Transform has organised a major session at the upcoming International Harm Reduction Conference in Bangkok next week, titled Can Harm Reduction End the Drug War, the session abstracts for which are copied below.
The broad principles of harm reduction have been widely adopted in much of the world but remain controversial for some political groupings in the prohibitionist camp. Some view harm reduction’s non-judgemental position and tolerance of continued use as tacitly condoning drug use, even encouraging or facilitating it, whilst for others the movement is portrayed as little more than a sinister ‘trojan horse for drug legalisation’. Yet for most working in the harm reduction field it is more simply a pragmatic set of principles and strategies aimed at, first and foremost, saving lives, and such debates are an irrelevance and distraction from the harsh day to day realities they have to deal with.
Whilst there is substantial support for moves towards legally regulated supply for some or all drugs within the movement – most obviously regards a medical model for prescribing of opiates - an anti-prohibtion / pro law-reform position does not yet feature specifically in the definitions or lists of harm reduction principles. Part of the reason for this is that it is far from the consensus view (particularly regards the wider debate around non-medical use), but there are also frequently aired practical concerns that vital harm reduction work might be jeopardised in some areas where it is most needed if more contentious elements of the drug law reform debate become too prominent. There is also an element of institutionalisation with the harm reduction movement – a reluctance to ‘bite the hand that feeds’ as it were and jeopardise funding (often from the state) through vocal dissent, a phenomenon that has similarly ensured a troubling degree of silence on drug law reform from the treatment sector (for more discussion see 'In pusuit of truth', by Danny Kushlick here - p.12).
Thus in contrast the claims of ‘Trojan-horse’ conspiracists, the drug law reform movement has in fact struggled to activate the wider harm reduction field, whose concerns are often far more immediate than the longer term goals of system wide legal reform. That said, a significant difference between the harm reduction movement and many of its most vocal opponents remains; it is at least genuinely open to honest intellectual engagement with the prohibition / regulation debate, which is now a regular fixture in harm reduction journals and conferences.
“Harm reduction approaches also seek to identify and advocate for changes in laws, regulations and policies that increase harms, or which hinder the introduction of harm reduction interventions.”Acknowledging the spectrum of views around what ‘harm reduction’ means, the important thing in the context of this discussion is to highlight the underlying principles of the paradigm, without necessarily endorsing everything done under its banner. From Transform's perspective Harm Reduction as currently described is somewhat limited in scope – a defensive position against the harms largely created by prohibition. It needs to evolve not only to more fully engage with the harms created by prohibition, as opposed to drug use harms, but also to evolve into a more creative and positive position that looks at wellbeing maximisation, not just mitigating harm.The International Harm Reduction Association
Can Harm Reduction End the Drug War?
For many in the drugs field, the harms caused by drugs are conflated by harms caused by the war on drugs – which makes harm reduction vastly more complex than it needs to be. This Major Session will explore the relationship between advocacy for harm reduction and advocacy to end the global war on drugs and replace it with an effective system of regulation and control.
The presentations will analyse which harms are created by the war on drugs and which are created by the use of drugs. The session will explore the extent to which harm reduction can reduce harms caused by the war on drugs and how the two movements can best work together. This session sets out to offer delegates the opportunity to explore issues that are rarely discussed in the harm reduction field – partly because of political pressures and partly due to the pressing need to save lives. It will be relevant to anyone in the harm reduction field whose work is influenced both by the behaviour of drug users and by the negative consequences of the war on drugs.
Ethan Nadlemann; Drug Policy Alliance
Time and location:
Thursday 23rd April, 11.30am , Queens Park Room2, Queens Park Hotel, Bangkok
Session presentation abstracts:
Differentiating between drug-related harms and policy-related harms
Steve Rolles Transform Drug Policy Foundation
There is a growing understanding and acceptance within the drugs field that a significant proportion of what are broadly termed 'drug related harms' stem directly from the policy of prohibition and the illicit markets it has inadvertently fostered. Attempts to disentangle the harms caused by drug use per se, and those created or exacerbated by policy, specifically the enforcement of punitive prohibitions, have been comparatively under-explored and specifically have not been a prominent feature in the harm reduction discourse.
This short presentation, as part of the proposed major session, will develop this theme by considering analysis from Transform Drug Policy Foundation and the 'Taxonomy of Drug Harms' by Reteur and McCoun (in 'Drug War Heresies' 2001). The broad analysis will then be illustrated by comparing harms associated with illicit use of 'street' heroin with supervised legal use of prescribed heroin. 'Prohibition harms' will be demonstrated to include:
- Dirty/shared needles (Hep C / HIV risk)
- unknown strength/purity (poisonings, infection, overdose risks)
- Drug litter
- Fueling large volumes of low level acquisitive property crime and street prostitution (low income dependent users fund raising to support a habit)
- Organised crime from local street dealing (including drug-gang violence and turf wars) to international criminal networks (links to conflict and terrorism)
- Destabiliation of producer countries (corruption and violence in Afghanistan)
A case will be made for the definition of harm reduction to be broadened to include the harms (or as the UNODC describes them 'unintended consequences') related to enforcement, for the harm reduction movement to more pro actively engage in the debate around the policy implications of this analysis; including changes to enforcement practice and alternatives to prohibition, and in the longer term, decriminalisation of use and legally regulated drug production and supply.
The Limits of Harm Reduction within the context of Prohibition
Donald MacPherson, Drug Policy Co-ordinator City of Vancouver
This presentation will consider the limits of harm reduction initiatives as a response to problematic substance use within the context of the criminalization of drugs and drug use. Harm reduction efforts take place in the margins between illegal underground drug economies, cultures of drug use and officially sanctioned efforts to deliver health care interventions and/or punishment to drug users and sellers. Current approaches to the use and sale of illegal drugs do not acknowledge how the criminalization of drug use limits the impact of health and/or criminal justice responses. International agreements that criminalize drug use have prevented communities from developing a full range of harm reduction interventions. These agreements have also prevented countries from developing alternative responses to illegal drug use and sales. The City of Vancouver has developed a strategy to prevent and reduce harm from substances that includes a call for dialogue on alternative regulatory mechanisms for currently illegal substances with a goal of maximizing prevention and reduction of harm. Regulation and control of currently illegal substances combined with social and economic development efforts can provide an alternative response to problematic drug use. This presentation will consider the significant limitations of harm reduction initiatives within a context of the continued criminalization of psychoactive substances in society.
Can Harm Reduction Win the War on Drugs? A Thai User’s Perspective
Paisan Suwannawong, Thai AIDS Treatment Action Group (TTAG)
Thailand drug policy consists of drug eradication, suppression and prevention approaches, with the heaviest financial and human resource investment on law enforcement and military techniques to achieve a “drug-free” country. Harm reduction is not included in its approach. In 2003, Thai drug policy reached its nadir when 2,500 people were extra-judicially executed and tens of thousands of other people allegedly associated with drugs experienced numerous other human rights violations in the name of drug control.
My community of both HIV-positive and HIV-negative people with a history of drug use is virtually the only group in Thailand to have publicly advocated against abuses committed by government sectors toward drug users. Thai drug users have introduced community-driven harm reduction interventions since the 1990s in spite of the ongoing repressive legal and policy environment: prior, during and following the infamous 2003 crackdown.
My presentation will depict the peer-led harm reduction interventions that we implement regardless of what stage of suppression the government wages, and how the drug war specifically effect the efficacy of our work. Our interventions are severely compromised by the lack of government support for this important rights-based public health approach. Until harm reduction policy becomes a reality in Thailand, drug users are placed at higher risk of HIV, viral hepatitis, TB and other severe diseases due to overemphasis on criminalization and resultant high rates of detention and incarceration.
The lack of support for evidence-based harm reduction approaches, plus the failure of relevant government ministries to recognize the various harms experienced by people who use drugs, combined with a criminalizing and stigmatizing environment condemns drug users and harm reduction workers to ultimately fail to make a significant impact due to the increased risk, extreme duress under which we work, lack of funding and political support, etc. Drug wars must be stopped.
The Bigger Political Picture: International Discourse on Harm Reduction and the Drug War
Sanho Tree. Institute for Policy Studies
Politicians and drug warriors often say that we know where the drugs are coming from, so why don't we stop them at the source before they can reach our kids? This is easier said than done. After decades of trying this simplistic strategy, more drugs than ever are reaching consumers. Despite spraying more than 3 million acres under Plan Colombia, coca cultivation has actually increased in that country and has been pushed into other countries in the region as well. In Afghanistan, attempts to curb opium poppy cultivation have been spectacularly unsuccessful. In both countries, hard line eradication policies have left peasant farmers with few economic alternatives and have helped drive some of them into the arms of insurgents.
There is simply too much ungoverned territory in the world and a relatively inexhaustible supply of impoverished farmers willing to take the risk of cultivating illicit crops. Attempts to eradicate these crops have been short-sighted -- trying to produce quick results (no matter how unsustainable) to meet the targets established by political officials -- while the economic development projects to compliment the eradication programs have been woefully under funded. In short, these supply side control measures have been about as effective as shovelling water.
The collateral damage associated with the drug war impacts the poor and people of color in ways unheard of to most harm reductionists. These lives are not squandered by necessity, but by political choice and accompanying neglect. Just as we advocate harm reduction policies for drug users on the demand side, there is a need for harm reduction in source country crop control on the supply side. This presentation will examine why these supply side policies have failed as well as the political dynamics driving this failed paradigm.