13th November 2020 • Sticky Post

Harm Reduction in 2020

Harm Reduction can be defined essentially as a range of policies designed to minimize the impact of behaviors with negative social, physical, and psychological consequences. The term is generally used to refer to a number of public policies related to substance abuse and addiction. Policies that fall under the umbrella of harm reduction would include needle exchanges, safe injection sites, opioid replacement therapy, and the decriminalization of drugs of abuse.

Harm reduction gained traction as a strategy for dealing with drug abuse in the 1980s, as the AIDS epidemic was at its height. A coalition of academics, activists, and public officials looked to limit the spread of the disease, and decrease the human and financial burdens created by addiction. As the concept developed over the years advocates of harm reduction have pointed to programs like supervised injections, needle exchanges, alternative sentencing measures, and decriminalization as ways to create better outcomes for both addicts and taxpayers. The concept has come to include creative measures such as “Illegal” magazine, a Danish publication provided to addicts which allows them to earn money by selling the publication in the manner of “The Big Issue” rather than resorting to crime or sex work.

Perhaps the greatest coup the movement has scored was persuading the Portuguese government to wholeheartedly adopt the strategy in 2001. Portugal decriminalized all drugs and began to treat addiction and substance misuse as a health issue, a tectonic shift that ended a great deal of the stigma and dehumanization that too frequently surround issues of addiction. Over the past two decades, Portugal has seen dramatic drops in the spread of HIV, deaths from overdose, and drug-related crime. Yet few countries have adopted this successful approach. Let’s take a look at the state of harm reduction measures in 2020, and explore the question of why the Portuguese model hasn’t been more widely adopted.  

We can see mentalities to illicit drug use changing, as cities, states, and countries move towards decriminalization of certain drugs. Canada, South Africa, and an ever-growing list of American states have recently legalized cannabis, a shift that signals that attitudes towards illicit drug use, if not addiction, are changing in the "First World". Meanwhile, Canada, Australia, and 10 European countries are currently operating safe-injection sites for intravenous drug use. This seems like progress, but if you consider the fact that these sites are proven to save millions of dollars in health-care costs by preventing overdoses and the spread of HIV and hepatitis, it’s shocking that these facilities aren’t more widespread. A similar problem exists with needle exchange programs. Even with an indisputable array of evidence demonstrating that needle exchanges prevent the spread of diseases associated with intravenous drug use, according to Wikipedia, only 14 countries around the world provide this service, and in the USA there is a federal funding ban on these exchanges.

Portugal’s decision not to arrest or incarcerate anyone for drug possession allowed the country to provide more funding for health-care services instead of law enforcement. Decriminalization has saved the government millions of Euros and changed public conceptions of who the addicted are. According to The Guardian, people who used to be called “drogados”, a derisive term for addicts, are now referred to as “people who use drugs.” And this has happened in a country that used to employ the slogan “Drugs are Satan!” 

Meanwhile, in countries like the United States, the UK, and Sweden, attitudes, and policies for dealing with the addicted remain mired in moral condemnation of drug users. 47% of the inmates in American federal prisons are incarcerated for drug offenses, while in the UK 15% of adults and over 20% of juveniles currently incarcerated are serving time for drug offenses. 

Outdated policies based on moralistic views of drug users have made the toll taken by the global opioid epidemic even more horrific. People who began using prescription drugs for genuine pain are now being forced into the black-market to procure the substances they’d been encouraged to use by healthcare professionals, a process that leads to incarceration and even death. Meanwhile, promising treatments including psilocybin, ayahuasca, and ibogaine are languishing in the wings while the problems they could help solve rage on unabated.

Attitudes towards the addicted are changing, and that gives us hope for a brighter future. We just hope that governments can accelerate their adoption of this new paradigm.

Harm Reduction in the Developing World

Countries like Ghana and Colombia have been pushing to decriminalize drugs, and reform draconian laws which too often ruin the lives of young and poor people. In Ghana, someone caught with a single joint of marijuana was subject to 10 years of jail time. Many activists in the country feel that the popular reforms are being stalled by a police force and judiciary who fear the change would weaken their hold on power. Meanwhile, reports from Colombia show that the number of people in jail for drug offenses jumped by 250% following legal changes in 2009 which decriminalized possession of small amounts of cocaine and marijuana.  

For intravenous drug users, the 2017 Lancet Global Health Report found that lower and middle-income countries (LMICs) experienced chronic under-funding for needle exchanges and other harm-reduction measures aimed at halting the spread of HIV. This is especially troubling because injection drug use is now far more prevalent in these countries than in the developed world.

In Asia, harm reduction seems even further away. The region leads the world in executions for drug offenses, and many of the continent’s largest countries, including Thailand, China, India, Korea, and Vietnam view drug trafficking as a capital offense. While harm reduction programs have appeared, the NCBI reports that they are generally small programs that reach few of the people in need. 

Structural issues are a major barrier to significant harm reduction in Asia, as the social stigma surrounding drug use is far greater than in the West, and harsh penalties for simple possession keep many of those in need of treatment from accessing healthcare systems. In the Philippines, the situation is extremely grim for drug users, as President Duterte’s misguided drug war has taken the lives of an estimated 20,000 people who’ve been targeted for extrajudicial execution.

The Future

As firm believers in harm reduction who have watched firsthand as Portugal’s progressive, humanitarian policies transformed thousands of lives, we find reasons to be both saddened and encouraged by the global progress of harm reduction. At Iboga Tree Healing House we dream of a day when governments around the world adopt the fiscally prudent, deeply compassionate policies that fall under the umbrella of harm reduction. For the time being, we would recommend that addicts in regions with outmoded, repressive laws and policies regarding addiction venture abroad for treatment.