Harm Reductionists Research Articles

HUMAN RIGHTS AS MORAL PROGRESS? A Critique

In this article I critically engage the view that the enactment of human rights is the enactment of moral and political progress. Drawing on my research of international and local harm reductionists in Russia, I focus on these activists’ arguments for and suggestions of rights-based legislation. I contend that such arguments are not only made according to the logic of security, prosperity, and normativity, but that the realization of such legislation primarily results in the strengthening of already existing state-government apparatuses. It is argued that such human rights activism is perhaps better understood in terms of post-Cold War democracy building rather than a concern for the health of injecting drug users as such. It is this institution building that the human rights industry calls progress, and it is this notion of progress that is called into question in the article. It will be argued that this human rights practice is best understood in terms of repetition, and such repetition ultimately marks a limit for the political and moral activity possible in the name of human rights.

Exploring the existence of drug policy ‘ideologies’ in Australia

Aims: Knowledge of public opinion towards drug policy is often limited to analyses of individual survey questions. There has been less thought given to the underlying structure of public opinion, and how attitudes towards different facets of drug policy, for example, law enforcement and harm reduction, might align into ideological positions. This paper aims to assess the extent to which distinct ideologies are present among the general public in Australia in relation to drug policy.Method: The study involved a Latent Class Analysis of data taken from the 2010 National Drug Strategy Household Survey. The analysis categorized individuals into mutually exclusive groups (classes), according to their responses to 15 attitudinal items.Findings: Six classes of individuals were identified, and were labelled as: uninformed, ambivalent, detached prohibitionists, committed prohibitionists, harm reductionists and legalizers.Conclusions: The unique analysis presented in this paper demonstrates the existence of six distinct classes of opinions towards drug policy in an Australian sample. Whilst there were a large proportion of respondents in support of both drug legalization and harm reduction, there were also many who opposed drug legalization, yet supported harm reduction. Any assumption that supporting harm reduction automatically equates with support for legalization, is erroneous.

Afterword: Police, policing, and HIV: new partnerships and paradigms

The important work in this volume tells us some powerful truths. It has long been clear that law enforcement has critical roles to play in protecting the health of the public, and that law enforcement entities have legitimate concerns of public safety, security, and protection. That these roles have led to a broad array of responses to substance use and substance users, which have ranged from harmful to helpful, has also been clear. But in the research and policy pieces brought together here by Nick Crofts and Nicholas Thompson and colleagues, a new paradigm emerges with the potential to have real impacts on key shared goals. Harm reductionists seek to see declines in the health and social consequences of substance use, including reductions in new HIV infections that will be so key to the trajectory of HIV epidemics in much of the world. Law enforcement seeks to see declines in crime, in insecurity, and increases in public safety. Both groups, and all of society more broadly, need to seek declines in unnecessary detention, incarceration, and the destruction of young lives which the use of detention for substance use has wrought. The new paradigm suggests that these goals are not inherently antagonistic—and indeed, are powerfully synergistic. How? By re-envisioning the role of law enforcement as supporting harm reduction, evidence-based substance use treatment, and the protections of human rights for all citizens, the goals of disease prevention and public safety can both be met. Harm reduction is an effective outreach tool for prevention, for public safety, and for accessing those who want, and need, access to drug treatment services. Partnering with law enforcement in new strategic alliances can empower public health authorities, and allow the voices and concerns of substance users to be heard in debates relevant to their lives and needs. And, as Professor Crofts has shown, police to police dialogues can be steps in the process of moving from aggressive resistance to harm reduction, to an embrace of the principles of engagement, health-centered approaches, and pragmatism. What remains to be done? As the reports here demonstrate, the ongoing use of detention, particularly novel forms of administrative detention without trial for substance users in Southeast Asia and in China, have emerged as real threats to the health and wellbeing of people who use substances or who have been detained for their putative use. These facilities continue to expand in too many countries, and continue to profit from the unpaid labor of detainees. This approach to substance use violates public health principles and human rights, but also undermines the role of law enforcement, creating parallel systems under uncertain legal grounds and often outside the scrutiny of courts and legal systems. This is bad public policy, bad public health, and threatens to undermine the impressive advances in policing practice documented here. We can do better. And the evidence now suggests that many states and countries are doing better. The theme of the 19th International AIDS Conference in July of 2012 is “Turning the Tide Together.” The theme attempts to capture the new optimism that an “AIDS Free Generation” is possible with the impressive new tools and policies we now have to fight HIV. But this optimism is tempered by the very real concern that HIV continues to spread in some key populations, including people who inject drugs. Yet this is one population where the evidence is the most abundant that HIV spread can be almost entirely prevented with an affordable package of services, including harm reduction, effective drug treatment, and access to anti-viral therapy for those living with the virus. This is one fight we know how to win. But we cannot win it without the engagement and support of law enforcement as partners in the HIV effort. With the new paradigm presented here this fight can be won, and an AIDS free generation just might be possible. What an achievement that would be for all who are working on these issues, public health, affected communities, and law enforcement. That’s the “together” part of the AIDS 2012 theme, and you have in your hands part of the blueprint for the way forward.

Public health or human rights?

The original paper (Hunt, 2004) was born out of recogition that my personal views had changed and that I had oved from ambivalence about a right to use drugs towards fuller recognition that people should be entitled to detercame apparent to me that there was merit in urging a more rigorous examination of our underlying assumptions about the rights of drug users to use drugs, and the intellectual and policy territory this takes us towards. Regardless of what might be written in formal definitions, it seemed useful to write the paper as a provocation that asks harm reductionists to interrogate their own beliefs and consider what might be implied in order to be true to these. The paper can, and has, been read as a call to redefine harm reduction but its first intention was, instead, to act as a call for introspection and logical consistency. Although ambiguity may be very practical within definitions it was primarily ambiguity of thought that was in my sights.

Public health and human rights: the virtues of ambiguity

“If it ain’t broke, don’t fix it” says folk wisdom. The harm reduction and drug law reform movements have created more drug policy reform in the last 20 years than ever before. There are more drug policy reform and harm reduction organizations with more members and activists than ever before. More nations are moving away from the punitive prohibition model pushed by the US and toward policies based on harm reduction principles than ever before. So what current conjuncture of events is pushing harm reductionists and drug policy reformers to choose either a strong-rights model rooted in John Stuart Mill’s (1946) sovereign self or a weak rights model rooted in public health principles? Do the re-negotiation of important international treaties (Bewley-Taylor, 2003) or pressing pieces of national legislation hinge on this choice? Will harm reduction services cease to be delivered unless allegiance is sworn to one? Have harm reductionists and drug law reformers been hampered by failing to choose between these two models? It is not clear that if some official choice along such lines were made, a vexing problem would be solved. Neil Hunt’s (2004) sensible and fair-minded essay on these questions provides the welcome service of framing the issues clearly and reflecting on what the different positions might mean. In outlining distinct “stylised” versions, Hunt “attempts to capture the essence of two possible, contrasting positions” which he intends “as an aid to analysis”. It seems odd to question the value of greater clarity, but I believe such clarity can entail certain risks that are also worth thinking through. To start with, are the harm reduction movement and the drug policy reform movement one and the same? Are there people who identify as harm reductionists who do not also favour of drug law reform? Are there people who identify as drug law reformers who do not also favour harm reduction? There no doubt exist some harm reductionists whose

Public health or human rights: what comes first?

Respect for human rights is a defining feature of harm reduction, which is commonly characterised as a public health-based movement. The importance it attaches to ‘user-friendliness’ and the view that drug users have a right to the same respect and dignity that other users of health and social care services receive is largely undisputed among harm reductionists. Within harm reduction there is also a developing discourse identifying drug use itself as a human right; nudging harm reduction towards being a rights based movement. This allows us to describe two philosophies of harm reduction: a ‘weak rights’ version, in which people are entitled to good treatment and a ‘strong rights’ version that additionally recognises a basic right to use drugs. Prioritising human rights or public health can lead to different concepts of harm reduction and different forms of ‘right action’. Privileging health may even, in some circumstances, be consistent with prohibitionary policies if these reduce harm. By contrast, the strong rights version of harm reduction subordinates public health considerations to the right to use drugs and implies support for policies that may sometimes increase harm. In the UK, the publication of ‘The Angel Declaration’, which recognises a right to use drugs and proposes a skeletal regulatory framework for a post-prohibition era, adds to the impetus for harm reductionists to clarify whether they fully embrace a right to use drugs within their understanding of harm reduction. This paper elaborates these issues in the context of the constraints upon the development of an evidence-based approach to controlling drug use that arise from the UN Conventions of 1961, 1971 and 1988.

Harm reduction — a historical view from the left

The harm reduction movement formed during a period in which social movements of the working class and the excluded were weak, neo-liberalism ideologically triumphant, and potential opposition movements were viewed as offering “tinkering” with the system rather than a total social alternative. This climate shaped and limited the perspectives, strategies, and tactics of harm reductionists almost everywhere. In many countries, this period was also marked by a “political economy of scapegoating” that often targeted drug users as the cause of social woes. This scapegoating took the form of “divide and rule” political initiatives by business and political leaderships to prevent social unrest in a long period of worldwide economic trends toward lowered profit rates and toward increasing income inequality. However, times have changed. Mass strikes and other labor struggles, opposition to the World Trade Organisation and other agencies of neo-liberalism, community-based protests against belt-tightening, and other forms of social unrest have been increasing in many countries. This opens up the possibility of new allies for the harm reduction movement, but also poses difficult problems for which we need to develop answers. On-the-ground experience in alliance formation needs to be combined with careful discussion of and research about what approaches work to convince other movements to work for and with harm reduction, and which approaches do not. Class differences within the harm reduction movement are likely to become more salient in terms of (a) creating internal tensions, (b) increasingly, opening up new ways in which working class harm reductionists can organize within their own communities and workplaces, and (c) producing different strategic orientations that will need to be discussed and debated. As a movement, we will need to find ways to accommodate and discuss differing perspectives, needs, and assessments of opportunities and threats without paralyzing harm reduction activities.

Networks and HIV risk: an introduction to social network analysis for harm reductionists

There is considerable evidence for the belief that networks affect the probability that an injecting drug user (IDU) becomes infected with HIV; the speed with which HIV travels through communities of IDUs; and the extent to which IDUs engage in risk behaviors. This paper gives a brief overview of network concepts and methods and discusses how prevention projects and /or user groups might become involved in network research alongside academic and public health researchers.

Comments on “Harm Reduction and Decriminalization in the United States: A Personal Perspective,” by Robert L. DuPont

I think there is a fundamental fallacy in the author’s comparison of social and economic costs of licit drugs (alcohol and tobacco) and presently illicit ones. The fact that the social economic costs of the former type of drugs are much higher than those of the latter type does not necessarily imply that legalizing illicit drugs would lead to a tremendous increase in the social economic costs of use of these drugs. For example, legalizing homosexuality does not lead to widespread practice and hence large social economic costs of homosexuality. The point is that it is the responsibility of the author to establish the claim that legalizing presently illicit drugs will cause their social economic costs to increase in the same direction as alcohol and tobacco. Also, harm reductionists would not advocate the legalization of all illicit drugs. In many places in the paper, the author quite deliberately equated harm reductionist and legalizationist views in order to discredit the former. I was quite struck by the author’s view that because needle exchange programs concerned only the risk of HIV transmission, they fell short of recognizing the need for reducing harm due to IV drug use, which would require a prohibitionist drug policy. I believe needle exchange programs are very sensible programs simply because we could not wait until IV drug use is successfully curbed by prohibition. We know so well that after so many decades of prohibition, there are still large numbers of IV users. The fact is that the prevention of spread of HIV among IV users couldn’t wait! Why did the author