Harm Reduction Works: Evidence and Inclusion in Drug Policy and Advocacy
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Harm Reduction Works: Evidence and Inclusion in Drug Policy and Advocacy Alana Klein1 Accepted: 29 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Harm reduction · Human rights · Evidence · Advocacy · Knowledge production
* Alana Klein [email protected] 1
Faculty of Law, McGill University, 3644 Peel Street, Montreal, QC H3A 1W9, Canada
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Health Care Analysis
Introduction Harm reduction signals itself as pragmatic in contradistinction with prevailing moral (criminal) and disease policy models which have dominated since the twentieth century. Now the primary alternative to those prohibitionist and abstinence-oriented policy models, harm reduction begins from the starting point that drug use is an “inescapable fact rather than a moral issue”, and therefore seeks to reduce negative consequences of drug use rather than to eliminate it. In that sense, harm reduction is said to frame drug use “in practical terms of cost–benefit analysis rather than…ideology” [20 at 471]. Yet debates persist about when the evidence base for these initiatives is sufficient to warrant making them public policy [30, 34]. Pragmatism, or grounding in “what works”, is only one of the distinguishing characteristics of harm reduction. As harm reduction came to prominence in the early 1990s, it wa
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