The best of harm reduction
Rob Calder writes about this important, and sometimes hotly debated, issue. The SSA website marks International Harm Reduction Day, beginning with Rob’s introduction to the topic in 1994, alongside a piece that looks at resistance to needle exchange programmes in the United States. Throughout May the SSA website will return to this theme, and as ever, welcomes comment and contributions.
The first time I saw a piece of harm reduction advice was in the Glastonbury ’94 programme sent to my brother along with his ticket. There was a short paragraph that said something along the lines of ‘drugs are illegal at Glastonbury, but if you choose to take drugs you should do so safely’. There were a few more paragraphs containing advice on how to do so.
“Declaring something as harm reduction is neither a reason to do, or not to do something”
I was amazed, I’d never seen anything like it before. For me, drugs were simply bad and there will be no more discussion thankyouverymuch. I showed the programme to everyone, I told my parents how amazing this was. They quite possibly then held an emergency meeting to decide if my brother really was going to Glastonbury that year (sorry Chris).
Although, of course, this was not the first piece of harm reduction I had encountered. I wore shinpads to reduce the harm from playing football. I used a lollipop person to reduce the risks of crossing the road. At primary school we walked in twos to reduce the risk of getting lost – not always successfully (sorry mum and dad).
But when I saw this paragraph in the festival programme (I can still remember where it was on the page), it struck me as something else, something new. That many drugs are illegal and can cause terrible harm of course makes a huge difference to the impact of such messages. Up until 1994, however, other forms of harm reduction hadn’t had anywhere near the same impact on me.
When I started working in addiction treatment services, 10(ish) years later, I enjoyed the debates about harm reduction. They were exciting and interesting. Now, however, I struggle to remember the last time I heard an original argument.
This is part of the problem. The term ‘harm reduction’ arrives with many pre-made arguments about gateways and about encouraging use, about seat belts and bungee jumping. About lollipop people and shin pads. They’re good arguments of course, and it’s good to hear the classics again. But they can be misleading and are rarely a good match to the subject being discussed. Is it really helpful to compare seatbelts with safer injecting facilities?
Harm reduction is not always a helpful category. Interventions are complicated and defining them as either harm reduction or not harm reduction can be…well… reductive. Opioid substitute prescribing, for example, can be viewed as treatment, or harm reduction, or both. A more helpful discussion is always to ask whether an intervention is effective and whether it has the potential to inadvertently cause harm. Some harm reduction measures are effective, some are not. Some have undesirable effects, some do not. Declaring something as harm reduction is neither a reason to do, or not to do something.
So, before I drift into a ‘best of’ harm reduction compilation, I thought I’d highlight several initiatives reported in Addiction News since January 2021 that might (if you were so inclined) be called harm reduction. If you have to call them something, it should probably be in reference to whether they work, and the evidence for their effectiveness. We should ask whether an old set of arguments can really apply across such a diverse and developing set of activities.
- New York Problem Gambling Bill; aiming to reduce the harm of gambling by providing education to people on self-exclusion lists
- Drug testing service in Canada; aiming to reduce the harm of using uncertain street drugs
- Remote Ketamine delivery technology developed; aiming to reduce the risks of overdose
- $30m pledged by the US government for harm reduction services; aiming to reduce harms across the country
- France bans drinking alcohol outside; aiming to reduce the harm from COVID-19 transmission
- Safe consumption site bills passed in New Mexico and Rhode Island; aiming to reduce the harms of injecting opioids
- Alaska passes take home Naloxone bill; aiming to reduce the risk of overdose
- Smoking banned on Barcelona beaches; aiming to reduce the environmental harms of smoking
- Ireland hands out 50,000 crack pipes; aiming to reduce physical harms from using crack
- Australia drug testing identifies ‘dangerous’ cathinone sold as MDMA; aiming to reduce the harms from using uncertain street drugs
by Rob Calder
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