Harm reduction is a broad term applied to a variety of programs and policies, so there is no clear consensus on its meaning, although its aim is to reduce the adverse consequences of drug use and even of drug control policies. The term originated in the Netherlands in response to the HIV/AIDS epidemic and is the cornerstone of not only Dutch drug policy but drug policy throughout most of the industrialized world (other than the United States).
Harm reduction is a pragmatic policy aimed at minimizing the damage that drug users do to themselves, other persons, the community, and society at large. Harm reduction approaches reject a drug-free society as unachievable, recognizing that drug use has always been present in human societies. Although the official U.S. view tends to place harm reduction in the same camp as legalization, most advocates of harm reduction do not support legalization, expressing concern that it would increase drug use. Yet, they recognize that drug prohibition not only is insufficient to stop drug use but actually creates crime and marginalizes drug users.
Harm reduction interventions thus focus on integrating or reintegrating drug users into the community, taking care not to further isolate, demonize, or ostracize them. Priority is placed on maximizing the number of drug users in contact with drug treatment, outreach, and other public health services. Practitioners evaluate drug policies in terms of their potential effects on minimizing the harms of drugs to the user and to society.
Harm reduction tactics include programs such as methadone maintenance and needle exchange programs. Harm reduction can also include street outreach programs to “hidden” populations of drug users, treatment instead of incarceration, safe injection rooms staffed by medical professionals, and heroin maintenance programs. Most EU nations make treatment widely available and have a policy of street outreach to drug users to prevent further marginalization of drug users and to improve their health and encourage participation in treatment. Most industrial countries do not incarcerate individuals for simple possession of drugs, and the incarceration of drug users and sellers, while increasing, has not contributed to an epidemic of incarceration, as is evident in the United States.
Obligatory treatment, practiced primarily in the U.S. criminal justice system, is rarely considered harm reduction and is a topic of considerable debate in other industrialized countries. Several industrialized countries utilize controlled heroin maintenance, practiced in a manner similar to methadone maintenance, for those who have had multiple failures (drop out) from methadone maintenance. Research in these countries suggests these types of programs are not appropriate as a first response but rather are helpful to a small number of addicts and to their communities, as they help reduce crime.
- European Monitoring Center for Drugs and Drug Addiction (EMCDDA). 2005. “EMCDDA Thematic Papers—Illicit Drug Use in the EU: Legislative Approaches.” Lisbon, Portugal: EMCDDA.
- Harrison, Lana D. 2002. “Harm Reduction.” Pp. 819-22 in Encyclopedia of Crime and Punishment, edited by D. Levinson. Thousand Oaks, CA: Sage.
- Inciardi, James A. and Lana D. Harrison, eds. 2000. Harm Reduction: National and International Perspectives. Thousand Oaks, CA: Sage.
- Korf, Dirk, Heleen Riper, M. Freeman, R. Lewis, I. Grant, E. Jacob, C. Mougin, and M. Nilson. 1999. Outreach Work among Drugs Users in Europe: Concepts, Practice and Terminology. Lisbon, Portugal: EMCDDA.
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Drug policy has emphasized suppressing drugs at their source by curtailing their distribution, but few policy makers have considered legalization as a remedy. On the other hand, much of drug policy has been a record of bureaucratic infighting and aggrandizement. At the same time, it has reflected nativistic and racial biases. These essays suggest, however, that alternative strategies would not necessarily be any more successful. David Courtwright argues that legalization of drugs would create its own problems. Given the nature of federal policy, institutional structures, and social mores, the authors question whether drug policy could have been otherwise constructed.
William O. Walker has brought together leading scholars writing in the field to contribute essays that offer broad perspectives on the history of drug policy. They provide a comparative and historical lens through which to view the current debate over drug policy in the United States.