Harm reduction as “moral improvisation”: the role of frontline drug workers within Hong Kong’s abstinence-based drug policy

Abstract

Background Within Hong Kong’s prohibitionist, abstinence-based approach to drug use and policy, frontline drug workers (FDWs) are the key point of contact between the state and People Who Use Drugs (PWUD). Adopting a street-level bureaucrat perspective, we examine the role of FDWs in implementing drug policy in Hong Kong. Methods We conducted five focus groups (n = 17) with frontline drug workers (FDWs) to understand how they perceive their role in relation to the needs of PWUD, and their perceptions of the barriers to service provision. Results In responding to the needs of clients, FDWs engage in “moral improvization” wherein harm reduction principles inform practice. Their approach is shaped by Confucian values which center familial and social connections, and a liberal emphasis on personal responsibility, autonomy and self-control. FDWs locate barriers to the take up of services with personal characteristics of PWUD and with the abstinence macro-policy context. Conclusion The findings reaffirm the importance of the “bottom up” perspective in drug policy and the role of values in shaping drug services. It furthers the idea that harm reduction is a pragmatic adaptive strategy which can be tailored to cultural contexts, with implications for the acceptability of harm reduction interventions in Hong Kong.