aren't asked whether they are exhausted. Or anxious. Or depressed. Or lonely. Or trying to survive circumstances that would flatten most of us.

The substance becomes the entire story.

And yet if there is one thing I have learned from people who work in harm reduction, it is that substances are almost never the entire story.

I also misunderstood what harm reduction actually meant; I assumed it was about drugs. As most people do. The phrase sounds like a strategy for managing substances.

Project ACCEPT made me realize that harm reduction is much more interested in people. Specifically, harm reduction is interested in what people are trying to do to survive. Nobody wakes up one morning and decides they would like to develop a dependency. People are usually trying to solve a problem. Sometimes the problem is physical exhaustion. Sometimes it is grief. Sometimes it is trauma. Sometimes it is the kind of anxiety that turns every room full of strangers into a threat assessment exercise. Sometimes it is simply the cumulative weight of being alive under conditions that seem increasingly difficult to endure without assistance.

The assistance may be coffee.

We all acknowledge that alcohol is some kind of social lubricant; but really we are using a psychoactive substance to regulate aversions to social interaction.

People addicted to nicotine know that at some point it stops being about looking cool or socializing; instead, it's about dragging yourself back to normal.

Then it could also be methamphetamine. Then the legality changes. 

The underlying question often does not: What is this person trying to get through?

The answer matters because public health has always been most effective when we as a society begin with compassionate curiosity rather than condemnation. A doctor treating diabetes does not start by asking whether a patient deserves insulin. A therapist does not begin by determining whether anxiety is morally acceptable. The purpose of healthcare is not to assign virtue. It is to mitigate harm and reduce suffering.

Which raises an uncomfortable possibility: What if our response to drug use has been asking the wrong question all along? Instead of "How do we stop people from using drugs?" How about "What makes people feel like they need them in the first place?"

That question does not excuse harm. It does not dismiss the risks associated with drug use. It simply acknowledges that people rarely abandon destructive behaviors because they were shamed or threatened into doing so.

People change when alternatives become available, when support becomes available, when healthcare becomes available, when community becomes available, when life itself becomes more bearable.

People cannot commit to changing behavior if they do not survive to see that they have the agency for and the systems to support a changed behavior.

This is the philosophy behind programs like Project ACCEPT of HIV & AIDS Support House. The sessions are not really about teaching people how to use drugs safely, despite what critics of harm reduction often assume.

They are about helping communities understand the relationship between substance use, mental health, stigma, blood-borne infection prevention, and wellbeing.

They are about equipping local government units, community organizations, schools, workplaces, and healthcare providers with something more useful than shame and fear.

Understanding.

Because the truth is that every community is already home to people who use drugs. The more important question is whether those people encounter judgment first or support first. Whether the first response they receive is punishment, or care. Whether the first person who shows up is a cop, or a health worker.

My dentist, without realizing it, reminded me of the difference. She saw evidence of harm and began with a conversation.

There are worse places to start.

Communities, after all, are built one conversation at a time. For local government units, schools, workplaces, and community-based organizations interested in exploring public health approaches to substance use, HIV & AIDS Support House offers harm reduction and Project ACCEPT learning sessions that create space for exactly these kinds of conversations—about drugs, certainly, but also about mental health, stigma, wellbeing, and the conditions that make people seek escape in the first place.

Interested organizations may reach out to HIV & AIDS Support House to arrange a session for their community via [email protected].

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