Where’s the harm?

I’ve mentioned harm reduction before in the context of tobacco control. I’ve been wondering why it’s so low on the agenda and why when it’s mentioned at all, it seems to be only in relation to harm to public health. The reduction of harm to the user is assumed to cause harm to society in general. We have arguments against reduced risk products on the grounds that they will increase use and thereby increase the harm. It’s a position based on the notion that the harm of a product or activity is the best protection for society.

This begs two questions;

1. If the harm is reduced to the user, isn’t the harm also reduced to society?

It seems not; “to reduce the harm from drug use to the lowest level possible by … developing the skills of less dangerous drug use” can be perceived as condoning rather than condemning outright drug use. Indeed, a person might argue that the end result of condoning drug use might be an increase in drug use and ultimately drug related problems. There is also the suspicion that many of the fears associated with drug use are dispelled by harm reduction information strategies and these may have the unintended consequence of encouraging use among non-users.  This from a response to Clements, I., Cohen, J. & Kay, J., (1996) Taking Drugs Seriously 3, A Manual of Harm Minimising Education on Drugs. Healthwise Helpline Limited, Liverpool.

2. If this assumption is correct then why not increase the harm of products and activities to discourage anyone for engaging in them? End needle exchange and methadone substitution. Regulate inherently dangerous activities and products to increase the risk to  a risk of instant death! Where death isn’t possible, impose fines and/or prison sentences for the miscreants foolish enough not to abandon their wicked ways. Punish those who do obey but enable other to indulge.

 This got me thinking, where’s the harm?

If we accept that the harm of engaging in an activity is due to the nature of that activity, a risk intrinsic to whatever it is you do, then anything beyond that is an artificial and imposed harm. Standing outside in the rain to have a smoke, being subject to income disparity by taxation, facing prosecution for using cannabis, being ripped off or risking death by overdose or contamination for using drugs, catching infections  from dirty needles, prosecution or assault for involvement in the sex industry. All of these harms are imposed by society to protect the rest of society who don’t do any of these things from the risks inherent in doing the thing. You can see how illogical this is! If they are not doing it then they are at no risk and need no protection. The most obvious and easiest harms to remove are the ones imposed by the state. Decriminalisation is not just a sensible policy but the first and easiest step in reducing the harm from drug use. Once that is done we can then get on with product testing, education and health interventions.

The same for the sex industry, criminalising either the provider or the client is imposing harm where none existed. It doesn’t address the actual risks or harms and only adds to the misery of those suffering them.

It was the advent of  the AIDS crisis in the early 90’s which forced the Irish government to acknowledge a role for harm reduction in the area of treatment. IV drug users were identified as a “high-risk category” and so there was the discrete introduction of methadone maintenance, needle exchange schemes, all harm reduction measures designed to curb the transmission of the virus. All designed to reduce harm to the non-user while maintaining the state imposed harms to the actual user. Abstinence being the only officially approved harm reduction for users.

This kind of harm reduction is based on the assumption that others need protection from not just the harms of drugs but from the users of drugs. It imposes a stigmatisation and social exclusion which are harms in themselves.

This isn’t an alien concept, harm reduction is already being used to regulate all sorts of things. Promotion of condoms, use of crash helmets, safety belts or the provision of lifebuoys near rivers. It’s the basis for regulating the alcohol industry. The total failure of prohibition in the U.S. clearly demonstrated the value of reducing harm while accepting that abstinence will never be achieved .User’s face no social stigma for drinking, they don’t worry if their beer is safe to drink and they accept the limitations on use, by and large, because they recognise that it reduces harm.

Opposition to harm reduction is a moral position, not a pragmatic or evidence based position. Actually, strike that. It’s an immoral position based on prejudice! The fact that the first tentative adoption of harm reduction was a self-serving action only highlights this. If drug policy was genuinely based on morality then the desire would be first to help the user reduce the harm to him or herself. If morality is based on force, correction or prohibition then it’s immoral because it violates the first principle of a moral action. Do no harm.

If this short rant had piqued your interest in the concept of harm reduction, here are two more opinions. The first link is a must read. One of the best arguments for a far more liberal harm reduction approach which genuinely seeks to help the user.

If harm reduction is reduced to a list of WHO-prescribed interventions, avoiding the imperative for decriminalization, then harm reduction becomes part of the problem. It becomes a mechanism whereby autonomy is wrested from drug-using members of the community and placed in the hands of prescriptive, paternalistic medical structures.

The Harm Reduction Movement Needs to Rediscover Its Soul

This second one questions the Nordic Model of regulating the sex industry; (may be NSFW!)

“If you care about gender equality or poverty or migration or public health, then sex worker rights matter to you,”

The laws that sex workers really want

 

 

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