Harm reduction as paradigm: Is better than bad good enough? The origins of harm reduction

Abstract

As the articles in the recent special issue on harm reduction illustrate, the last decade has seen an impressive expansion of harm reduction in public health. Policies and programs using it have dramatically improved the formerly ignored health problems of marginalized populations. This article looks at the history of harm reduction, and the growing role that the medicalization of social and political problems plays in the governance of the margins in the neo-liberal state. It describes how the acceptance of harm reduction approaches coincided with a political need to address social disorder and reduce expense in health and legal services, and criticizes the current assumption that more harm reduction services will automatically result in a more humane society. While this paper supports those authors who urge a greater political engagement from harm reduction advocates in public health, it also urges a direct political critique of the social and legal systems that create harm, and the harm reduction research that critically examines how harm reduction, while aiming to prevent harm in the short term, may sustain systems of harm in a larger sense.

Still “at risk”: An examination of how street-involved young people understand, experience, and engage with “harm reduction” in Vancouver’s inner city

“…Young people described how drug consumption could not be “by the book, every time,” underscoring how a focus on the individual “rational” and “responsible” drug consumer fails to take into account the social, structural and environmental contexts that powerfully constrain the “choice” to use drug use safely (Bourgois, 2000; Keane, 2003; Moore & Fraser, 2006; Rhodes, 2002; Roe, 2005, 2009). In particular, young people referenced addiction severity, periods of mental health crisis and extreme poverty as factors that constrained their ability to make “good” choices when it came to using drugs more safely.…”

Harm reduction, human rights, and access to information on safer abortion

“…"[B]y ameliorating their worst effects, harm reduction simply relieves the institutions of prohibition…of responsibility for those harms. It reduces their incentive to fundamentally change those damaging policies" [29]. In the legal case of A.B.C.…”

The Limits of Autonomy: Ideals in Care for People with Learning Disabilities

“…The organization Mainline (2013), for example, argues that forbidding is "not effective" and promotes policy aimed at harm reduction rather than abstention (Marlatt and Witzkiewitz 2010;Roe 2005;Stevens 2011), with emphasis on the consequences of use, such as criminal behavior and harassment. The second problem is that there is no authority to implement restrictions on use, unless things go seriously wrong and legal interference is warranted.…”