Harm Reduction Agencies Research Articles

Rethinking Drug Markets and Societal Reactions to them: Contributions in Drug Policy Research

This issue of Contemporary Drug Problems consists of selected articles from the first Annual Conference of the International Society for the Study of Drug Policy (ISSDP). The conference was held in Oslo on March 22-23, 2007 and was attended by 75 researchers, mostly from Australia, Europe, and the United States.The ISSDP has been founded in recognition that drug policy has become itself a substantial research topic, engaging many disciplines. As reflected in the articles of this volume, it involves at a minimum criminology, economics, operations research, political science and public health. Though there are learned societies, such as the Society for the Study of Addiction (in the United Kingdom), the College on Problems of Drug Dependence (in the United States) and the Australasian Professional Society on Alcohol and other Drugs (Australia and New Zealand), that include drug policy in their remit, the topic is generally of marginal interest at those conferences. With the growth of the European Monitoring Center on Drugs and Drug Abuse, the topic and data related to it has become prominent in Western Europe. A preliminary meeting in London in December 2005 established that there was an interest in developing a new society and the Oslo conference was the first test of that proposition. The second Annual conference was held in Lisbon in April 2008 and it attracted twice as many Abstracts as did the first one.The principal purpose of the Society is to build a community. Interdisciplinary fields are always challenged in that respect. We are trained in a discipline and it is hard to reach outside of it. Yet all real life policy problems are multi-disciplinary and progress requires collaboration, and that in turn may require at least a partial redefinition of one's professional identity. For example, Jonathan Caulkins, one of the authors in this volume, is both an operations researcher and a drug policy researcher. He publishes in disciplinary journals such as Operations Research and Management Science and in journals of interest to drug policy analysts, such as this one and Addiction. The ISSDP aims to make more researchers feel comfortable with dual identities.This issue contains nine articles, all of which were subject to peer review; originally eighteen articles were offered for this issue. We believe the articles here nicely illustrate the range of issues and methods that the ISSDP intends to foster.In an analysis focused on the United States, Harold Pollack offers an appraisal of the challenges inherent to seeking a balance between deterrence and compassion in drug policy (an enduring tension as he puts it). He describes the political controversy over needle/syringe distribution programs (NSPs) within the United States, and highlights the difficulty experienced by the public health community in negotiating the politicised terrain around the concept of reduction. He carefully distinguishes the way in which syringe exchange for HIV prevention is a powerful, but unique case. He also emphasises that combining elements of both use reduction and reduction policies offers a pragmatic way forward, placing this within an emergent public sentiment in favour of viewing the latter as non-contradictory with the former. The article concludes with some tentative, hopeful signs that a more humane strand can become the guiding principle of future policy.In Identity theft? Re-framing the policing of organized drug crime in the UK as reduction, Martin Elvins offers a timely examination of the increasingly diverse use of the term reduction. The article focuses on the recent movement in use of the term away from its original emphasis on the rights of drug users towards a more broadly based, policy driven concept of community and societal harms linked to drugs. In discussing the 2005 attempt by the Home Office to develop a drug index and the emergence in 2006 of the Serious Organised Crime Agency (SOCA) as a harm reduction agency with law enforcement powers, the article explores the extent to which there has been a reframing of UK drug policy, the significance of reduction terminology in public understanding of illicit drug issues and argues that there is now a need to reconsider the current nomenclature, particularly in relation to user rights and law enforcement. …

Identity Theft? Re-Framing the Policing of Organized Drug Crime in the UK as Harm Reduction

The central defining characteristic of a harm reduction approach to drug policy, as argued by Lenton and Single (1998, p. 213), is it focuses on reduction of harm as its primary goal rather than reduction of [drug] use per se. However, Hunt and Stevens (2004, p. 337) note that while there is some consensus around what harm reduction is and what it has achieved, it lacks a formal definition. Caulkins (2004, p. 305) argues that the debate over the merits of harm reduction against use reduction approaches has - unhelpfully in his view - tended to conflate goals and interventions. On this basis, harm reduction has been seen as the province of drug treatment and public health interventions whereas use reduction has been seen as the province of law enforcement when in his view each is better characterized as a goal rather than a specific set of policies.Hunt (2004, p. 231) points out that harm reduction is most commonly characterized as a public health-based movement. It embodies, he suggests, a rights-based concept that positively asserts the claims of drug users to respect and dignity in the provision of health and social care services. Inciardi and Harrison (2000, p. vii) have also suggested that at the core of the concept of drug harm reduction is the belief that people who use drugs should not be regarded as enemies of the state. On one hand, harm reduction is characterized as a rights-based appeal to soften the hard edge of prohibition and its negative characterization of certain individuals but on the other, drawing on Caulkins distinction, it does not logically exclude policies that may at first appear to be integral to the enforcement of prohibition by the state, if they could be shown to have, say, public health benefits.Outside of the somewhat rarefied confines of the harm reduction debate any discussion of the political saliency of the term harm reduction in relation to public policy must be set against the deeply ingrained perception, held by a very significant constituency in liberal democratic societies, that success in drug policy coheres around some notion of stopping bad people.Furthermore, that the predominant harm associated with drugs has its root causes in the actions of criminals. Strategies to reduce drug supply are thus intrinsically bound in important ways to defense of the state in mainstream political discourse. This in turn has important links to the construction of harm that is applied. Despite the association of harm reduction with the personal well being of drug users a broader concept for understanding harm was developed in the early 1990s. Newcombe (1992) produced a schema of types of harm (health, social, and economic) that occurs on different levels (individual, community and society). As Hunt and Stevens note (2004, p. 337) this opens the possibility that harms to be reduced can encompass both drug users and non-drug users alike. However, the schema gives no guidance on how to value different types of harm.This article examines the recent emergence of an apparent reframing of the approach to drug policy by the government of the United Kingdom (UK) in terms of harm reduction. Law enforcement has been given a prominent role, exemplified by the self-declared description of the Serious Organised Crime Agency (SOCA), formed in 2006, as being a harm reduction agency with law enforcement powers. The article will examine the emergence of SOCA and the extent to which the redefinition of its role stems from a wider government attempt to reconfigure the UK approach to managing drug problems in relation to harm, and whether this reflects a more pessimistic, or a more pragmatic view of drug policy outcomes. It will explore the recent etymology of harm in UK drug policy discourse and ask whether in encroaching into an area that has hitherto encapsulated acceptance of the inherent limitations of law enforcement, SOCA shows that there is a need to reassert or redefine the use of concepts of harm in relation to UK drug policy. …

SACHR: An example of an integrated, harm reduction drug treatment program

In this article, we report on our work at St. Ann's Corner of Harm Reduction, a multi-service agency committed to implementing effective public health strategies in disenfranchised communities from a harm reduction perspective. Based on our experiences, we hope to contribute to the ongoing dialogue about the definition of harm reduction, while proposing to integrate harm reduction and abstinence-oriented treatment modalities into a model of comprehensive drug prevention and care. The five components of our harm reduction service provision are discussed, and a vignette is provided. We conclude with a plea for close collaborations between innovative researchers and harm reduction agencies, and a call for the full integration of harm reduction approaches into the substance abuse field at large.