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2 - Soft defection and the domestic normalization of harm reduction

Published online by Cambridge University Press:  05 December 2012

David R. Bewley-Taylor
Swansea University
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The HIV/AIDS pandemic has intensified debate over the norms and institutions of the global drug control regime.

Richard Elliott, Joanne Csete, Evan Wood and Thomas Kerr (2005)

It is currently difficult to contest Andrew Lee Ball’s 2007 statement that ‘Few terms in the world of drug policy evoke such extremes of emotion as “harm reduction”’. According to Ball, ‘Drug policy conservatives shudder, believing that traditional values and drug control will be undermined. Drug legalizers see opportunities for radical law reform. Somewhere in between, service providers and community advocates hold to a hope for more pragmatic, evidence-based interventions.’ He is also right to believe that these ‘emotions are stirred by the lack of a clear definition’, and ‘complicated further by a dynamic discourse that has often generated more heat than light’.

While the principle of harm reduction as generally understood today can arguably be traced back to the UK in the 1920s, the term itself, or variants such as harm minimization, risk minimization and risk reduction, only came into use in the mid to late 1980s. Then some of those involved in working with individuals engaging in IDU in a number of industrialized countries across Europe, Oceania and parts of North America began to recognize the risks associated with drug injection and the spread of HIV/AIDS and other blood-borne infections such as hepatitis C. The result was a variety of modest localized initiatives designed to reduce risk behaviours. From its narrow origins in public health, harm reduction has developed over the years into a far broader and at times apparently nebulous approach incorporating various responses to many aspects of both illicit and licit drug use. Accordingly, the term has been used variously to describe a ‘principle, concept, ideology, policy, strategy, set of interventions, target and movement’. The phrase in general then remains broad and fluid, and is inevitably given different meanings by different actors addressing in varying capacities problems associated with the use of psychoactive substances.

International Drug Control
Consensus Fractured
, pp. 36 - 99
Publisher: Cambridge University Press
Print publication year: 2012

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Ball, A. L.HIV, injecting drug use and harm reduction: a public health responseAddiction 102 2007 684CrossRefGoogle ScholarPubMed
Riley, D.Sawka, E.Conley, P.Hewitt, D.Mitic, W.Poulin, C.Room, R.Single, E.Topp, J.Harm Reduction: Concepts and Practice. A Policy Discussion PaperSubstance Use and Misuse 34 1999 11CrossRefGoogle Scholar
Riley, D.O’Hare, P.Harm Reduction: National and International PerspectivesLondon, Thousand OaksSage 2000Google Scholar
Reinarman, C.Levine, H. G.Crack in America: Demon Drugs and Social JusticeUniversity of California Press 1997Google Scholar
Tammi, T.How the Harm Reduction Movement Contrasts Itself Against Punitive ProhibitionInternational Journal of Drug Policy 18, 2007 84CrossRefGoogle Scholar
Degenhardt, L.Hallam, C.Bewley-Taylor, D.Comparing the Drug Situation across Countries: Problems, Pitfalls and PossibilitiesBeckley, Oxon.The Beckley Foundation Drug Policy Programme 2009Google Scholar
Pollack, H.Moral, Prudential, and Political Arguments about Harm ReductionContemporary Drug Problems 35, 2008 214CrossRefGoogle Scholar
Roe, G.Harm Reduction as Paradigm: Is Better than Bad Good Enough? The Origins of Harm ReductionCritical Public Health 15, 2005 243CrossRefGoogle Scholar
Miller, P. G.A Critical Review of Harm Minimization Ideology in AustraliaCritical Public Health 11, 2001 173CrossRefGoogle Scholar
Elliott, R.Csete, J.Wood, E.Harm Reduction, HIV/AIDS, and the Human Rights Challenge to Global Drug Control PolicyHealth and Human Rights: An International Journal 8, 2005 105CrossRefGoogle Scholar
Wolfe, D.War on Drugs, HIV/AIDS and Human RightsNew YorkInternational Debate Education Association 2004Google Scholar
Wolfe, D.Malinowska-Sempruch, K.Illicit Drug Policies and the Global HIV Epidemic: Effects of UN and National Government ApproachesNew YorkInternational Harm Reduction and Development, Open Society Institute 2004Google Scholar
Hunt, N.Trace, M.Bewley-Taylor, D.Reducing Drug Related Harms to Health: An Overview of the Global EvidenceBeckley, Oxon.The Beckley Foundation Drug Policy Programme 2006Google Scholar
EMCDDAAnnual Report 2007: The State of the Drugs Problem in EuropeLuxembourgOffice for Official Publications of the European Communities 2007Google Scholar
WHOEffectiveness of Sterile Needle and Syringe Programming in Reducing HIV/AIDS among Injecting Drug UsersGenevaWorld Health Organization 2004Google Scholar
WHOWHO, UNODC, UNAIDS Technical Guide for Countries to set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug UsersGenevaWorld Health Organization 2009Google Scholar
Wodak, A.The Current Status of Heroin Prescription Treatment for Heroin DependenceExpert Opinion 4, 2005 817Google Scholar
Oviedo-Joekes, E.Brissette, S.Marsh, D. C.Lauzon, P.Guh, D.Anis, A.Schechter, M. T.Diacetylmorphine versus Methadone for the Treatment of Opioid AddictionNew England Journal of Medicine 361, 2009 777CrossRefGoogle Scholar
Hedrich, D.European Report on Drug Consumption RoomsEMCDDA, LuxembourgOffice for Official Publications of the European Communities 2004Google Scholar
Aoyagi, M. T.Beyond Punitive Prohibition: Liberalizing the Dialogue on International Drug PolicyInternational Law and Politics 37, 2005 555Google Scholar
Bergeron, H.Reuter, P.Editor’s Introduction: Policy change and policy analysisInternational Journal of Drug Policy 20, 2009 455CrossRefGoogle Scholar
Wodak, A.Ethics and Drug PolicyPsychiatry 6, 2007 59CrossRefGoogle Scholar
Nadelmann, E. A.Commonsense Drug PolicyForeign Affairs 77, 1998 115CrossRefGoogle Scholar
IHRA , Harm Reduction and Human Rights: A Programme of the International Harm Reduction AssociationHarm Reduction and Human Rights: The Global Response to Injection-Driven HIV EpidemicsLondonIHRA 2008Google Scholar
International Harm Reduction DevelopmentHarm Reduction Developments 2008; Countries with Injection-Driven HIV EpidemicsNew York 2008Google Scholar
Barrett, D.Cook, C.Lines, R.Stimson, G.Bridge, J.Harm Reduction and Human Rights: The Global Response to Drug Related HIV Epidemics, Harm Reduction and Human Rights. A Programme of the International Harm Reduction AssociationLondonIHRA 2009Google Scholar
Malkin, I.Elliott, R.McRae, R.Supervised Injection Facilities and International LawJournal of Drug Issues 33, 2003 567CrossRefGoogle Scholar
IDPCThe International Narcotics Control Board: Current Tensions and Options for ReformWitley, SurreyInternational Drug Policy Consortium 2008Google Scholar
Utyasheva, L.Elliott, R.At What Cost? HIV and Human Rights Consequences of the Global ‘War on Drugs’New YorkOpen Society Institute Public Health Program 2009Google Scholar
Spivak, D.A Fourth International Convention for Drug Policy: Promoting Public Health PoliciesParisBritish Institute of International and Comparative Law and the Senlis Council 2003Google Scholar
Malkin, Legislating for Health and Human Rights: Model Law on Drug Use and HIV/AIDSCanadian HIV/AIDS Legal Network 2006Google Scholar
Chatterjee, S. K.Legal Aspects of International Drug ControlThe HagueMartinus Nijhoff 1981Google Scholar
UNCommentary on the Convention on Psychotropic Substances, Done in Vienna on 21 February 1971New YorkUnited Nations 1976Google Scholar
UNCommentary on the United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances 1988, Done at Vienna on 20 December 1988New YorkUnited Nations 1998Google Scholar
UNODC2008 World Drug ReportViennaUnited Nations 2008Google Scholar
Elliott, R.Malkin, I.Gold, J.Establishing Safe Injection Facilities in Canada: Legal and Ethical IssuesMontrealCanadian HIV/AIDS Legal Network 2002Google ScholarPubMed
Boister, N.Penal Aspects of the UN Drug ConventionsThe Hague, London, BostonKluwer International 2001Google Scholar
Dorn, N.Jamieson, A. 2000
UNSpecial Session of the General Assembly Devoted to Countering the World Drug Problem Together, 8–10 June 1998, Political Declaration, Guiding Principles of Drug Demand Reduction and Measures to Enhance International Cooperation to Counter the World Drug ProblemViennaUnited Nations 1999Google Scholar
Room, R.Trends and Issues in the International Drug Control System – Vienna 2003Journal of Psychoactive Drugs 37, 2005 375CrossRefGoogle Scholar
Finnemore, M.Sikkink, K.International Norm Dynamics and Political ChangeInternational Organization 52,4 1998 902Google Scholar
Brem, S.Stiles, K.Cooperating Without America: Theories and Case Studies of Non-Hegemonic RegimesLondonRoutledge 2009Google Scholar
MacCoun, R. J.Reuter, P.Drug War Heresies: Learning from Other Vices, Times & PlacesCambridge University Press 2001CrossRefGoogle Scholar
Chatwin, C.Drug Policy Developments within the European Union. The Destabilizing Effects of Dutch and Swedish Drug PoliciesBritish Journal of Criminology 43 2003 570CrossRefGoogle Scholar
Yates, J.Sweden; A Totalitarian Threat to EuropeInternational Journal of Drug Policy 9, 1998 233Google Scholar
Hallam, C.What can We Learn From Sweden’s Drug Policy Experience?Beckley, Oxon.The Beckley Foundation Drug Policy Programme 2010Google Scholar
UNODCSweden’s Successful Drug Policy: A Review of the EvidenceViennaUnited Nations Office on Drugs and Crime 2006Google Scholar
Mares, D. R.Drug Wars and Coffeehouses: The Political Economy of the International Drug TradeWashington, DCCQ Press 2006Google Scholar
Cook, C.Bridge, J.Stimson, G. V.Harm Reduction: Evidence, Impacts and Challenges EMCDDA Monographs, 10LuxembourgPublications Office of the European Union 2010Google Scholar
Cook, C.Kanaef, N.Global State of Harm Reduction 2008. Mapping the Response to Drug-Related HIV and Hepatitis C EpidemicsLondonIHRA 2008Google Scholar
Brettle, R. P.HIV and Harm Reduction for Injecting Drug UsersAIDS 5 1991 125CrossRefGoogle Scholar
Boyam, D.Reuter, P.An Analytic Assessment of Drug PolicyWashington, DCThe AIE Press 2005Google Scholar
Bertram, E.Blachman, M.Sharpe, K.Andreas, P.Drug War Politics: The Price of DenialUniversity of California Press 1996Google Scholar
Nadelmann, E.Commentary: Challenging the Global Prohibition RegimeInternational Journal of Drug Policy 9, 1998 89CrossRefGoogle Scholar
Hedrich, D.Pirona, A.Wiessing, L.From Margin to Mainstream: The Evolution of Harm Reduction Responses to Problem Drug Use in EuropeDrugs: Education, Prevention and Policy 15, 2008 504Google Scholar
Stimson, G. V.O’Hare, P.Editorial: Harm Reduction: Moving Through the Third DecadeInternational Journal of Drug Policy 21, 2010 91CrossRefGoogle Scholar
Solinge, T. Boekhout vanDealing with Drugs in Europe. An Investigation of European Drug Control Experiences: France, the Netherlands and SwedenThe HagueBJU Legal Publishers 2004Google Scholar
Harm Reduction and Human RightsHarm Reduction and Human Rights: The Global Response to Injection-Driven HIV EpidemicsLondonInternational Harm Reduction Association 2008Google Scholar
WHOThe Practice and Context of Pharmacotherapy of Opioid Dependence in Central and Eastern EuropeGenevaWorld Health Organization 2004Google Scholar
Engelsman, E. M.Dutch Policy on the Management of Drug Related ProblemsBritish Journal of Addiction 84, 1989 216Google Scholar
Marlett, G. A.Harm Reduction: Pragmatic Strategies for Managing High-Risk BehavioursNew York, LondonThe Guilford Press 1998Google Scholar
Grund, J-P. C.Commentary. Harm Reduction in the United States at a Moment of Change: Moving Innovation from Grassroots to MainstreamAddiction 104, 2009 1450Google Scholar
Wodak, A.Going Soft on Evidence and Due Process: Canada Adopts US Style Harm MaximizationInternational Journal of Drug Policy 19, 2008 227CrossRefGoogle Scholar
Iulianelli, J. A. SilvaGuanabara, L. P.Fraga, P. C. P.Blickman, T.A Pointless War: Drugs and Violence in BrazilAmsterdamTransnational Institute 2004Google Scholar
Nissaramanesh, B.The Rise of Harm Reduction in the Islamic Republic of IranBeckley, Oxon.The Beckley Foundation Drug Policy Programme 2005Google Scholar
Qian, H.-Z.Schumacher, J. E.Chen, H. T.Ruan, Y-H.Injection Drug Use and HIV/AIDS in China: A Review of Current Situation, Prevention and Policy ImplicationsHarm Reduction Journal 3 2006CrossRefGoogle ScholarPubMed
Trebach, A.The Heroin SolutionNew Haven, ConnecticutYale University Press 1982Google Scholar
Gouwe, D. van derGallà, M.Gageldonk, A. vanCroes, E.Engelhardt, J.Laar, M. vanBuster, M.Prevention and Reduction of Health-related Harm Associated with Drug Dependence: An Inventory of Policies, Evidence and Practices in the EU Relevant to the Implementation of the Council Recommendation of 18 June 2003,UtrechtTrimbos Instituut 2006Google Scholar
Wood, E.Kerr, T.Cities and Drugs: Responding to Drugs in the City of Vancouver, CanadaInternational Journal of Drug Policy 17, 2006 55CrossRefGoogle Scholar
Hamilton, M.Drug War American Style: The Internationalization of Failed Policy and Its AlternativesNew YorkGarland Publishing 2001Google Scholar
Evans, M.Buller, J.Policy Transfer in Global PerspectiveFarnham, EnglandAshgate 2004Google Scholar
James, primarily O.Lodge, M.The Limitations of “Policy Transfer” and “Lesson DrawingPolitical Studies Review 1 2001 179CrossRefGoogle Scholar
Jones, T.Newburn, T.Learning from Uncle Sam? Exploring US Influences on British Crime Control PolicyGovernance 15, 2002 104CrossRefGoogle Scholar
Parsons, W.Public PolicyCheltenham, EnglandEdward Elgar 1996Google Scholar
Dolowitz, D. P.Marsh, D.Learning from Abroad: The Role of Policy Transfer in Contemporary Policy MakingGovernance 13, 2000 6CrossRefGoogle Scholar
Boothroyd, J.Out of Harm’s Way: German Support for Countries in Reducing the Harm of Injecting Drug Use and HIVEshborn, GermanyGesellschaft für Internationale Zusammenarbeit 2010Google Scholar
McCann, E. J.Expertise, Truth, and Urban Policy Mobilities: Global Circuits of Knowledge in the Development of Vancouver, Canada’s “Four Pillar” Drug StrategyEnvironment and Planning 40 2008 885CrossRefGoogle Scholar
Radaelli, C.Policy Transfer in the European UnionGovernance 13 2000 6CrossRefGoogle Scholar
Bergeron, H.Griffiths, P.Drugs: Policy and PoliticsLondon University Press 2006Google Scholar
Chatwin, C.Multi-level Governance: The Way Forward for European Illicit Drug Policy?International Journal of Drug Policy 18, 2007 494CrossRefGoogle Scholar
Elvins, M.Anti-Drugs Policies of the European Union. Transnational Decision-Making and the Politics of ExpertiseBasingstoke, UKPalgrave Macmillan 2003CrossRefGoogle Scholar
Solinge, T. Boekhout vanDrugs and Decision-Making in the European UnionAmsterdamMets and Schilt Publishers 2002Google Scholar
Jelsma, M.Diverging Trends in International Drug Policy Making: The Polarization Between Dogmatic and Pragmatic ApproachesAmsterdamTransnational Institute 2002Google Scholar
International Drug Policy ConsortiumThe European Union Drug Strategy: Progress and ProblemsWitley, SurreyInternational Drug Policy Consortium 2007Google Scholar
Birt, C. A.The Onward March of European Public HealthJournal of Epidemiology and Community Health 52 1998 770CrossRefGoogle ScholarPubMed
Solinge, T. Boekhout vanDutch Drug Policy in a European ContextJournal of Drug Issues 29, 1999 527Google Scholar
Long, D.The European Union and the Ottawa Process to Ban LandminesJournal of European Public Policy 9, 2002 441CrossRefGoogle Scholar
Commission of the European CommunitiesCommission Staff Working Document Accompanying the Communication from the Commission to the Council and the European Parliament on an EU Drugs Action Plan (2009–2012) Impact AssessmentBrussels 2008Google Scholar
Commission of the European CommunitiesCommission Staff Working Document accompanying Document to the Communication from the Commission to the Council and the European Parliament on an EU Drugs Action Plan (2009–2012). Report of the Final Evaluation of the EU Drugs Action Plan (2005–2008)Brussels 2008Google Scholar
Leonard, M.Why Europe will Run the 21st CenturyLondonFourth Estate 2005Google Scholar
Nye, J. S.The Paradox of American Power: Why the World’s Only Superpower Can’t Go It AloneOxford University Press 2002Google Scholar
Bewley-Taylor, D.Jelsma, M.Selling US WarsNorthampton, MassachusettsOlive Branch Press 2007Google Scholar
Kamarulzaman, A.Saiffuddeen, S.M.Islam and Harm ReductionInternational Journal of Drug Policy 21, 2010 117CrossRefGoogle Scholar
Schumacher, J. E.Fischer, G.Qian, H-Z.Policy Drives Harm Reduction for Drug Abuse and HIV/AIDS Prevention in some Developing CountriesDrug and Alcohol Dependence 91, 2007 301Google Scholar
Reuter, P.Pollack, H.How Much Can Treatment Reduce National Drug Problems?Addiction 101 2006 344CrossRefGoogle ScholarPubMed
Larney, S.Dolan, K.Compulsory Detoxification is a Major Challenge to Harm Reduction in ChinaInternational Journal of Drug Policy 21 2010 165CrossRefGoogle Scholar
DeBeck, K.Wood, E.Kerr, T.Montaner, J. 2007
Wodak, A.Going Soft on Evidence and Due Process: Canada Adopts US Style Harm MaximizationInternational Journal of Drug Policy 19, 2008 226CrossRefGoogle Scholar
Savary, J.-F.Hallam, C.Bewley-Taylor, D.The Swiss Four Pillars Policy: An Evolution From Local Experimentation to Federal LawBeckley, Oxon.Beckley Foundation Drug Policy Programme 2009Google Scholar
Csete, J.From the Mountaintops: What the World Can Learn from Drug Policy Change in SwitzerlandNew York, Open Society Foundations, Global Drug Policy Program 2010Google Scholar
Aust, A.Modern Treaty Law and PracticeCambridge University Press 2009Google Scholar

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