| Harm Reduction – the Idea and the Ideology
Professor Dr A. Hamid Ghodse, Member and Past President, INCB.The role of harm reduction within drug treatment services, against a background of emerging HIV infection is considered, and augmented by detail description of component services – needle exchange, substitute prescribing, and outreach services. The author concludes by commenting on the positives and negatives of harm reduction philosophy and practice, the basic aim of limiting harm amongst users being subjugated in some quarters as a ‘front’ for liberalisation of drug policies. The author argues for a more positive approach by health care professionals, rather than a sense of fatalism that can be induced by the very term ‘harm reduction’.
When Harm minimization is not harm minimization – Australia as a Case Study
Stuart Reece MBBS (Hons), FRCS (Ed.), FRCS (Glas.), MD, FRACGPThis paper is based on evidence given by the author to the Family and Human Services (FHS) Committee, House of Representatives, Parliament of Australia, in 2007. The Committee undertook an enquiry into the impact of illicit drugs in Australia and particularly the impact of harm minimization on Australian families. It released its final report on 13th August 2007 [1, Table 2.3, ] in which 31 recommendations were made. In general the committee were highly critical of various harm minimization practices in today’s Australia, on which some $500 million is spent annually. The evidence given by this author was extensive and detailed, and constituted an assessment of current harm reduction practices in Australia, comparing them where applicable to other countries, and concluding with detailed suggestions as to how a more health-promoting strategy and range of practices could be initiated.
The “Local” Matters: A Brief History of the Tension Between Federal Drug Laws and State and Local Policy
Kevin A. Sabet, Ph.D. In the U.S., drug policy is traditionally viewed as a national issue, since federal laws apply to all state and local jurisdictions. The historical review of drug policy presented in this article, however, shows that there remains a constant tension between drug policymaking by federal and state/local actors. Accompanying this dynamic is an ever-changing emphasis on either use reduction policies (i.e. those focused on reducing drug prevalence) or harm reduction policies (i.e. those focused on reducing the potential harms of both drug use and drug policies). Analysts need to be sensitive to these twin dynamics (federal versus non-federal loci of drug policy control and use reduction versus harm reduction philosophies) which result in considerable drug policy variation throughout the United States. A more accurate scope of drug policy analysis would focus on the juridical relationship between national, state and local policies and practices. History shows that these are not new phenomena in drug control, even if they are often overlooked in present-day analyses.
Putting ethics in its place – right at the heart of drug policy debates
Dr Gregory K Pike, PhDMaking decisions of an ethical and moral nature is part of the everyday business of human existence. It is not possible to be value free or to act without making a moral or ethical decision of one sort or another, for good or ill. Personal decisions about taking mind-altering drugs have ethical dimensions, and these frequently have particular reference to pleasure.Pleasure needs to be understood with nuance and distinctions made between pleasures which are in keeping with human fulfillment and those that are not. Ethics can also be valuable in understanding the roots of overarching policies like harm minimization. Harm minimization has its basis in the ethical theory of utilitarianism which judges actions by considering the balance between pleasure and pain. It is argued that this is a flawed approach and that harm minimization not only promotes unethical practices, but ultimately ends up failing the very people it seeks to assist. History of Harm Reduction - Provenance and Politics, Part 3
Peter Stoker C. Eng. – Director, National Drug Prevention Alliance, UKThe 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 various countries. The text takes extracts from or synopses of papers presented by various writers on both sides of the argument. As the scope of a historical review of Harm Reduction - over several decades and across several countries - is necessarily large, this paper is presented in 3 parts. Part 1 examines the developments in the USA; whilst Part 2 looks at Britain, Canada, and Australia. Part 3 considers mainland Europe, and then goes on to explore reasons why the package called ‘Harm Reduction’ has fared better than ‘Responsible Use’ as well as 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. | |
