Neil Hunt

1. Horse trading harm: How should harm reductionists resolve tensions between crime prevention and health promotion? Neil Hunt Based on the paper: Whose harm? Harm reduction and the shift to coercion in UK drug policy, Hunt N and Stevens A. Social Policy and Society - forthcoming)

2. Origins • 1997 Blair declares war on drug users  • Drug Treatment and Testing Orders (DTTOs) • Drug Abstinence Orders (DAOs) The expansion of….. • Criminal Justice Intervention Programmes (CJIP)

3. Worse still… • Conservative Party wants to ‘out-war’ Labour and have announced plans to increase intensive residential rehabilitation places from 2,000 to 20,000 “each young addict will be given the choice between undergoing treatment and facing criminal proceedings” (Oliver Letwin) • ‘Boot camps’?  

4. But…. • In 2000 Gerry Stimson declared war on Tony Blair • A wake up call to UK harm reductionists who had been largely blind to crucial changes in UK drug policy • Initiated a refreshed harm reduction critique of drug policy within the UK

6. Of course….. • Nothing intrinsically wrong with crime prevention • Being a victim of robbery is bad • Being a victim of burglary is bad • No argument!

7. Furthermore……. • Drug users are frequently also the victims of crime • Burglary, robbery, assault are no less unpleasant for drug users and…

8. What’s more….. • Drug users are arguably victims of various specific drug related crimes • Mugged for your stash • Ripped off during deals • Weights and measures • Trading standards – poor purity and misrepresented product content • No-one realistically expects governments to care about this - though that doesn’t actually mean it’s ok!

9. Some harm reduction theory • Types of harm • Health • Social • Economic • Levels of harm • Individual • Community • Societal

10. From Newcombe R (1992) The Reduction of drug-related harm: a conceptual framework for theory, practice and research. In: O’Hare P, et al. The Reduction of Drug Related Harm. London: Routledge.

11. From Newcombe R (1992) The Reduction of drug-related harm: a conceptual framework for theory, practice and research. In: O’Hare P, et al. The Reduction of Drug Related Harm. London: Routledge.

12. From Newcombe R (1992) The Reduction of drug-related harm: a conceptual framework for theory, practice and research. In: O’Hare P, et al. The Reduction of Drug Related Harm. London: Routledge.

13. Illicit drug use is (of course) just one of several consumption behaviours that have impacts across the same levels and types • Tobacco • Alcohol • High fat/high carbohydrate (junk) foods

14. But……. • Illicit drug use is almost unique in the way that social policy can allow harms to the wider community and society to be prioritised over those that affect the consumer

15. There is a problem with harm reduction theory… • It is ambiguous as to who drug interventions ought primarily to benefit • This is unproblematic where benefits occur across different ‘levels’. • Trouble arises when outcomes are more ambiguous i.e. programmes to prevent crime where evidence of benefits to drug users is unclear

16. Opportunity costs within public policy choices • The public purse is always finite • Spending in one area necessarily excludes spending in another

17. Opportunity costs in the UK include…. • Hepatitis C strategy • Needle exchange coverage • Reducing drug related deaths strategy • Resourcing of drug user involvement and self-empowerment • Enhanced family planning services for drug using women • Resourcing of training for drug workers • Development of safer injecting facilities

18. What’s more… • The crime prevention discourse increases the perception that drug use is inextricably linked to crime. • Obstacle to treatment uptake • Increasing of stigma and shame surrounding drug use • We could have invested in programmes that reduce the stigma of drug use and increase social inclusion of drug users • Another ‘opportunity cost’

19. Preliminary conclusion • Harm reduction theory is currently weak in guiding policy decisions between policies that benefit the health and well-being of drug users or may benefit non-drug users (the community and societal levels of harm). • The UK is a country case study which indicates that our theory is not adequate to the task of protecting the interests of drug users

20. Two assertions • It is neither acceptable or right for harm reduction to be ambiguous regarding the expected beneficiaries and benefits from programmes ostensibly concerned with the health and well-being of drug users • It is neither acceptable or right for programmes to be unduly swayed by expected or desired benefits for non-drug users.

21. Final musings • Horse trading with drug users’ health and well being arises from the marginalized and vilified position of drug users • We need a harm reduction theory that better defends us against drug policy driven by political priorities

22. Final conclusion • “The primary test for any harm reduction intervention or programme should be the extent to which it contributes to the optimisation of the health and well-being of drug users” • Embracing this principle would substantially improve the effectiveness and justice of our programmes. • Benefits at the community and social level should be seen as a bonus (but only that) • Harm reduction theory that is genuinely user-centred should explicitly embrace this priority at the heart of what we mean by ‘harm reduction’.

23. Thank you Neil Hunt neil@dadden.demon.co.uk +44 (0) 7780 665830