Harm Reduction Drug Policy Research Articles

FROM BUDAPEST TO BRUSSELS: Discursive and Material Failure in Mobile Policy

AbstractThis article introduces an analytic of discursive and material failure, developing a spatial grammar for analysing both the discursive framing of policies as failed and the actually existing processes and effects of failed policy. Using the case of harm reduction drug policy in Budapest, I demonstrate how a successful policy was made to fail at the local and national scales, and how that failure in turn spurred the mobility of harm reduction's implementation across scales and into the European Union's Drugs Strategy. I show how focusing on policy failure exposes the politics of making and mobilizing urban policy, and how an analysis of failure can uncover unforeseen effects of the local politics of policy mobility. Analysing failure as both discursive and material allows scholars to break down policymaking processes into the political and practical elements assembled in policy mobilization. Discursive policy failures take into consideration the framing and accounting of actions, events and processes, while analysis of material failure begins with seemingly fewer political questions because of its focus on the technical. I argue that it is in understanding the relationship between material and discursive failure that the politics of urban policy mobility becomes a central question.

Harm reduction drug policy in Israel: what has been accomplished and what still needs to be done?

The leading formal drug policy in Israel is the traditional approach of abstinence, probation, and punitive measures based on three main pillars: Enforcement, Treatment and Rehabilitation, and Prevention. However, under the treatment pillar, Israel has adopted a number of harm reduction services, focused mostly on people who use heroin and people who inject drugs. These include Methadone Maintenance Treatment, Buprenorphine Maintenance Treatment, and Needle and Syringe Exchange Programs. More specialized services are designated mostly for people who use drugs, who frequent the largest open drug scene in Tel-Aviv. These include a health clinic, an emergency apartment for female addict sex-workers, and a ‘First Step’ center. Even so, the harm reduction approach has remained controversial, stigmatized, and is considered a sub-category for total-abstinence treatment in Israel. This paper follows the evolution of harm reduction interventions in Israel among people who use drugs and sheds light on the lack of a comprehensive, well-planned, formal national harm reduction drug policy. Additionally, this article expresses concern over the uncertain future of Israel’s comprehensive and balanced drug treatment policies caused by the structural changes in abolishing the Israel Anti-Drug Authority, the statutory authority and central body in Israel that promoted and coordinated all national policies related to treatment and harm reduction.ConclusionsAlthough it is a major challenge to translate worldwide evidence and research findings into action and social change, recommendations are offered to implement a comprehensive harm reduction drug policy led by a multidisciplinary group of policy-makers across all areas of drug policy. These focus on expanding and developing more services for Opioid Maintenance Therapy patients and people who inject drugs as well as a national effort to reduce high levels of stigma and discrimination against them, encompassing other common substances and focusing on populations such as adolescents and young adults that engage in other types of substance use such as cannabis, amphetamine-type stimulants, and hallucinogens.

Political struggles on a frontier of harm reduction drug policy: geographies of constrained policy mobility

This article contributes to the conceptualization of how policy models circulate by analysing the ‘frontier politics’ that occurs when a mobile policy meets resistance and constraint. We argue that advocates of harm reduction drug policy operate within a constrained political–institutional environment, but one that is not closed or predetermined. We make the argument in reference to struggles over harm reduction drug policy in Surrey, BC, a suburban municipality in Greater Vancouver. Thus, even at frontiers, policy change may occur, even if slowly, incrementally, or cautiously. In conclusion, we reconsider questions of constrained mobility, policy assemblages, and frontier politics to reflect on the character of, and possibilities for, policy change.

Mobilizing drug consumption rooms: inter-place networks and harm reduction drug policy

This article discusses the learning and politics involved in spreading Drug Consumption Rooms (DCRs) globally. DCRs are health facilities, operating under a harm reduction philosophy, where people consume illicit drugs in a supervised setting. Approximately 90 are located in almost 60 cities in 11 countries. They are intensely local attempts to improve the lives of specific populations and urban neighborhoods. DCRs are also global models that travel. This article examines the relationship between DCRs as facilities that are fixed in place and DCRs as globally-mobilized models of drug policy and public health practice. Drawing on research from seven countries, we apply concepts from the policy mobilities literature to analyze the travels of the DCR model and the political strategies involved in the siting of these public health service facilities. We detail the networked mobilization of the DCR model from Europe to Canada and Australia, the learning among facilities, the strategies used to mold the DCR model to local contexts, and the role of DCR staff in promoting continued proliferation of DCRs. We conclude by identifying some immobilities of DCRs to identify questions about practices, principles and future directions of harm reduction.

Assembling the dominant accounts of youth drug use in Australian harm reduction drug education

Education programs are a central element of Australian harm reduction drug policy. Considered less judgmental and more effective than the punitive policies of Australia's past, harm reduction drug education is premised on the goal of reducing ‘risks’ and harms associated with illicit drug use rather than an elimination of use per se. In this article I analyse two sets of key texts designed to reduce drug related harm in Australia: harm reduction teaching resources designed for classroom use and social marketing campaigns that are targeted to a more general audience. I identify two significant accounts of young people's drug use present in Australian harm reduction drug education: ‘damaged mental health’ and ‘distress’. I then draw on some of Deleuze and Guattari's key concepts to consider the harm reducing potential these accounts may have for young people's drug using experiences. To demonstrate the potential limitations of current drug education, I refer to an established body of work examining young people's experiences of chroming. From here, I argue that the accounts of ‘damaged mental health’ and ‘distress’ may work to limit the capacity of young drug users to practice safer drug use. In sum, current Australian harm reduction drug education and social marketing may be producing rather than reducing drug related harm.

Veritable inventions: cities, policies and assemblage

The purpose of this paper is to explore the notion of assemblage and how I have deployed it in my work on urban policy mobilities and harm-reduction drug policy. My research entails the detailed tracing of flows of policy knowledge among cities around the world. In detailing and conceptualising these circulations, I am interested in how they are actively and purposively assembled and negotiated in place in productive ways. The paper uses the case of harm reduction – a public health approach to the governance of illicit drug use – as a frame within which to discuss the benefits of assemblage in the study of urban policy-making, urban politics and global–urban connections.