Paper short abstract:

Harm Reduction approaches are situated between two poles: biopolitical and humanitarian. The former transforms people who use drugs into responsible risk-averse citizens; the latter reconceptualizes them from criminals to suffering beings who achieve legitimization due to their biologic condition.

Paper long abstract:

Historically, policy surrounding illicit substance use focused heavily on criminalization, an approach which has been under scrutiny since the 1980s with the advent of the Harm Reduction (HR) movement as part of Thatcher’s New Public Health in GB. Traditionally seen as criminals, the HR movement construed PWUD as individuals engaging in risky health behaviour who can make the responsible choice to live “healthier” lives without abstinence. Meanwhile, HR has become an important approach for governing at risk populations by targeting the mortality and morbidity of these populations, which foregrounds the physical and biological existence of PWUD and precludes questioning the underlying causes of increased substance use in our societies. Simultaneously, HR promotes a human rights platform thereby conceptualizing life as a supreme good that justifies every action undertaken in its name. With Fassin’s (2019) concept of biolegitimacy we will demonstrate that HR perpetuates a hierarchy of lives as the COVID-19 pandemic makes explicit. Despite living in biopolitical societies, the pandemic systematically worsened the exaggerated vulnerability and precarity of expendable groups such as PWUD. What is most striking about HR is that PWUD are only intelligible as suffering beings in need of help to physically survive. Paradoxically, it is the use of drugs itself, and therefore the increased risk of death from overdose or infection from unhygienic consumption practices that becomes the only venue for PWUD to achieve limited forms of visibility and to make claims in the name of the sacredness of life.

Paper short abstract:

In my ethnographic study of Pike and Wayne Counties, participants view users, especially Whites addicted to prescription drugs, as both actors in and victims of their addiction. They refuse harm-reduction strategies in fear of attracting more use, removing users’ agency over their own health.

Paper long abstract:

This paper exposes results of my ethnographic study of Pike and Wayne Counties to demonstrate how residents conceptualize the responsibility of people with addiction, of the medical field, and of the government in responding to increased drug-related mortality rates. Participants confirmed findings by Campbell (1995, 2000, 2007) which suggested that users are considered untrustworthy and unreliable actors deprived of agency, rendering harm-reduction strategies incoherent as they rely on personal responsibility.

Participants sympathized with users—especially, if not uniquely, those addicted to prescription opioids, mirroring Becker (1963) and Lindesmith (1947)’s canonical studies demonstrating differential understandings of “criminals” and “patients” suffering from an illness depending on whether the drug used was illicit or pharmaceutical—but reaffirmed their stigmatization, given participants’ beliefs about drug use’s dirtiness and criminality. Residents have refused locally-proposed drug-exchange and rehabilitation centers in fear of attracting more users. State and federal Naloxone-distribution programs were suspected of leading to increased use, mirroring the 1988 Drug Abuse Act’s logic that forbid federal funding for needle-exchange programs.

While participants did not immediately associate drug use with Blackness—perhaps due to the counties’ demographics (89.3% and 94.3% White) and overdose statistics (80.7% and 90.8% White)—and they admitted that addiction can affect any socioeconomic category, intersections of race and class altered participants’ perspectives. Participants often imagined users as Whites in situations of poverty, associating them with poor decision-making, low will-power, and other characteristics linked to the “poor, White trash” stereotype, ripe itself with connotations of dirtiness, criminality, and immorality since the mid-19th century.

Paper short abstract:

By analysing recent public debates on harm reduction programmes, in my presentation, I will look at ways of understanding responsibility and pleasure in Poland. I will consider to what extent these understandings are shaped by the dominant abstinence model, and to what extent by state homophobia.

Paper long abstract:

Although the first harm reduction services in Poland were introduced in the late 1980s and early 1990s, the abstinence-based approach, which prevailed for decades, assumed that a figure of responsible user or addict cannot exist. The only way to become responsible for people who use drugs was to completely dissociate oneself from drugs and choose abstinence. This belief, anchored not only in popular discourses on drug use but also in public policies, has made it difficult to implement some of the harm-reduction measures. The process of implementing harm reduction in recent years is being put to the additional test of public institutions taking on homophobic narratives. Taking into account this historical background and the recent populist and right-wing turn of events in the Polish government, I would like to consider to what extent and in what way state homophobia and the abstinence model present in Poland shape the concept of responsibility and responsible citizenship. In my paper, I would like to look at the recent public controversies surrounding harm-reduction programmes, addressed, among others, men who have sex with men and use drugs. The public debates initiated by government representatives and attacking harm-reduction programmes for the 'promotion of drug use and gay sex' will serve as a site of exploration of meanings and definitions of the concept of responsibility in the context of drug use and sexuality. The meanings of responsibility will be discussed together with the understandings of pleasure that emerges in public discourses on drugs and non-heteronormativity.

Paper short abstract:

Brazil, Portugal, and the United States each interpret the term "harm reduction" differently. Given such little consensus, there is much to be learned from a comparative analysis of national harm reduction policies and practices, as well as their impact on people who use drugs and society at large.

Paper long abstract:

It is a well-documented phenomena that vulnerable populations face inequalities in healthcare access and quality. No matter the nation, people who use drugs (PWUD) have faced scrutiny and stigma from medical professionals, politicians, and their communities at-large. That said, initiatives for harm reduction in Brazil and Portugal, countries which take a human rights approach to healthcare, vastly differ in and of themselves, as well as differ from those living in the United States. A comparative approach of the three countries using historical analyses of drug use, as well as analyses of interviews with PWUD, activists, healthcare workers, and policymakers, helps to reveal the differing meanings of harm reduction across health systems and countries. Given the priorities of each system, Portugal's approach at decriminalization seems to have elicited satisfaction from PWUD and policymaking respondents alike, with social support seen and accepted as a responsibility of the state and a means of harm reduction. Brazil's largest city, São Paulo, attempted a similar social welfare policy to respond to crack cocaine use, yet the program was received immediate criticism and has since been severely defunded. The United States has yet to implement a national harm reduction strategy, thereby deferring to states and municipalities. The variations within and across countries as to whether harm reduction is the responsibility of the state reveal how deeply stigma is rooted in national policy, as well as the potential for success when such policies take a human rights approach.