How should drug use be prevented?
In most countries, attempts to reduce drug consumption dominate the policy approach to alcohol, tobacco, prescribed and illicit drugs. Attempts to reduce drug use sometimes decrease consumption and also sometimes reduce harm, especially in the case of legal drugs.
Options
One option is to consider that harm reduction and drug law reform are quite separate and unrelated policy options. Another option is to consider that in a particular community, drug law reform might be desirable in the long term but some public health imperatives, such as the urgent need to control HIV infection among and from injecting drug users, require a harm reduction but not a drug law reform framework. This means that drug law reform may be considered an unaffordable luxury in the short to medium term.
Yet a third option is to consider that in a particular community at a particular time, drug law reform is not possible politically for the foreseeable future. A fourth option is to consider that as the majority of the present day harms from illegal drugs are the consequence of current drug laws, harm reduction carried out to its logical conclusion requires reform of these drug laws.
Discussion
Confusion about the extent to which harm reduction and drug law reform overlap, are synonymous, or are entirely separate entities adds to the bewilderment of an already confused area. A great deal would be achieved by the development of an international consensus about this question. The International Harm Reduction Association is ideally placed to try to increase international understanding about the overlap between these terms.
There are unquestionably some ardent supporters of harm reduction who are opposed to all forms of drug law reform. Often these individuals are relatively new to harm reduction; but sometimes support for separating harm reduction and drug law reform is particularly common in areas where harsh forms of drug law enforcement are strongly supported.
It is easy to understand that serious consideration of drug law reform in some communities is not feasible for the foreseeable future. Public health practitioners in these communities may be faced with a threatened or actual HIV epidemic among and from injecting drug users. These practitioners may quite understandably wish to avoid any threat to policies and programmes which could protect their communities from an extensive HIV epidemic. Even in these settings, it is hard to deny that the major obstacle usually preventing the implementation of effective public health programmes is the entrenched belief, unsupported by evidence, in the effectiveness of supply reduction policy. In these settings, harm reduction measures like needle syringe programmes inevitably require a more flexible interpretation of drug laws.
In almost all countries in the world for the last few decades, some drugs have been totally prohibited. Nevertheless, substantial demand for these drugs has continued to exist notwithstanding valiant efforts to suppress demand. Demand for these drugs has generally increased over the years. In the face of this growing and irrepressible demand, a vibrant black market distribution system has developed so that supply has risen to match demand. Most of the health, social and economic costs of drug use today result from the arrangements made by communities to protect themselves rather than being direct and pharmacologically predictable consequences of the consumption of these drugs. It is therefore hardly surprising that many harm reduction supporters argue that the logical extension of harm reduction is to reform the very drug laws responsible for most of the negative consequences.
Recommendations
Any decision about the extent to which harm reduction and drug law reform should be considered as separate entities or as indivisible aspects of the same philosophical framework can only be made at a local level. This decision will depend on local conditions. In some areas, the urgency of responding promptly and effectively to a threatened or actual HIV epidemic among and from injecting drug users or implacable support for harsh forms of drug law enforcement may encourage local public health practitioners to regard these entities as quite separate. In other communities, public health practitioners may well take the view that meaningful harm reduction inevitably requires reform of the drug laws considered responsible for most of the drug-related harm.
