An interview – What is Harm Reduction?

This is a BIC pen, and there’s something quite special about this pen. Because the lid of it has a hole. And the reason it has a hole in it, is that in the case of it being swallowed, there is the possibility that this hole can keep the airways free and the people won’t choke. And it was designed deliberately. It’s not just by chance, but that’s just a good example of harm reduction. Is that simple you know As a person who uses drugs, harm reduction to me is about making sure that people who use drugs receive the same right to accessible, quality and most importantly, non judgmental health care, the same as everybody else.

So harm reduction for me, and I think it’s pretty established now, is any set of interventions or programs or practices that seek to reduce harm related to drug use. I guess that’s at the level of individuals, communities and beyond the level of society. Harm Reduction It’s a broad perspective. It’s a way to address drug use, but mainly people who use drugs. So harm reduction. It’s more like an ethic position, professional position or even a political position on how to deal with people who use drugs. So harm reduction recognizes the rights of of people who use drugs, adhere to the principles of “support, don’t punish” all of these things which ensures the dignity and the rights of people who use drugs.

For me, harm reduction among many things is about putting your opinions aside. What I mean is it’s about doing things evidence based, not morality based or opinion based. So with injecting drug use in Liverpool, it was all of a sudden we found out that there was this thing called HIV that could be transmitted through injection equipment. So they started to give out clean needles, whether you like it or not, you know, you can’t stop people engaging in these activities. And, you know, all you can do is make it safer for them to do it.

It’s shocking how often and to what extent people are denied health care simply based on their substance of choice. Harm reduction is not about enabling drug use as prohibitionist would claim, but is simply about empowering people with the information and materials we need to protect ourselves from blood borne infections such as HIV, hepatitis C and death from overdose. It’s about giving people the means to be responsible for their own health and of those around them. We need to understand that a drug free world doesn’t exist. And even with such a small island as Mauritius where I’m from, we found out quickly that people use drugs and sometimes people develop problematic drug use.

And in Mauritius, we have quite a high number of people who have sadly developed problematic drug use and to counter the effects of problematic drug use, Harm reduction was the only means we found to be effective. Even though there’s not many people who inject drugs or there’s not much opioid use in Latin America, there’s still a lot of harm reduction intervention. There’s still a lot of harm reduction perspective in different kind of services. You have to understand that harm reduction does not focus only on drug use itself or in the way you use it. It focuses more on the general perspective, life perspective or life situation that people live.

So my background’s in social science and particularly qualitative methods, And so I’ve been applying qualitative studies to issues of drug use and risk and harm reduction. And one key takeaway there for me, which I think is really important in terms of the contribution of research, is how those studies have shown how people use and people who inject drugs in a way work very hard with their environments to make them better.

Drug policies, which are punitive and criminalize drug use, you know, drive people underground, and because of the fear of arrest, people who use drugs do not gain access to all these prevention and treatment modalities.

Many harm reduction programs require daily attendance and refuse to provide take home doses of opioid agonist therapy, but methadone and buprenorphine are like any other daily medication and should be treated as such.

Somehow, throughout our lifetimes, we accumulate negative perspective about people really deeply impregnated without even realizing it, and sometimes it seems to take a lot of courage to take a step back and acknowledging that we’re projecting false emotions not based on logic or fact. About 1988, we published a leaflet called ‘Chill Out’. And probably the most famous leaflet ever made about drugs. It was about ecstasy because the ecstasy craze kind of started back then. So ‘Chill Out’ was a harm reduction approach. I was demoniSed and the editorial inside was finished with the words, The people of Liverpool should storm the office of Mr. O’Hare and throw him and his leaflets into the River Mersey.

Mauritius is a tiny island in the Indian Ocean where multicultural country, an African country, and we’ve got different people from different countries around the world. And the fact that at the start of the introduction of harm reduction programs, the religious leaders were instrumental in able to provide key messages within communities who are most affected by drug use. Harm reduction in Latin America has focused mainly on with the people living in poverty or discriminated and stigmatized. But it definitely goes much further. So now we’re started seeing harm reduction interventions in parties and raves. So people are testing drugs. For example, Mexico and Colombia and Brazil.

Also related to cocaine users, A lot of cocaine use and cocaine is mostly focus in middle and high income classes. It just occurred to me another way of thinking about that is to think about what harm reduction isn’t. And so therefore, harm reduction, what harm reduction isn’t, is anything, any intervention or practice or policy work which enhances or allows harm to happen. This is really, really useful because it points us towards the idea that there are risk environments in which people are living.

And as soon as you ask the question, what is harm reduction not that helps you kind of, I think, identify the kind of things in a society or in an environment, whether it was a drug law or another kind of law, a bad housing condition, which makes up risks or harm. And it gives you a sense of what people in a way are fighting against or trying to navigate their way through beyond the services and the structures and the models of intervention. Harm reduction represents an approach. It’s a way of thinking. It’s a paradigm shift away from trying to force people into an ideal image of what is a ‘good citizen’ to a pragmatic, non-judgmental approach.

It’s more than 30 years ago. Yeah, it was it was an incredible kind of journey, you know, it was something that’s. You know, I feel privileged that I was part of it. It’s going to change, you know, people are gonna see they’re gonna see and hopefully they’ll be ashamed of themselves for this. You know, for all these people who use drugs includes people who smoke cigarettes, people who drink alcohol. But just because your drug is not one of the legal ones you’re looked down upon, you’re despised. you’re treated absolutely appallingly.

And I think that in the last few years, the most significant thing and the thing that pushed it more is the incredible work of people who use drugs when harm reduction is done right. It makes an incredible contribution to people’s lives. I started harm reduction very early on in my drug using career and it’s been a safety net for me. It’s literally saved my life, helped me to manage and regulate my use, prevented overdose and gave me stability. Very simply, harm reduction is about social justice, centered around the idea that we do not forfeit any of our humanity, dignity or rights because of our drug use.