Thursday, April 1, 2010

an oldie but a goodie

I'm stoked to audit a class in the Community Health Sciences Department this quarter.  It is named "Managing Drug Abuse from a Public Health Perspective."  Hello!  It started today, and already I'm energized to learn the language and logic of this approach (in more formal terms than my noodling around drug policy conferences, anyway).

Among the first reading assignments was a paper published in the journal Addiction over a decade ago, titled "Setting goals for drug policy: harm reduction or use reduction?"  The reason I like it is that it describes the philosophies, merits, and policy implications of each approach so much more articulately than I have ever managed to, and it is thought-provoking and challenging while being level-headed and just.  Its main point is that in order to be effective, drug policy needs to define attainable goals (there is a world of goals beyond use reduction), set up reliable measures by which to gauge success (use/harm reduction can be conceptualized in several ways, not all of which go hand in hand), and recognize that with different goals come different policy implications.  It also touches on some sad truths, like the idea that choice of strategy comes down to things like political feasibility (appearing "soft on drugs") and ultimate values (caring about drug-related things like health problems, poverty, crime, etc. versus viewing drug use itself as "bad").  And as far as I can tell, all of the arguments stand to this day.

The end of the paper also states some author opinions that I really liked.
"Our recommendation is that the overall objective be to minimize the harm associated with the production, distribution, consumption and control of illicit substances.  Reducing use should be seen as a principal means of attaining that end.  However, although reducing use is a principal way of reducing harm, it is neither the only way nor a foolproof way." 
"It is our belief that augmenting use reduction with explicit harm reduction goals and admitting the possibility that one might at times be willing to accept higher use if it yields substantially less harmful use, would encourage wiser policies."

It's been over a decade since.  Surely, some harm reduction programs (needle exchanges, etc.) have made great strides, but lots of work remains to be done.  Can we get to it now?

Reference: Caulkins JP, Reuter P. (1997)  Setting goals for drug policy: harm reduction or use reduction? Addiction 92(9), 1143-1150.

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