Harm reduction among cocaine users: reflections on individual intervention and community social capital

Abstract

This paper presents an update on the progress and barriers to harm reduction for cocaine users, with proposed new directions, since the overview of Erickson [Erickson Patricia G. Prospects of harm reduction for psychostimulants. In: Nick Heather et al., editors. Psychoactive Drugs and Harm Reduction: From Faith to Science. London: Whurr, 1993, pp. 184–210.]. Though not without challenges, various approaches for opiate use, ecstasy and cannabis—even alcohol and tobacco—have all advanced significantly throughout the 1990s [Erickson Patricia G, Riley Diane, Cheung Yuet W, O’Hare Pat, editors. Harm Reduction: A New Direction for Drug Policies and Programs. Toronto: University of Toronto Press, 1997.]. Compared to these drugs, initiatives for cocaine have been relatively few and far between. We use Zinberg’s organizational framework of drug, set and setting to summarize the available literature on the various expressions of harm reduction around cocaine. It is argued that it is the interaction of these components—that is the social context of use—rather than any one pharmacological feature that shapes the nature of cocaine problems. In particular, there is promise for harm reducing approaches to cocaine in a focus on the social environmental setting of cocaine use and access, applying the concept of community social capital.