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Harm Reduction Works: Evidence and Inclusion in Drug Policy and Advocacy

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Abstract

One of harm reduction’s most salient features is its pragmatism. Harm reduction purports to distinguish itself from dominant prohibitionist and abstinence-based policy paradigms by being grounded in what is realistic, in contrast with the moralism or puritanism of prohibition and abstention. This is reflected in the meme “harm reduction works”, popular both in institutional and grassroots settings. The idea that harm reduction is realistic and effective has meant different things among the main actors who seek to shape harm reduction policy. Drawing on scholarly literature about harm reduction, as well as examples from recent harm reduction advocacy efforts in relation to drug policy in Canada, this paper argues that harm reduction distinguishes itself through a unique “way of knowing”. Grassroots harm reduction advocates, particularly as they argue through human rights frameworks, do more than simply make claims for the provision of particular services—like needle exchange, safe consumption sites, safe supply and the like—on the basis that these are realistic paths toward the health and well-being of people who use drugs. Rather, as they marshal lived experience in support of these policy changes through peer-driven initiatives in contexts of prohibition, they make particular claims about what constitute valid, methodologically rigorous evidence bases for action in contexts where policies to date have been driven by ideology and have developed in ways that have excluded and marginalized those most affected from policymaking. In doing so, they advocate for the centrality of people who use drugs not only in policy-making processes, but in evidence production itself.

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Notes

  1. Universal Declaration of Human Rights, 10 December 1948; International Covenant on Civil and Political Rights, 19 December 1966, 999 UNTS 171 [51, 52].

  2. These include the preamble of the Constitution of the World Health Organization, 19-22 July 1946, WHO (entered into force 7 April 1948); the Universal Declaration of Human Rights, 10 December 1948, UN art 25, and the International Covenant on Economic, Social and Cultural Rights, 16 December 1966, 2200A GA XXI art 12 (entered into force 3 January 1976) [51, 52].

  3. See Committee on Economic, Social and Cultural Rights, General Comment No. 14, The Right to the Highest Attainable Standard of Health, UN Doc. E/C.12/2000/4 (2000) at paras 50 [12].

  4. See Committee on Economic, Social and Cultural Rights, General Comment No. 14, The Right to the Highest Attainable Standard of Health, UN Doc. E/C.12/2000/4 (2000) at paras 50, 43(f) [12].

  5. The Canadian Association of People Who Use Drugs (CAPUD) states in its manual “This Tent Saves Lives: How to Open an Overdose Prevention Site” (31 August 2017) that “OPS have been initiated in Canada because of the overdose crisis and the lack of rapid response from health authorities. OPS are grassroots and peer-driven initiatives that operate outside the health care system, federal drug laws, and the bureaucracy of government. OPS have proven to be a powerful tool for motivating provincial and municipal governments to take long overdue action.” [5].

  6. The court concluded that the refusal violated the life, liberty and security of the person guaranteed by s. 7 of the Canadian Charter of Rights and Freedoms, and that this unjustifiable infringement was arbitrary and grossly disproportionate to any purported benefit of criminalizing people accessing this service. It stated at para 136: [T]he potential denial of health services and the correlative increase in the risk of death and disease to injection drug users outweigh any benefit that might be derived from maintaining an absolute prohibition on possession of illegal drugs on Insite’s premises.”.

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Acknowledgements

Funding was provided by Social Sciences and Humanities Research Council of Canada (Grant No. 245255). The author would like to thank Yasmeen Dajani and Yuan Stevens for their excellent research assistance.

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Correspondence to Alana Klein.

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Klein, A. Harm Reduction Works: Evidence and Inclusion in Drug Policy and Advocacy. Health Care Anal 28, 404–414 (2020). https://doi.org/10.1007/s10728-020-00406-w

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