Discuss the Potential For, and Barriers To, Implementing a Harm Reduction Approach as a Response to Illicit Drug Use at Local Level.

(1)   Introduction to Harm Reduction.

During the 1980s grassroots advocacy inaugurated a drug treatment approach in Amsterdam, Rotterdam, and Liverpool which later influenced policies in other European cities and several nations (MacCoun, Saiger, Kahan and Reuter, 1993). This new ‘bottom-up’ approach enunciated a typology of practical, pragmatic and conceptual policy goals that soon attracted increasing acceptance as a public health strategy - this policy was Harm Reduction (HR) (MacCoun, 1998). It was perceived as a judicious and successful, if somewhat controversial, third way option to the two traditional ‘bottom-up’ approaches, i.e. the disease and moral/criminal models of drug use and addiction. The former saw addiction as a biological/genetic pathology for which only prevention and abstinence was sufficient whilst the latter considered supply reduction through prohibition and punishment as the only suitable treatment. Accordingly, this emergent third way was a useful corrective to this ideological dichotomy as it ascribed credence to the multiple social and individual realities of the drug misuser (Erickson, Riley, Cheung and O’Hare, 1997). However, by seeking a judicious balance between the diversity of user realities and treatment options, it often had to reconcile positive and negative barriers to its implementation and concomitant continuation. This essay would address some of these barriers and conclude by considering how judicious HR actually was.

(2)   Background to Harm Reduction.

HR could be defined as “…an attempt to ameliorate the adverse health, social or economic consequences of mood-altering substances without necessarily requiring a reduction in the consumption of these substances” (Heather, Wodak, Nadelmann and O’Hare, 1993: vi). Accordingly, HR encouraged the user through immediate and realisable goals to be a proactive participant, to focus on their problem, and not to consider abstinence as the ultimate program objective (Single, 1997). This perspective sat in almost diametric opposition to traditional programs where zero-tolerance through abstinence was the only end objective (Inciardi, 2000).

HR was a revolutionary paradigmatic approach with a wide spectrum of policies and procedures that addressed problems from addiction to Acquired Immune Deficiency Syndrome (AIDS). The potential and indeed impact of HR programs had been considered for amongst others: youths/adolescents in schools (Poulin and Elliott, 1997); dance raves (Akram and Galt, 1999); needle exchange programs (NEPs) (Hughes, 2000); and in particular for early to late stage problem users (Inciardi, 2000). Indeed, its recent popularity was in response to the spread of AIDS amongst injection drug users (IDUs), i.e. NEPs (Riley and O’Hare, 2000).