Introduction: Reducing Harm Responsibly?

This article is part of the series:

The United Nations Office on Drugs and Crime (2021) estimated that, worldwide, 269 million people used drugs in 2018, a 30% increase since 2009. In the same period, the number of people with drug use disorders has risen to between 35 and 50 million. The massive increase in drug use has also led to a significant impact on the users’ health and health statistics more widely; for instance in 2017, opioid usage accounted for almost 80 per cent of the 42 million years of ‘healthy’ life lost as a result of disability and premature death (UNODC, 2021:15); a more than 22% increase in global opioid use disorder-related DALYs (disability-adjusted life years) was observed between 2005 and 2015 (GBD 2015). These numbers stress the need for substantial interventions;  and harm reduction measures are a prime candidate for success in treating drug use disorders worldwide.

Harm reduction practices for people who use drugs are generally understood to be about enabling a more responsible treatment of the body. Whether it is through the use of clean syringes and needles, ear acupuncture or (pharmaceutical) replacements of (illegal) substances, harm reduction practices are focused on producing a more responsible body. Given the ongoing governmental push to increase individual responsibilization, one would assume that, in particular, (neo)liberal states would adopt this set of harm reduction practices into their public health systems. However, very few countries have incorporated evidence-based harm reduction practices, such as safe injection sites, into their public health approach to treating the effects of drug use. Through our own research with people who use drugs in France, the UK and the US, we have observed this ideological and political paradox at the heart of debates about the theory and practice of contemporary drug policies.

This series’ contributors explore this paradox in different geographical, regulatory and administrative contexts: on the one hand the trope of responsible citizen fundamentally excludes (illegal) drugs from its practices – a tension that contributes to the continuous rise of the carceral state. On the other hand, society is increasingly obsessed with responsibilizing the body – through nutrition, exercise and measuring regimes, for instance. Self-management techniques are supposed to produce a perfectly productive individual – paradoxically, sometimes, through the use of licit and illicit substances. What happens when the ideologies of the ‘clean responsible citizen’ and ‘substance (ab)using productive body’ clash in a person who uses drugs?

In the first contribution to our series, “Incarceration as Harm Reduction: The realities of lethal street-based opioid overdoses in neoliberal Philadelphia,” Tali Ziv takes us to to the American East Coast to observe how judges use probation and incarceration as a form of harm reduction. In the second piece, Johannes Lenhard touches on the preface to the opening to France’s first safe injection facility in Paris. In “Criminalisation, harm reduction and responsibility in Polish drug policies”, Justyna Struzik describes competing logics of risk and responsibility in attitudes towards Polish citizens who use drugs. In “A cup of coffee and a needle”, Johanna Kinnock takes us back to Europe, specifically to Copenhagen, Denmark, with her observations on a harm reduction café. In Laroque, Foth and Gifford’s piece “Nothing about us without us. Really?’, the authors report on their fieldwork in Canada on what they found to be an ongoing ‘hierarchisation’ of lives in a harm reduction NGO. Eana Meng describes acupuncture as harm reduction; and the series concludes with a contribution from Jarret Zigon on what he terms ‘radical harm reduction’.  

Johannes Lenhard teaches and researchers at the Max Planck Cambridge Centre for Ethics, Economy and Social Change. While one strand of his research is concerned with survival practices of people experiencing homelessness in Paris, London and Cambridge; his most recent research is on the ethics of venture capital investors. His by-lines are with: ProspectSiftedConversationAEONCrunchbase and Vestoj among others. He published an edited volume with Bloomsbury entitled Home – Ethnographic Encountersand his monograph ‘Making Better Lives – Hope, Freedom and Home-Making among people sleeping rough in Paris’ is about to appear in May. Twitter: @JFLenhard.

Eana Meng is a first year medical student at the Harvard MD-PhD in History of Science program. Her research has traced the lesser known histories of the use of acupuncture by American activists (including those in the Black revolutionary movement) since the 1970s and the legacies that emerge from them, which include a five point ear acupuncture protocol currently used around the world for substance use and behavior health conditions. She is interested in the histories that sit at the intersection of radical politics of health, integrative/alternative healing modalities, community healthcare, the opioid crisis and pain, and crucial dimensions of race, gender, and class. Twitter: @eanam38.

Works Cited:

GBD 2015 DALYs and HALE Collaborators. “Global, Regional, and National Disability-Adjusted Life-Years (DALYs) for 315 Diseases and Injuries and Healthy Life Expectancy (HALE), 1990-2015: A Systematic Analysis for the Global Burden of Disease Study 2015.” Lancet (London, England) 388, no. 10053 (October 8, 2016): 1603–58.

United Nations Office on Drugs and Labor. World Drug Report 2020. UN, 2021.

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