"People are dropping like flies in those regions of the country, while I would imagine the West Coast, where black tar heroin is sold, hasn't seen as much of an increase in overdoses/deaths."
'Harm reduction' programs don't really do that much.
Since the 'Insite' facility in Vancouver opened - there has been basically no change in the number of users or ODs. The area around the clinic is still a zombie land - it's the only place in all of Canada that I'm afraid to walk down the street in the middle of the day.
There has been a massive spike of ODs in Vancouver lately, but it's mostly due to fentanyl and other purity issues.
I agree that 'doing heroin' should be treated more as a social health issue, and less as a criminal justice issue, but I'm entirely doubtful of the efficacy of shoot up clinics. They cost a lot, and the money just might be more effectively spent on other kinds of 'soft interventions'.
I think the real value of the clinics boils down to the fact that while there, users can be convinced to join 'get clean' programs, and that the health workers can have 'trusted and direct' access to the community.
And some 'harm reduction' efforts can be very destructive: in the Innes Road prison in Ottawa - if you go in with a heroin addiction - they give you three doses of "Diacetylmorphine" or whatever (similar to heroin) every day - and basically they keep their prisoners hooked. The users will go crazy in the time leading up to their 'dose time', screaming, banging on the door etc. etc..
'Reducing short term harm' by giving people doses of a drug, several times a day, for months or years - is utterly worse than what those people might have to do were they to have to spend a few days in 'hard withdrawal' and then a few weeks in less severe withdrawal.
Keeping prisoners hooked on extremely powerful opioids I think is a terrible form of 'cruel and unusual punishment'.
'Withdrawal' is not the end of the world, and usually it's not dangerous. It's inevitable. It's the 'first and most obvious step' of recovery. And the only path to recovery. And something and addict must eventually do - so 'going to prison' if anything, should be an opportunity to get them off of heroin. At least in a controlled environment they can be monitored during initial withdrawal, and have zero access afterwards for some time while in prison. (And yes, it's entirely possible to limit contraband drugs in prisons).
FYI - I'm not suggesting prison for users, but at least those who go to jail for other things, it's a chance to get clean.
Sadly, it seems there's just as much ideology and politicization of the 'harm reduction' approach as there is 'it's a crime/moral issue' approach.