As strong as the weakest pillar: Harm reduction, law enforcement and human rights

Abstract

The adoption in 2001 of a “four pillars” approach to drug addiction in Vancouver, Canada is widely viewed as a watershed in the city’s efforts to address one of the developed world’s most severe injection-driven HIV/AIDS epidemics. Vancouver’s HIV/AIDS epidemic first came to national attention in the mid-1990s with the publication of estimates that the city’s injection drug users were becoming infected with HIV at a rate of about 20% per year, and that HIV prevalence among injection drug users stood at approximately 30–40% (Baglole, 2003; Crary, 1997). Policymakers increasingly embraced the view that traditional approaches to drug addiction, emphasizing criminal sanctions against drug users and provision of drug treatment and rehabilitation, were failing to stem drug use in the city and explosive rates of disease transmission. The four-pillars approach, which emphasized a “balance” of prevention of drug use, treatment, law enforcement, and harm reduction, was meant to depart from “business as usual” and to add Vancouver to the roster of progressive jurisdictions that emphasized “evidence-based” rather than punitive approaches to drug use and related HIV epidemics. Deliberations of United Nations bodies in recent years suggest that other jurisdictions, as well as the UN itself, are also veering toward a global “balanced approach” to drug policy, one that ostensibly respects the role of both law enforcement and public health. This “balanced approach” is often expressed as meting out harsh punishment to drug traffickers and organized criminals, while treating drug users as “patients” in need of support and treatment. At the 48th ses