Caught Between the “Soft” and “Hard” Arms of the State: A Conceptual Apparatus for Situating the Formative Role of Drug User Organizations in National Policy-Making and Local Service Delivery –A Commentary

Abstract

The purpose of this commentary is to develop a conceptual apparatus for understanding the role of drug user organizations in the development and implementation of national harm reduction initiatives by extrapolating some general trends and important lessons derived from the collection of essays found in this special issue. The development of such a framework will include the findings of this research, while also suggesting systemic trends within which the role of drug users as “change agents” can be more generally examined. As these essays demonstrate, the formative role of drug user organizations in public policy can be evaluated from a number of perspectives. But rather than present a causal reason for why drug users become involved in policymaking and service delivery, I propose a structural framework that links the theme of drug users as “change agents” to the antagonism that exists between the state institutions of public health (PH) and law enforcement (LE) over the most efficient means to reduce injection-related harm. This approach, which is developed to a certain extent by the essays in this volume, will enable us to assess the strategies that characterize “drug user activism” as well as allowing us to examine the sources of power that become available to drug users when they organize their efforts collectively as civil organizations. In what follows, I will demonstrate how a universal asymmetry between the contradictory logics of PH and LE provides a tension from which to explore the myriad of forces that motivate drug users to become involved in service delivery and policy-making. While the specific antagonisms that exist in a particular country are relative to the ideological systems that inform its raison d’ˆ etre, the internal, push-pull relationship between these two poles (LE & PH) nevertheless provides a general framework to examine both the factors that motivate drug users to become politically active and the “sources of power” that