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The Lure and the Loss of Harm Reduction in UK Drug Policy and Practice
Neil McKegancy, BA, MSc, PhD, FRSA
Since the late 1980s drug policy and practice within UK has been heavily influenced by the idea of reducing drug related harm. The paradigm of harm reduction, which has shaped drug treatment services grew out of the fear that HIV may spread rapidly and widely amongst injecting drug users. This article looks at the extent to which drug use or HIV have had the greater impact on individual and public health within UK and the extent to which it has been possible to reduce drug related harm in the face of continuing drug use. The article concludes that in the face of the growth in the prevalence of problem drug use over the last 10 years and the persistence of an array of drug related harms including: the extent of Hepatitis-C amongst injecting drug users, the extent of drug related crime and the impact of drugs on communities and families that it may be appropriate now to make drug prevention, rather than harm reduction, the key aim of drug policy and practice.
A Critique of Canada’s INSITE Injection Site and its Parent Philosophy: Implications and Recommendations for Policy Planning
Colin Mangham, PhD
This report provides a critical analysis of the evaluations done on INSITE, the drug injection site in operation in Vancouver, British Columbia, and billed as North America’s first medically supervised injection facility. In doing so, it provides a documented historical discussion laying out INSITE’s context within a national drug strategy that has been driven increasingly toward an ideology of harm reduction, as distinct from specific adjunct harm reduction strategies in support of a broader policy. An informed critique is made of the specific published INSITE evaluations. Serious problems are noted in the evaluations’ reporting and interpretation of findings. Specifically, the published evaluations and especially reports in the popular media overstate findings, downplay or ignore negative findings, report meaningless findings and overall, give an impression the facility is successful, when in fact the research clearly shows a lack of program impact and success. The published findings actually reveal little or no reductions in transmission of blood-borne diseases or public disorder, no impact on overdose deaths in Vancouver, very sporadic individual use of the facility by individual clients, a failure to reach persons earlier in their injecting careers and very little or no movement of drug users into long-term treatment and recovery. The fact that the evaluators and the funders of INSITE nonetheless have hailed the program as successful reveals a serious problem in drug policy today. It is argued that harm reduction has so permeated governments and the civil service and so politicized drug policy that evidence against the philosophy and its practice are being ignored, information is being managed in support of it, voices in opposition are decreasingly being included in drug policy dialogue and a culture of defensiveness has taken hold. This can only harm efforts to reduce drug problems and produce negative impacts on prevention and treatment, which are discussed along with other implications and recommendations for future policy directions.
Is It Harm Reduction - Or Harm Continuation?
Peter O’Loughlin
From a long career in treatment services, this author has first-hand experience in the practice of harm reduction and the consequences of applying it – which are not always positive. This author suggests ways of bringing greater clarity to the whole arena. The abandonment of abstinence as a goal in UK treatment practice is scrutinised with the conclusion that it could best be described as ‘harm continuation’. The interaction between national treatment bodies and ‘Whitehall’ (the UK government) and the enforced reconciliation of treatment needs and political interests is appraised and found wanting. Some hope is seen in scientific and pharmacotherapeutic current advances, whilst at the same time recognising the ongoing effectiveness of 12-step fellowships (albeit difficult to scientifically measure) and its ready correlation with the transtheoretical model. This author concludes that British practice facilitates continued drug/alcohol use – whether intentionally or consequentially – and that statistical smoke screens mask the process, a process which if not corrected is likely to increase rather than decrease society’s problems.
History of Harm Reduction – Provenance and Politics, Part 1
Peter Stoker C. Eng.
Published in three parts, the history of ‘so-called harm reduction’ - starting with its conception in and dissemination from the Liverpool area of Britain in the 1980s - is described in comparison with American liberalisers’ ‘Responsible Use’ stratagem in the 1970s and with subsequent so-called Harm Reduction initiatives in the USA, Canada, Australia, Britain and mainland Europe. The text takes extracts from or synopses of papers presented by various writers on both sides of the argument. Reasons as to why the packaging of ‘Harm Reduction’ has fared better than ‘Responsible Use’ are explored as are some possible reasons why the present, Harm-Reduction-biased situation has come about. The paper concludes by suggesting possible ways forward for those advocating a prevention-focused approach – learning from history. |
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