Applying a ‘harm to others’ research framework to illicit drugs: political discourses and ambiguous policy implications

Abstract

During the past decade, ‘alcohol's harm to others’ (AHTO) has emerged as an international approach to studying alcohol problems and informing policy. The AHTO approach seeks to increase political will for alcohol policy by mapping, measuring and often costing harms beyond the person who drinks (e.g. family members, co‐workers). In this paper we consider the implications of a ‘harm to others’ approach for illicit drugs. We ask whether it could and should be used as a policy tool, given the high risks of further stigmatizing people who use drugs. We consider the ways in which the concept and measurement of ‘harm to others’ may be either productive or potentially harmful, depending on the extent to which the AHTO is replicated for illicit drugs. Shifting the language may assist: the term ‘harm from others’ appears to carry less risk of stigma. In addition, all harms inclusive of drug supply and drug consumption need to be included if a full picture of harms that accrue to other people from illicit drugs is to be achieved.

Harm to others from alcohol or other drug use is an inclusive frame for an important dimension: a response to Wilkinson & Ritter

“…Harm to others from alcohol or other drug use adds an important dimension in research. We agree with much of the analysis by Wilkinson & Ritter [1], but not with all of it.…”

Studying harm from others’ illicit drug use—can stigma really be avoided?

“…In their paper ‘Applying a “Harm to Others” research framework to illicit drugs: political discourses and ambiguous policy implications’, Wilkinson & Ritter [ 1 ] provide a welcome and critical discussion of using a ‘harms to others approach’ (HTO) to illicit drug use. Although several benefits of this approach are recognized, the paper concludes that if only HTO from individual drug use is considered, discrimination and stigmatization of drug users will outweigh the benefits.…”

Thinking beyond the individual, a response to commentaries

“…We thank the authors of the four commentaries [1–4]. We are pleased to have stimulated a wide‐ranging discussion about the application of an Alcohol's Harm to Other (AHTO) approach to illicit drug research [5]. Commentators have recognized the social and political dimensions to our argument.…”