Harm Reduction

History

The current harm reduction movement could be said to have its genesis in the Merseyside Medical Authority prescription program in England as well as the liberalization of drug polices and Junkie Union movement in the Netherlands in the 1970s and 1980s. The Merseyside Medical Authority, near Liverpool, England, began a harm reduction program to combat the rise of heroin use in the 1980s. The Merseyside program offered a full range of services to users that included education, needle exchange, therapy, employment and housing services, and medical care. A key service of the Merseyside program was the implementation of prescriptions for illegal drugs, which were administered under medical supervision.

Drugs such as heroin and cocaine are prescribed in smokeable, as opposed to injectable, form. In the Merseyside model, prescriptions were viewed as a means of outreach and retention, serving as an intermediate goal in the overall improvement of the users' lives. Law enforcement officers were also important partners in the program. Police officers referred users to Merseyside while at the same time reducing their presence in the vicinity of the outreach center so users did not fear arrest when accessing the facility.

In the Netherlands, harm reduction policies also arose from efforts by the Dutch to deal with an increase in drug use, particularly heroin, which began in the 1960s and escalated in the 1970s. Initial crime control polices did not curb the problem, leading to the formation of the Hulsman and Baan commissions to explore possible solutions to the issue. Based on the recommendations of these commissions, the Netherlands revised the Dutch Opium Act in 1976. This effectively decriminalized hashish and marijuana, and allowed for limited public sale in “coffee houses.” Shortly thereafter, in 1980, intravenous drug users in Rotterdam formed the Junkiebond or “Junkie Union” and began to agitate for policy changes, such as increased access to healthcare and housing. This movement spread throughout the Netherlands. Junkiebonds worked with government health agencies to set up and operate that nation's first needle exchange programs.

With the outbreak of acquired immune deficiency syndrome (AIDS) in the early 1980s, harm reduction gained legitimacy as a viable public-health approach to reducing human immunodeficiency virus (HIV) infections and other negative consequences across the spectrum of drug, alcohol, and tobacco use. Throughout the 1980s and 1990s, other Western European countries, Canada, and Australia incorporated various aspects of harm reduction into their national drug control policies. In 1999 the European Union adopted the reduction of drug-related disease and death as outcome measures in its drug control strategy.

In the United States, harm reduction has met more resistance than in other developed countries. U.S. drug control policy has progressed within two distinct, but complementary, paradigms. First, there is a crime-control paradigm (epitomized by the “War on Drugs” and zero-tolerance policies), which frames drug use as an individual moral failing and societal threat that must be eliminated through criminal sanctions. Second, there is a treatment paradigm centered on the disease model of addiction, which frames substance abuse as a physiological disorder that must be prevented and treated primarily through abstinence-based programs. Although the crime-control and treatment paradigms may appear to be at odds, both share abstinence as an ideological foundation and a drug-free society as a goal. Thus these paradigms can be mutually supporting. For example, the criminal-justice system can be a means to coerce people into treatment via mechanisms such as drug courts.

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