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Defining "Harm Reduction" - An On-Going Debate.

Jamshyd

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This thread has been inspired by a recent tangent I got into in CEP. I'd link it here for posterity, but it is so riddled with irrelevant sub-arguments that I think it is best that we start anew while keeping in with the problem presented:

Like everything else Drug-Related, the mere mention of HR is bound to polarize people of different persuasions. There is an on-going debate about the definition of "Harm Reduction" within and amongst drug users themselves, HR-related NGO's, and Policy-makers.

First, I will post the definition of HR that is formally adopted by most entities dealing with it, for example:

IHRA said:
Harm reduction refers to policies, programmes and practices that aim to reduce the harms associated with the use of psychoactive drugs in people unable or unwilling to stop. The defining features are the focus on the prevention of harm, rather than on the prevention of drug use itself, and the focus on people who continue to use drugs.

Source: International Harm Reduction Association.

Very similar definitions can be found in other sources, including college textbooks, as well as being Bluelight's mandate (unless I'd been doing something wrong all these years ;)).

The problem is that, over-time, disparate instances of harm-reductive practices have inevitably converged to give rise to a philosophy of HR based on commonalities between these practices.

Because of the fact that a central concept in HR is the tolerance towards the individual's continued drug-use and instead focusing on minimizing the risks associated with that use, a major debate arose as to whether HR should necessarily entail de-penalization of drug users (and, to some, the legalization of drugs by extension).

For example, the Canadian Centre on Substance Abuse published a paper detailing their position in the debate. They conclude:

(Hunt 2003) said:
For some, harm reduction has evolved into a philosophy for dealing with drug abuse and addiction. We would argue that ―harm reduction‖ is not a single entity, but consists of any number of programs, policies and interventions that seek to reduce the adverse consequences of drug use, be it alcohol consumption, smoking or injection drug use.

(...)

The argument is sometimes made that harm reduction is far more than a term or a sampling of interventions drawn from its menu, but rather that it constitutes a philosophy. Adopting what is often positioned as an "all or nothing" approach simply reinforces the fears of those opposed to endorsing an open-ended definition. If this remains as a precondition of agreement on harm reduction measures, then we can despondently project little change for the future. It is time to break free of strongly held positions and to commit to understanding harm reduction measures as part of a comprehensive continuum that also includes prevention, education, detoxification, treatment and follow-up.

The debate is best illustrated from both sides in A widely-cited literature-review by Neil Hunt (VERY recommended background reading, both for this thread and in general, for those active in HR).

ome people consider that harm reduction’s underlying tention is to achieve drug law reform and promote the legalization of drugs. It is an undeniable fact that some advocates of harm reduction are also advocates of drug law reform and the creation of some form of legal, regulated market, for some or all drugs that are currently proscribed and, effectively, unregulated. Equally, many harm reductionists would oppose such developments. Yet others would reject dealing with drugs within the criminal law but retain civil penalties for drug use. There is no consensus on this issue among harm reductionists.

Some harm reductionists would, and do, argue that public policy regarding drugs - including the prevailing system of drug prohibition - should be subject to a utilitarian appraisal that evaluates the costs and benefits of prohibition and bases policy upon the evidence of what works best. This somewhat glosses over the considerable difficulties of generating good evidence in this area; although there is a developing and instructive evidence base concerning depenalisation policies, primarily with reference to cannabis, which is summarised in section 3.4.


(He then goes on to talk about the CCSA's position outlined above as a typical example of the other side of the argument.)

----

So with this at the table, I'd like to hear what people think here. I am especially interested by those of you who have positions of authority (doctors, teachers, etc.), as well as those who have an understanding of Social Theory (I have at least three in mind ;)). Any opinion is welcome, as we are all on a HR forum :).

My personal opinion can be found in the following post.
 
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Now, my personal opinion on this (as one who is active in HR on- and off-line), and I'm pretty sure the opinion of a large selection of BL'rs if DITM responses tell us anything, heavily leans toward the "HR-as-a-philosophy" (principled) side rather than the "HR-as-a-set-of-practises" (pragmatic) side. However, from the outset allow me to clarify that my extreme disagreement with the pragmatic side does not prevent me from working with them to achieve this common goal. It is with the latter point that I actually agree with the CCSA: that ideology ought to be secondary to goals.

With that said, allow me to begin by quoting Hunt's own definition of HR:

In essence, harm reduction refers to policies and programmes that aim to reduce the harms associated with the use of drugs. A defining feature is their focus on the prevention of drug-related harm rather than the prevention of drug use per se. One widely-cited conception of harm reduction distinguishes harm at different levels - individual, community and societal - and of different types - health, social and economic (Newcombe 1992). These distinctions give a good indication of the breadth of focus and concern within harm reduction.

I have bolded a line that I think is critical, and I couldn't help but note that community and society were simply left out of their formal definitions. This is because if we are to accept that that individuals are shaped by their communities, and if we are to accept that societies emerge from the individuals and communities whom they comprise, then we would have to agree that reducing harm for the individual and community necessarily means reducing harm for society, and vice-versa. This would inevitably lead to the question of the societal-harms of criminalization and penalization.

If we are to examine society as a power-dominant structure which is comprised of various smaller structures or institutions (Education, Law, Medicine, etc.), themselves comprised of hierarchies of power-relations; we would clearly find in policies, textbooks, and diagnosis manuals an implicit, but very clear lack of acceptance of the drug-user’s validity as a human. This is demonstrated primarily through the criminalisation of the drug-user, and in some cases the medicalization thereof. As such, we are not surprised that drug-users are ostracized within their own communities, thus compromising their social-integration. The drug user, when not behind bars, is either a criminal or a sick person, or potentially either, or both. He is a mythological creature that exists on the periphery of human reality, occasionally appearing and disappearing, but never recognized as essentially-human. This, of course, is the conclusion derived through a systemic-analysis to arrive at the status-quo. There may be individuals and groups (such as BL and the HR-related ones discussed here) that have a more humane outlook on drug-users, but their opinions are, as it stands, heterodox with regards to the abovementioned reality-consensus implied by the dominant structure.

This systemic stigmatisation of the drug-user is every bit as, if not even MORE harmful, than the drug-use itself. It harms the community by alienating its youth, it harms society by allowing atrocities like the War on Drugs to gnaw on financial and social resources endlessly and legitimating the imprisonment of what could have been a productive members of society otherwise. Going back to Hunt’s paper, we find a very succinct survey of research examining the social and community harms of the penalization of drug-users (subsection 3.4, see link above).

Ignoring the social impacts of penalization makes life easy, but doesn’t change the fact that we’re lying to ourselves by ignoring the social aspect of HR. So long as the dominant structure ostracizes the drug-user, the pragmatic part of HR (it’s apparently-successful application), is at best incomplete. So long as the War on Drugs is alive and well, any successful application or HR is successful in spite, rather than because of the power-dominant structure. It would take a systemic paradigm shift, a “turn” in all institutional practises that exclude or otherwise subjugate the drug-user by denying her humanity, for HR to become an integral part of society, hence extending its scope to Social-HR.

And indeed, even with those who left out society from their formal definition, nevertheless implicitly but clearly express the fact that society is just as important as the individual when it comes to HR. Observe the subsections as you scroll down IHRA’s. And as for bodies like the CCSA, it is understandable that one seeking change within the bounds of the system would attempt to present their view as objective and free of ideology. But as such, they are in fact implicitly consenting to the same status-quo that has been shown to cause harm to individuals and communities that they are trying to help.

I do not purport to be neutral on the matter. I have strong biases shaped by my (limited) training in Social Theory, namely the neo-marxist point of view. That said, I also realize that the current reality only allows me to work within the bounds of the law. I think it is wrong not to take an opportunity to help others, even if you realize that said opportunity is nothing more than bone thrown to us by the master, and can be taken away any time at his whim.

(Thank you for reading!)
 
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I'll gladly chime in as a voice from the world of healthcare.

Harm reduction is a medically practiced concept. There are clinical cases of people who are deemed, based on the best available hard evidence, to have an unquestionably better quality of life on one or more Schedule II~V psychotropic drugs due to their physical or mental condition. The drug(s) are scripted at the lowest effective dose, with a dosing and lifestyle modification protocol that aims to reduce the risk for harm from the drugs' side effects. There are a lot fewer of these medical system legitimized cases than you might think. Whether this is due to stingy or skittish underutilage of harm reduction prescription courses, or whether it really represents a low number of people for whom it works or is warranted (as it currently exists), is not an easy question to answer, and a big part of the controversy surrounding it.

Does harm reduction, as defined from the source you quoted, lead directly to decriminalization? Clearly. That's what the schedules are for. A medically, surgically, or psychiatrically warranted medication that happens to have recreational potential can be made legally available in a tightly controlled way, with the aim of the drug getting (ideally) only to the people who need it, and lessening the harm inflicted on society by lessening drug abuse.

The problem, as I'm sure we're all aware, is that there will always be a certain number of people who seek any available drug with recreational potential for its recreational effects primarily. To alter one's mental reality is an ancient urge that's never going to disappear entirely from any society.

The solution, as I see it, is the foundation of institutions -- hence, the institutionalization -- of the social use of drugs that are medically deemed to have a very low individual and interpersonal risk for harm (including dependancy), when used ritually, socially, and sporadically, in modest doses.

Drugs I've tried that one could probably found clubs or fraternal orders for the responsible usage of:
* Marijuana
* MDMA
* DXM
* Ketamine
* n,n-DMT
* LSD
* psilocybin mushrooms

One of these clubs or orders would be pretty amazing to imagine. I'm picturing large compounds with lots of privacy, where users would gather and remain for the duration of the drug's effects. Ideally the buildings would be well-integrated with respectable neighborhoods, but secretive and secure just the same. There'd need to be elaborate and fun-but-serious protocols, rituals, and traditions surrounding the taking of the drug and the enjoyment of its effects. There would also need to be a code of lifestyle given to all initiates to follow as long as they remained active members in good standing, which was medically and psychiatrically justified in keeping the harmful effects of this sporadic drug use to an absolute minimum. I'm picturing community outreach and charity activities, to lubricate social relations with the surrounding non-drug-using community.

I say take all the Schedule I drugs for which there's a large volume of peer-reviewed literature. Do a meta-analysis to look for rates of harmful side effects and ease of dependency. Then do a trial run of a well-designed club for responsible recreational use, by exclusive invite and under elaborate secrecy. If this goes well, legally require each such lodge to hire a physician assistant or nurse practitioner to administer the drug and oversee its communal use (while sober), and reschedule the drug in question to Schedule II.

I can dream. :)

The United States DEA's official position negates any merit in the sale or use of any drug explicitly for its recreational effects, except alcohol, tobacco, and caffeine. It must, then, logically, reject the idea and practice of harm reduction. And indeed, it actively does. You wouldn't believe the paper hoops doctors need to jump through to document that a scheduled drug they're scripting is medically justified, and not just mentally pleasant. And doctors who script scheduled drugs are watched pretty closely by the DEA -- 'preyed upon' would not be a huge exaggeration.

In the US and countries that take their legal cues from the US, the only prayer for the broadening of harm reduction to include sanctioned recreational use is by keeping it well corralled into members-only, well-run, and accountable social institutions for adults only, that provide a safe, community-oriented, and well-informed venue for its use. These groups would have to plays by tight rules and screen out those physically and/or mentally unfit for responsible use of the sanctioned drug.

I have some hope for this. First of all, I have a strong sense that such secret societies already thrive, especially in cosmopolitan areas among the well heeled, and are just very good at keeping secret due to the illegality of their purpose in gathering. Also, corralled drug use is something I've already seen in action in certain... scenes, if you will. Users strike a truce with law enforcement for a short period of time, and for the most part few people get hurt or suffer major adverse consequences.

But as long as the DEA remains active in its current form, and send legal ripples around the globe, there's no hope.
 
A thread I started in trying to get info on the Zurich Needle Park scene 1986-1992 ended up morphing to "evolution of the harm reduction model in Switzerland. This was exaustively researched and I feel is essential reading for any true student of harm reduction. A powerpoint presentation given to the University of Geneva medschool symposium on the topic. Post # 17 and 18, or 18 and 19 are also essential. One has the Swiss, British, and American concepts, reserach, experience, and principles, as well as definitions of harm reduction. For instance, one little known fact was that in the 50s commie witch hunt era the American Medical Association, and the State Bar of New York, I believe, advocated heroin maintenace (you have to read article to get full story). It goes into the history and current state of afairs in those countries. Another good article is a Norwegian one that was google translated to English (so I couldn't cut and paste.) Here it is:

Evolution of the Harm Reduction in Switzerland

There are also pix and articles of Needle Park, discussion of possible legalization of cocaine maintenance. The Norwegian article discusses individual safe injection centers in debth (like the age limit is 18 except for the one in Bern were it is 16.)

In my opinion, drug prohibition is the greatest cause of harm and ending it would cause the greatest decrease in real harm, that plus education and humanizing the user (which McNamara insists narco dehuminize.), akin to what was done with tobacco will cause a decrease in the incidence if drug use. Making them legal, but limited to adults 23-25 and older for crack, Nicotine, meth, and heroin (and other potent opiates), 21 for other drugs including cocaine HCl, MDMA, EtOH, 18 for cannabis- although age limits could philosphically be an elure in themselves. Drug users shouldn't be treated like criminals or sick needing treatment unless that is indeed the case. Tax revenues could help fund treatment/ education just like with CA tobacco laws.
 
Post 16 and 18 are great reads. I will post as I have posted in many places and some avid BLers are probably getting tired of reading this but this is the exerpt of Joseph D McNamara, former Chief of Police of San Jose CA 1976-1992currently Stanforf proff:

NSFW:
QUOTEWe turned next to a former police chief-Mr. McNamara was chief of police in Kansas City, Mo., and San Jose, Calif.-to inquire into the special problems of the war on drugs on the street. Mr. McNamara, who has a doctorate in public administration from Harvard, is the author of four books on policing and is currently a research fellow at the Hoover Institution.

T'S THE money, stupid." After 35 years as a police officer in three of the country's largest cities, that is my message to the righteous politicians who obstinately proclaim that a war on drugs will lead to a drug free America. About $500 worth of heroin or cocaine in a source country will bring in as much as $100,000 on the streets of an American city. All the cops, armies, prisons, and executions in the world cannot impede a market with that kind of tax-free profit margin. It is the illegality that permits the obscene markup, enriching drug traffickers, distributors, dealers, crooked cops, lawyers, judges, politicians, bankers, businessmen.

Naturally, these people are against reform of the drug laws. Drug crooks align themselves with their avowed enemies, such as the Drug Enforcement Administration, in opposing drug reform. They - are joined by many others with vested economic interests. President Eisenhower warned of a military-industrial complex that would elevate the defense budget unnecessarily. That military-industrial complex pales in comparison to the host of industries catering to our national puritanical hypocrisy-researchers willing to tell the government what it wants to hear, prison builders, correction and parole officers' associations, drug-testing companies, and dubious purveyors of anti-drug education. Mayor Schmoke is correct about the vested interests in the drug war.

Sadly, the police have been pushed into a war they did not start and cannot win. It was not the police who lobbied in 1914 for passage of the Harrison Act, which first criminalized drugs. It was the Protestant missionary societies in China, the Woman's Christian Temperance Union, and other such organizations that viewed the taking of psychoactive substances as sinful. These groups gradually got their religious tenets enacted into penal statutes under which the "sinners" go to jail. The religious origin is significant for two reasons. If drugs had been outlawed because the police had complained that drug use caused crime and disorder, the policy would have been more acceptable to the public and won more compliance. And the conviction that the use of certain drugs is immoral chills the ability to scrutinize rationally and to debate the effects of the drug war. When Ethan Nadelmann pointed out once that it was illogical for the most hazardous drugs, alcohol and nicotine, to be legal while less dangerous drugs were illegal, he was roundly denounced. A leading conservative supporter of the drug war contended that while alcohol and nicotine addiction was unhealthy and could even cost lives, addiction to illegal drugs could result in the loss of one's soul. No empirical proof was given.

The demonizing of these drugs and their users encourages demagoguery. William Bennett, the nation's first drug czar, would cut off the heads of drug sellers. Bennett's anti-drug rhetoric is echoed by Joseph Califano, the liberal former Secretary of Health, Education, and Welfare, now chairman of the Center on Addiction and Substance Abuse at Columbia University. Last June, the Center hysterically suggested (with great media coverage) that binge drinking and other substance abuse were taking over the nation's colleges, leading to an increase in rapes, assaults, and murders and to the spread of AIDS and other sexually transmitted diseases. The validity of the research in Califano's report was persuasively debunked by Kathy McNamara-Meis, writing in Forbes Media Critic. She was equally critical of the media for accepting the Center's sensational statements.

Conservatives like Bennett normally advocate minimal government. Liberals like Califano ordinarily recoil from the draconian prison sentences and property seizures used in the drug war. This illustrates why it is so difficult to get politicians to concede that alternative approaches to drug control need to be studied. We are familiar with the perception that the first casualty in any war is truth. Eighty years of drug-war propaganda has so influenced public opinion that most politicians believe they will lose their jobs if their opponents can claim they are soft on drugs and crime. Yet, public doubt is growing. Gallup reports that in 1990 only 4 per cent of Americans believed that "arresting the people who use drugs" is the best way for the government to allocate resources.

It was my own experience as a policeman trying to enforce the laws against drugs that led me to change my attitude about drug-control policy. The analogy to the Vietnam War is fitting. I was a willing foot soldier at the start of the modern drug war, pounding a beat in Harlem. During the early 1960s, as heroin use spread, we made many arrests, but it did not take long before cops realized that arrests did not lessen drug selling or drug use.

I came to realize just how ineffective we were in deterring drug, use one day when my partner and I arrested an addict for possession of a hypodermic needle and heroin. Our prisoner had,already shot up, but the heroin charge we were prepared to level at him was based on the tiny residue in the bottle cap used to heat the fix. It was petty, but then-and now-such arrests are valued because they can be used to claim success, like the body counts during the Vietnam War.

In this case the addict offered to "give" us a pusher in exchange for letting him go. He would lure the pusher into a hallway where we could then arrest him in the act of selling drugs. We trailed the addict along Lenox Avenue. To our surprise, he spoke to one man after another.

It suddenly struck me as humiliating, the whole scene. Here it was, broad daylight. We were brilliantly visible, in uniform, in a marked police car: and yet a few feet away, our quarry was attempting one drug transaction after another. The first two dealers weren't deterred by our presence-they were simply sold out, and we could not arrest them without the goods. We finally arrested the third pusher, letting the first addict escape, as we had covenanted. The man we brought in was selling drugs only to support his own habit.

Another inherent difficulty in drug enforcement is that violators are engaging in consensual activity and seek privacy. Every day, millions of drug crimes similar to what took place in front of our police car occur without police knowledge. To enforce drug laws the police have to resort to undercover work, which is dangerous to them and also to innocent bystanders. Drug enforcement often involves questionable ethical behavior by the police, such as what we did in letting a guilty person go free because he enticed someone else into violating the law.

Soldiers in a war need to dehumanize the enemy, and many cops look on drug users as less than human. The former police chief of Los Angeles, Daryl Gates, testified before the United States Senate that casual users should be taken out and shot. He defended the statement to the Los Angeles Times by saying, "We're in a war." New York police officers convicted of beating and robbing drug dealers (their boss at the time is now Director of the White House's Office of National Drug Control Policy) rationalized their crimes by saying it was impossible to stop drug dealing and these guys were the enemy. Why should they get to keep all the money?

Police scandals are an untallied cost of the drug war. The FBI, the Drug Enforcement Administration and even the Coast Guard have had to admit to corruption. The gravity of the police crimes is as disturbing as the volume. In New Orleans, a uniformed cop in league with a drug dealer has been convicted of murdering her partner and shop owners during a robbery committed while she was on patrol. In Washington, D.C., and in Atlanta, cops in drug stings were arrested for stealing and taking bribes. New York State troopers falsified drug evidence that sent people to prison.

And it is not just the rank and file. The former police chief of Detroit went to prison for stealing police drug buy money. In a small New England town, the chief stole drugs from the evidence locker for his own use. And the DEA agent who arrested Panama's General Noriega is in jail for stealing laundered drug money.

The drug war is as lethal as it is corrupting. And the police and drug criminals are not the only casualties. An innocent 75-year-old African-American minister died of a heart attack struggling with Boston cops who were mistakenly arresting him because an informant had given them the wrong address. A rancher in Ventura County, California, was killed by a police SWAT team serving a search warrant in the mistaken belief that he was growing marijuana. In Los Angeles, a three-year-old girl died of gunshot wounds after her mother took a wrong turn into a street controlled by a drug-dealing gang. They fired on the car because it had invaded their marketplace.

The violence comes from the competition for illegal profits among dealers, not from crazed drug users. Professor Milton Friedman has estimated that as many as 10,000 additional homicides a year are plausibly attributed to the drug war.

Worse still, the drug war has become a race war in which non-whites are arrested and imprisoned at 4 to 5 times the rate whites are, even though most drug crimes are committed by whites. The Sentencing Research Project reports that one-third of black men are in jail or under penal supervision, largely because of drug arrests. The drug war has established thriving criminal enterprises which recruit teenagers into criminal careers.

It was such issues that engaged law-enforcement leaders-most of them police chiefs-from fifty agencies during a two-day conference at the Hoover Institution in May 1995. Among the speakers was our colleague in this symposium, Mayor Kurt Schmoke, who told the group that he had visited a high school and asked the students if the high dropout rate was due to kids' being hooked on drugs. He was told that the kids were dropping out because they were hooked on drug money, not drugs. He also told us that when he went to community meetings he would ask the audience three questions. 1) "Have we won the drug war?" People laughed. 2) "Are we winning the drug war?" People shook their heads. 3) "If we keep doing what we are doing will we have won the drug war in ten years?" The answer was a resounding No.

At the end of the conference, the police participants completed an evaluation form. Ninety per cent voted no confidence in the war on drugs. They were unanimous in favoring more treatment and education over more arrests and prisons. They were unanimous in recommending a presidential blue-ribbon commission to evaluate the drug war and to explore alternative methods of drug control. In sum, the tough-minded law-enforcement officials took positions directly contrary to those of Congress and the President.

One hopes that politicians will realize that no one can accuse them of being soft on drugs if they vote for changes suggested by many thoughtful people in -law enforcement. If the politicians tone down their rhetoric it will permit police leaders to expose the costs of our present drug-control policies. Public opinion will then allow policy changes to decriminalize marijuana and stop the arrest of hundreds of thousands of people every year. The enormous savings can be used for what the public really wants-the prevention of violent crime.

This is dated, from 1996, but relative

http://www.drugtext.org/library/spec...gs/wodbuc.html

This thread has many enlightened thinkers- lawyers, politicians, ect...in addition to McNamara. The point is that the drug war is causing harm measurably and intagibly, difficult to measure. So the ultimate form of harm reduction, in my opinion, is ending prohibition. It has created a war without end were both combatants have alot at stake monitarily and in terms of power, and the real casualties are the end users and society as a whole...and as McNamara pointed out, The Truth.

Instead, I believe that using drugs is a human rights issue and ending prohibition involves governments not engaging in the unatural act of prohibiting an essential human right, or liberty, if you will. Happy New Years everyone! Lets hope the Icy glacier of world-wide prohibition will thaw with each passing year.
 
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The United States DEA's official position negates any merit in the sale or use of any drug explicitly for its recreational effects, except alcohol, tobacco, and caffeine. It must, then, logically, reject the idea and practice of harm reduction. And indeed, it actively does. You wouldn't believe the paper hoops doctors need to jump through to document that a scheduled drug they're scripting is medically justified, and not just mentally pleasant. And doctors who script scheduled drugs are watched pretty closely by the DEA -- 'preyed upon' would not be a huge exaggeration.

In the US and countries that take their legal cues from the US, the only prayer for the broadening of harm reduction to include sanctioned recreational use is by keeping it well corralled into members-only, well-run, and accountable social institutions for adults only, that provide a safe, community-oriented, and well-informed venue for its use. These groups would have to plays by tight rules and screen out those physically and/or mentally unfit for responsible use of the sanctioned drug.

I have some hope for this. First of all, I have a strong sense that such secret societies already thrive, especially in cosmopolitan areas among the well heeled, and are just very good at keeping secret due to the illegality of their purpose in gathering. Also, corralled drug use is something I've already seen in action in certain... scenes, if you will. Users strike a truce with law enforcement for a short period of time, and for the most part few people get hurt or suffer major adverse consequences.

But as long as the DEA remains active in its current form, and send legal ripples around the globe, there's no hope.

Plus, the USA along witth the majority of the worlds countries are parties to the UN Single Convention on Narcotic Drugs and its many ammendments, supplementary treaties, ect... make it very difficult for a signatory to legalize drugs outright without abrogating the terms of the treaty. They even have US style schedules. If prop 19 passed and the feds did nothing, maybe condemnation would come from certain UN member states for the US not meeting its treaty obligations, a treaty it pushed hard, if not the hardest, to broker, ironically.
 
Heuristic said:
I understand, but I would disagree with the distinction you're drawing.

To be clear, I am conceptualizing autonomy as participation in the creation the the socio-political conditions that shape how cooperation and oppression will transpire. This plays out in social, political, medical, economic, kinship, etc. institutional venues, rather than as exercise of explicit juridical power in institutions in and near the courtroom.

Forfeiting the right to vote marks a lack of autonomy, as does applying for work as a convicted felon, as does interfacing with medical professionals as a priori mentally pathological.


Put differently, to the extent the law focuses on punishment as just retribution, it views users of illegal drugs as being as autonomous as anyone else. To the extent the law focuses on rehabilitation, it focuses on users of illegal drugs as suffering from a pathology.

Indeed. Law may only be understood in terms of inter- and intra-relationships between discourses and institutions. Formal equality of legal procedure is less important as an analytical criterion here than proper dynamics of wider social systems.

One needn't think of human beings as perfectly autonomous agents - or as all drug use as a legitimate choice - to favor HR practices.

Yes, but we (Jamshyd and I?) were arguing that status-quo institutional frameworks and discourses limit what may be done within the confines of HR, and then the discourse of HR cast to fruition, interpelating the drug user as a non-pathologized, non-criminalized agent, stands heterodox/sub-altern/(what term do you like, Heur? :P) before practices in dominant institutions.

The socio-political conditions you seem to assert are necessary for HR practices to exist, aren't necessary.

There's HR, and then HR unfettered.

ebola
 
To be clear, I am conceptualizing autonomy as participation in the creation the the socio-political conditions that shape how cooperation and oppression will transpire. This plays out in social, political, medical, economic, kinship, etc. institutional venues, rather than as exercise of explicit juridical power in institutions in and near the courtroom.

Forfeiting the right to vote marks a lack of autonomy, as does applying for work as a convicted felon, as does interfacing with medical professionals as a priori mentally pathological.

Then we're no longer talking about how the law views every user of drugs, since not every user is either committing or has been convicted of a felony. Nor, from a medical vantage, is every drug user viewed as an addict. What was cast as a monolithic feature of the law and medicine, isn't.

If I'm understand you correctly, then when you say that the law "views drug users as less than autonomous" (paraphrasing), you mean that the law imposes certain penalties for certain actions involving certain substances, and that these penalties reduce the ability of the punished to participate fully in society. With this much, I agree.

Yes, but we (Jamshyd and I?) were arguing that status-quo institutional frameworks and discourses limit what may be done within the confines of HR, and then the discourse of HR cast to fruition, interpelating the drug user as a non-pathologized, non-criminalized agent, stands heterodox/sub-altern/(what term do you like, Heur? :P) before practices in dominant institutions.

There's HR, and then HR unfettered.

Translating, do you mean that HR implies that the choice to use drugs is fully legitimate, should be without legal penalty, and should never be viewed as the result of pathology?

If you mean this strong statement, then I disagree. I don't think HR implies any of that.

The premise of HR is simply that policies which reduce harm to individuals should be enacted. I do NOT think full decriminalization of all drug use accomplishes that (though I favor decriminalization of some); nor do I think it worthwhile to not view certain types of use as indicative of a pathology.

What you and Jam are proposing isn't HR unfettered, but rather one particular variation of HR. To the extent the instantiation of that proposal would lead to more harm - and if the strong interpretation above is what you believe, then I think it would lead to more harm - it's actually "HR gone amok." ;)
 
drugs are technology. they are often synthesized and have a wide array of applications. i think the reason for which drugs are stigmatized so is that we began using drugs before we could quantify the results. i guess you could say the cart was put before the horse and the people in the coach were put off by the smell of shit.

now we have clinical studies and MRI machines but it still isn't enough to shake the stigma because for all the positives, drugs have very far-reaching negative effects as well.

regardless, the automobile has far-reaching negative effects too but we put seatbelts and airbags in them because faster transportation is crucial to our progress as a society. some luddites argue that we should just ban all that shit and live like the Amish, who make use of archaic technology and are satisfied to get things done slower and make far less progress.

That seems like a rational response to a society where a few people make all the progress and millions are left downtrodden and feeling purposeless as a result. Coincidentally, that's a very common state of mind for drug users to be in. We feel increasingly powerless and so we abuse drugs.

I think if drugs were treated like any other technology, responsible drug use for everyone might make as much sense as it did to put seatbelts and airbags into cars so they can be used positively while mitigating the negatives.

Unfortunately, it is becoming painfully obvious that the two players in the drug war are organized crime and the pharmaceutical industry, neither of which actually give a fuck about society and the harm they are causing by publicly clashing and promoting their own poisons without extolling the virtues of the other side's medicine.

Although I hate the concept of paying taxes on recreational drugs, they have just as much legitimate use as the pills doled out at the pharmacy so I think that moving toward legitimizing rec drugs is a step in the right direction for society as a whole. Furthermore, legitimizing rec drugs would take the market away from criminals, many of whom are quite carcinogenic to society yet we are forced to tolerate them and often even glorify them because they symbolize a rebellion against the illogical and often downright callous way by which modern western governments treat their citizenry.

Does it make sense to place a murderer on a pedestal because he does something right by accident? No, but it also doesn't make sense to keep faith in governments willing to do wrong by society on purpose. A new age is dawning where we realize the vital importance of transparency for a new world order; for a better world order where informed citizens are allowed to help shape the future rather than being told we are too stupid to know what's good for us while our elected overlords cut the school budgets to free more funds for lasers in space and other outrageous weapons initiatives.
 
Heuristic said:
Then we're no longer talking about how the law views every user of drugs, since not every user is either committing or has been convicted of a felony. Nor, from a medical vantage, is every drug user viewed as an addict. What was cast as a monolithic feature of the law and medicine, isn't.

I was never talking exclusively about how law treats controlled substance violations. Rather, due to the particular relevant components of a social-structural and discursive system, we need to examine how multiple institutions function in unison.

Also, I never argued that such practices are monolithic; rather, I pointed toward dominant tendencies, with prototypical examples. But really, how many psychiatrists and general practitioners, let alone legal and penal professionals, would leave room for regular drug use that is not pathologized? Drug use is quite tangibly refracted as drug abuse via dominant institutions, without consideration of the individual's particularities as a competent, autonomous drug user.

Translating, do you mean that HR implies that the choice to use drugs is fully legitimate, should be without legal penalty, and should never be viewed as the result of pathology?

I think that you are misunderstanding Jamshyd and my analytical approach. Here, concepts are cast widely, understood, indeed accorded 'meaning' insofar as they function in relation to social practices, in relation to a wider social system. Such social-analytical concepts shouldn't be viewed as static, straightforwardly operationalizable things. Rather, they are tools put to use in effecting social change. In this light, we should ask, if the social system were different in [x] way, what would be the consequences for the practical realization of [y] discursive complex? In this case, the present configuration of the status-quo system [x1] hinders possible practical human goods that HR could produce in practice [y1].

What you and Jam are proposing isn't HR unfettered, but rather one particular variation of HR.

The many currently circulating (if subaltern) socio-political visions which require changes in the basic social system to be realized (for any question of socio-politics, eg, specific conceptions of HR) share this quality of current fettering (almost tautologically so :P). Not everyone will agree on where social change should go, what their political future should look like, as you illustrate in your argument immediately prior. However, your point of contention, based on the type of polity favored, doesn't invalidate Jamshyd's prior argument.

ebola
 
It strikes me that the distinction between HR as a set of practices and HR as a philosophy proposing legalization is not as meaningful as it appears at first glance. Most people who favor legalization do not, after all, favor it for axiomatic ideological reasons, but for pragmatic reasons. An ideologically neutral pragmatist invested in harm reduction should arrive at this position. The issue is simply one of expanding the concept of "harm" to encompass the "harm" caused by the existence of the black market, the "harm" caused to users by stigmatization and criminal penalties, and the "harm" caused to all of us by the privation of our autonomy.
 
A view that prohibition or a call to abstinence is workable or morally required is the opposite of HR in my opinion.

HR either assumes that people will use or accepts that people will use and desires to spread knowledge, tactics, and policies that maximize safety.When a philosophy starts meeting policy that is its opposite you will have people who call for radical change ASAP and some will be incremental. The populous and key professions coming to embrace HR will likely have to happen incrementally imo.I accept incrementalism politically while being close to a philosophical absolutist about HR.

When I look at a hospital's policy from the outside I can call for the immediate change of endless practices and policies. If somehow I was on a board running a hospital and aware of other board members, accrediting agencies, professional bodies, laws, liability, income flow, personnel issues, etc I'd definitely be putting aside many of my HR goals and be looking for the few thing that could be implemented quickly without friction. Many other things would require coalition building and taking a genuine interest in all sorts of other hospital issues and people.

Look at the comments section of a local news source when there is a story involving drug deaths or drug crimes. It really gives you a view of the average person who opposes HR. Comments are often along the lines of he/she was stupid, broke the rules and got what was coming to him. Some are more sympathetic and some actually antagonistic but the power of the most anti-HR agencies and politicians derives from that segment of the population. I don't know the numbers of anti-HR average folks but I think it is fair to say there numbers are large and their influence considerable.
 
My post just got erased somehow. But anyway Jam, I thouroghly enjoyed both papers, the CCSA and Hunts paper explained harm reduction, principles, history, and HR in contemporary use today very well.

One area that was addressed by believe the CCSA, and its refreshing that your government is funding research into harm reduction and the issues around it, the subject of cost/benefit analysis came up.

To quote Chief McNamara from my previous post, "The first casualty of any war is the truth. This is probably true with the war on drugs than any war in modern history. One of your sources I believe mentions harm reduction as a trojan horse for legalization and I don't see the problem with that.

For a second, I want to examine the harm to society as a whole as a result of drugs and the war the current political climate foments. Thousands are dying yearly in the drug war in Mexico. Corruption is reaching high levels of certain national (including developed nation's governments), law enforcement's public image is suffering. Compare (atleast in the US) an average person's attitude toward a cop and an average person's attitude towards a figher fighter or medic. The form are viewed by many as punishers, atleast in this country, while the latter as life savers. In this distoration of the truth, people emotions take ove their rationality as do there morality and need to feel moraly superior to others and you get a situation were 2 +2=11, doesn't compute. Banks are scandalized.

The human cost were families are broken up, and other violent/property crimes that might never had been learned are being taught in jailbird U and passed on to inmates- facing few job prospects- and to their children.

As Hunt article points out, people on heroin maintenance are more stable on a number of indicators of social functioning, have bette health, and are less likely to continue using heroin 18 months later (like 1/3 of initial enrolies). 1 study from my research found that those enroled in a swiss study decreased their dose by 1/2 -2/3 who stayed on HMT.

Good to see paper n harm reduction commissioned by Canadian government. In the USA, forget peer review, the editorial boards would be scared they'd lose NIDA money.

http://addictologie.hug-ge.ch/_library/pdf/ISAM08Harmreductionatwork.pdf

Good powerpoint presentation from symposium at The Univ of Geneva med school, I believe, dug it up from my evolution of swiss harm reduction post. Very good, well illustrated presentation.

It was cool to see hun't article discuss non opiate (dexedrine manitenance for stimulant addicts. I be aware, the director for i believe the swiss program was trying to come up a few years back with a protocal of Rx cocaine maintenance because so many of their patients used that drug too- in the interest of harm reduction.

Ultimate harm reduction: complete abstinence. My theory with opiates, and other drugs is that addiction becomes a ritualized actvity, were addicts wake up dope sick, hustle money, then get an extra reward, euphoria when they get the dope and go from really sick to well. Get rid of the amount of time in withdrawl and you weaken the psychological hold of the drug on a person. In animals you see this in conditioned place preference studies were they get a rat strung out and then put them in a special cage to withdraw. Once done with withdrawl, with no more drugs to get a physical habit they will still avoid the box were they experienced withdrawl. Through maintenance one way your reducing harm is by deprograming and not reinforcing withdrawl which motivates antisocial behavior of a number of types.
 
Thanks for the post :)

jspun said:
My post just got erased somehow.
Modnote:There isn't an erased post within this thread, so I'm assuming you mean there was a glitch by which your post got lost rather than posted. Generally I don't remove a post from view without PMing the member. The server has been very taxed of late and a lot of errors can happen if one posts when we are losing matter/anti-matter containment. Sorry you had to compose twice.
 
I am sorry that you guys misunderstood my staement as suspicion of beinb sensored- I hit an enter button at the wrong time and it disappeared- I just I was frustrated because I had worked hard on it. Didn't suspect mods in any way. However, I tend to post to long so it was probably a good thing. No lack of fair play susspected.

Anyway, Another milestone in HR was the Franfort Resolution.

The ultimate form of drug hR is abstinence. Since that will never happen, put simply, HR is a method or methods that minimize the degree of harm drug to the user, family, and society in general.

The story of the evolution of the Frankfurt safe smoking/injection program and arly days of an open scene is facinating. maybe I'll post it someday ((its in the seccond page of my swiss thread).
 
Also, I never argued that such practices are monolithic; rather, I pointed toward dominant tendencies, with prototypical examples. But really, how many psychiatrists and general practitioners, let alone legal and penal professionals, would leave room for regular drug use that is not pathologized? Drug use is quite tangibly refracted as drug abuse via dominant institutions, without consideration of the individual's particularities as a competent, autonomous drug user.

I'd suspect nearly all psychiatrists would. The criteria for substance dependence disorder does not include regularity of use as a sufficient or necessary condition to diagnose.

As to legal practitioners, while addiction may be a factor in determining the appropriate punishment and court for someone who violates drug laws, the question of pathology is a medical one. As to what the practitioner personally may suspect, I'd imagine that largely is determined by the type of drug being used and other characteristics of the person who violated the law.

The view of drug use is actually much more nuanced among medical professionals than I think your description of a dominant tendency allows.

But what you're really asking about here, imho, isn't whether regular drug use is viewed as pathological by medical professionals. What you're asking is whether medical professionals view regular drug use as a perfectly legitimate choice for individuals to make. This will, again, depend on the drug in question and the individual in question.

I think that you are misunderstanding Jamshyd and my analytical approach. Here, concepts are cast widely, understood, indeed accorded 'meaning' insofar as they function in relation to social practices, in relation to a wider social system. Such social-analytical concepts shouldn't be viewed as static, straightforwardly operationalizable things. Rather, they are tools put to use in effecting social change. In this light, we should ask, if the social system were different in [x] way, what would be the consequences for the practical realization of [y] discursive complex? In this case, the present configuration of the status-quo system [x1] hinders possible practical human goods that HR could produce in practice [y1].

Which is a fine question, and one in which various proponents of HR will find much to disagree about. But this is going far, far afield of the actual issue.

The issue was never about what questions we should be asking.

The issue was whether support for HR implies that one should have such a view of the current system that one's views could NOT be Republican. Remember that this was sparked by a member's remark expressing puzzlement that any proponent of HR could also either support the current political system in other respects.

So, sure, someone could have certain values and a certain ideology that implies not only support of HR practices, but also of a radically different configuration of the political system.

But there will be a significant range of values and ideologies that allow support for HR practices. THAT is the point.

The point isn't that the questions raised by that range of values and ideologies are unimportant or shouldn't be raised.

Put differently, the issue is whether support for HR (p) implies support for a radically different political system (q). It does not because multiple combinations of values and beliefs can imply support for p without implying support for q, e.g. a implies p but does not imply q, b implies p and q, etc.

Whether you want to view concepts as "static" or "functional" isn't really relevant to the issue.
 
I'd suspect nearly all psychiatrists would. The criteria for substance dependence disorder does not include regularity of use as a sufficient or necessary condition to diagnose.
[/QUOTE]
Err, the APA begs to differ.

DSM-IV-TR said:
Criteria for Substance Dependence
(cautionary statement)

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) tolerance, as defined by either of the following:
(a) a need for markedly increased amounts of the substance to achieve Intoxication or desired effect
(b) markedly diminished effect with continued use of the same amount of the substance

(2) Withdrawal, as manifested by either of the following:
(a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
(b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a longer period than was intended

(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use

(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects

(6) important social, occupational, or recreational activities are given up or reduced because of substance use

(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Source: http://www.behavenet.com/capsules/disorders/subdep.htm

(Bolding mine)

The parts I have bolded show that repeated use is implied in every single point, as you simply cannot have these effects without repeated use... and you only need three of them for the diagnosis of dependance.

Btw, Heu, I really would appreciate it if you were to address the OP.

Just wanted to correct this oversight. I will post more later re: other posts here.
 
you simply cannot have these effects without repeated use... and you only need three of them for the diagnosis of dependance.

But you can have regularity of use without these effects, which is the relevant point. Also I think that the presence of three or more of the diagnostic criteria does paint a picture of drug dependence and not a picture of responsibly controlled drug use. To be honest, I agree with your opinion re: the way regular drug use is framed in the discourse, but I don't think that the excerpt you quoted supports this opinion.
 
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