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| Question | Answer |
| Harm Reduction: Harms of Drug Use | What sort of harms are associated with drug use? Health risks, mental health risks, spreading and contracting of diseases, damaging to relationships and family life, addiction, [gun] violence, death. |
| Harm Reduction: In what way does criminalization and stigma make addressing the harms of drugs most challenging? | Yes, it is hard to get out of their bad habits because people are judgemental and exclude them (hard to seek help). A lot of other types of crime associated with drug use. Difficult to get clean., safe supplies to use drugs because it is illegal |
| Harm Reduction: In what way is the discussion of harm reduction in drug use reminiscent of the discussions we had about sex work/? | Community has a ‘not in my backyard’ type of mentality. Mainly affects drug user and drug dealer, like prostitution mainly affects the prostitution and the buyer. |
| Harm Reduction: Can there be a legal solution to an illegal activity? | - Legalize everything and open clinics to help regulate it. - Decriminalize everything, so people feel safer to seek help. - Legalize it in terms of medical benefits. |
| Needle Exchange Programs Three Paradigms (1) | The first is conservative. In this paradigm, harm reduction is seen as a temporary strategy, and the ultimate goal is conformity (e.g., abstention). The values which inform this approach are narcophobic, support pejorative labelling and language, and encourage shaming and blaming. The conservative approach accepts the myths about drugs and drug users without question, and reluctantly provides service. This approach is an approach which is rampant in the delivery of medical and social work services. "Undesirable" clients are "othered", diminishing and demeaning them. |
| Needle Exchange Programs Three Paradigms (2) | The second paradigm is liberal. Its aim is to support informed choice and provide a safety net. The worker here may or may not hold his or her nose, but will give the user new rigs and will probably require them to give them used rigs in return; the user will most probably be provided with a "teaching", from a position of social or moral authority. |
| Needle Exchange Programs Three Paradigms (3) | The final paradigm is structural. This approach embraces empowerment, advocacy and emancipation. It is user?driven. Needle exchange becomes needle distribution, and services are typically offered by drug users, usually in concert with professional or paraprofessional staff. Here, the person accessing service is respected as the expert and, as such, capable of making responsible choices about her or his life, including whether or not to use drugs. Harm from drug use is recognized as having more to do with poverty, oppression or disinformation than with the drugs themselves. The actions taken within this paradigm not only support the individual but challenge social and structural inequalities in order to assist disempowered individuals and groups in gaining access to their legitimate power. |
| Harm Reduction: Cavalieri’s Preferred Paradigm | Cavalieri believes the structural approach is the best approach for a variety of reasons. Structural is the only approach in which clean needles are distributed, as opposed to exchanged for dirty needles. It is also the only approach in which drug users are considered experts, and are actually the ones distributing the needles, alongside professional staff. I agree that this is the best approach, for a number of reasons, but most pressingly because the “person accessing service is respected as the expert and, as such, capable of making responsible choices about her or his life, including whether or not to use drugs” (Cavalieri). Giving the drug user respect and control allows them to take the reigns on their own life, and thereby choose what is best for them. I believe this is the only method which truly allows for a full recovery and/or a healthy life because the only person who can make you get better, is you. |
| Ethical approaches to the use of illicit drugs | - Why should we look at the ethical dimensions of this issue rather than simply at their practicalities, with which, I imagine, many of you are involved? At one level the answer is quite simple. Ethical concerns are basic to human interaction. They are the fundamental currency of interpersonal conduct. It is, most probably, an ethical concern—whether of compassion, beneficence, or justice—that prompts us to commit ourselves to social welfare or harm-reduction, a sense that we cannot simply stand on the sidelines as people risk catastrophic harm to themselves and to individual and collective others. We do not wait for bad consequences to occur in other spheres—we have safety standards and seatbelt regulations, for example—and there is no adequate reason for making an exception here. |
| Moral approaches to the use of illicit drugs | If the overall social effect that is sought is the same and is achieved more effectively as well as with less harm, that is not a bad compromise. What is more, the existence of an NSP conveys no positive regard for the activities of nondependant drug dealers. Both sides might reasonably view them as self-interestedly exploitative. We might put the point even more strongly by saying that even if we should not only do what we can to reduce drug dependence but also believe that drug use is inappropriate, we are morally better off not to adopt social policies that contribute nothing to its reduction and that probably exacerbate the harms already caused by it. Opponents falsely believe that if NSPs are not available drug use will be diminished. That represents a serious misunderstanding of the dynamics of drug use as well as the drug-injecting population. |
| Legal approaches to the use of illicit drugs | - There is the assertion that NSPs (or NEPs) are “misguided efforts to weaken drug laws.” It is, of course, a claim we might wish to challenge. Maybe these are laws that we should seek to weaken—not necessarily, of course, because we are opposed to drug laws but because we believe that the kinds of laws we have are inappropriate to the problem to which they are addressed. But, as I mentioned, I am here prescinding from that inquiry. - Taking it at its face value, how is this weakening intended (as suggested) or, if not intended, then consequent upon NSPs? Three possibilities are hinted at. One is that NSPs convey the message that drug use is not as seriously wrong as it really is: If you provide means whereby people can continue to do what the law forbids, then you weaken its condemnatory force. A second is that access to such means actually increases the amount of illicit behavior. And the third is that harm reduction is not enough; we should be aiming for harm minimization or, better, harm elimination, and NSPs impede the latter’s achievement. |
| The points from George W Bush’s speech to which Kleinig responds (1) | (A) There is the assertion that NSPs (or NEPs) are “misguided efforts to weaken drug laws.” It is, of course, a claim we might wish to challenge. Maybe these are laws that we should seek to weaken—not necessarily, of course, because we are opposed to drug laws but because we believe that the kinds of laws we have are inappropriate to the problem to which they are addressed. But, as I mentioned, I am here prescinding from that inquiry. Taking it at its face value, how is this weakening intended (as suggested) or, if not intended, then consequent upon NSPs? Three possibilities are hinted at. One is that NSPs convey the message that drug use is not as seriously wrong as it really is: If you provide means whereby people can continue to do what the law forbids, then you weaken its condemnatory force. A second is that access to such means actually increases the amount of illicit behavior. And the third is that harm reduction is not enough; we should be aiming for harm minimization or, better, harm elimination, and NSPs impede the latter’s achievement. |
| The points from George W Bush’s speech to which Kleinig responds (2) | Connected to this is a further argument implicit in Bush’s speech, namely, that there is some incompatibility between NSPs and the menu of other options he prefers—“a comprehensive mix of prevention, education, treatment, law enforcement, and supply interdiction.” But there is no deep incompatibility here. True, to the extent that one has an NSP, there will need to be selective law enforcement; you won’t station drug police at NSP premises, but—as existing Australian practice indicates—law enforcement is not thereby abandoned.25 And, given that staffed NSPs do not increase drug use and also provide increased opportunity for and likelihood of needed and accepted treatment, they simply add to the menu of options available for safely diminishing dependence on drugs. |
| The points from George W Bush’s speech to which Kleinig responds (3) | (C) Yet another implicit claim is that NSPs wrongly signal that drug use is here to stay. They are, Bush suggests, concessions to a false reality. But the false reality—at least as we are able to perceive it at present—is that drug use can be eliminated or is more likely to be eliminated in the absence of NSPs. Offering “hope” is inappropriate and irresponsible if it is not a realistic hope. one might well argue that our current policies have contributed more to the actual intractability of the “drug problem” than NSPs are likely to symbolize. But if, as mentioned earlier, there is no reason to believe that NSPs increase drug use and in addition they offer a modestly effective gateway to treatment, then they offer a much more realistic understanding of a social phenomenon than the one that in 2000 underpinned his own. |
| The points from George W Bush’s speech to which Kleinig responds (4) | (D) Do NSPs obscure the message “that there are right choices in life and wrong choices in life, that we are all responsible for our actions, and that using drugs will destroy your life”? No more, I guess, than seatbelts and airbags and other harm-minimization strategies obscure the message that reckless driving is wrong and will endanger you. NSPs may not operate moralistically, but they do not obscure the message that some choices in life are bad. Indeed, insofar as they acknowledge and respond to the risk of harm they carry a clear message, and if they also constitute a safe bridge or offer a gateway to treatment, they reinforce that point. Access to treatment and other public health services, insofar as they are available via an NSP, also acknowledge responsibility for actions insofar as they provide realistic social choices. The only thing that is missing (though not explicitly rejected) is the censorious claim that the injecting drug user is morally condemnable. |
| The points from George W Bush’s speech to which Kleinig responds (5) | Bush’s final remark, that NSPs constitute “a dead-end approach that offers despair and addiction,” is of course a cheap parting shot. Ĺ Why “dead-end,” particularly if they offer a safe bridge or gateway to treatment; why dead end, if they diminish the amount of harm caused by a social problem? Ĺ Why “despair” when they provide an opportunity for and even access to treatment to those who would otherwise, given our current social policies and provisions, not have realistic access; why despair, when they reduce the spread of harm to others? Ĺ Why “addiction,” when they do not increase drug use and offer an alternative to it when users are ready to avail themselves of it and will be more likely to benefit from it in both the short and long term? |
| What Kleinig thinks a truly ethical approach to harm reduction would involve | the concern is with the cost of their care for the community, not with the deeper issue of their human situation and what might be done to enable its recovery. If we believe that there is something humanly diminishing about drug dependence, then responsive programs—even harm reduction programs—ought to be funded and administered in ways that enable and encourage them to address the underlying issues and problems of dependence and not simply transmissible harms. This might not be an issue were we lacking evidence that needle programs offer a more effective and safe bridge to treatment than would be available in their absence. But that evidence exists, and though I would not argue that needle programs lack moral justification absent their responsiveness to the deeper problems of those who need their services, I believe that justification is much less compelling than it might be. |
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