The battle over harm reduction

The more it becomes official policy, the more it is criticized for policy failures

Two protests - one for safe drug consumption sites, one against them

Last week was a sad week for the harm reduction movement, when the man who first used the term in print, Dr Russell Newcombe, passed away from cancer. Newcombe was one of a small group of activists, doctors and drug users in Merseyside in the 1980s who revolutionized how the world perceived drugs, and who arguably shifted the global approach to drugs from prohibition to harm reduction.

The revolution began in a Merseyside addiction clinic where Dr John Marks tried a new approach to opiate use. Rather than prohibition or even promoting 12-step-style abstinence, Dr Marks sought to reduce the harms associated with drug use. His clinic offered clean syringes, healthcare for drug users, and even free access to heroin and cocaine. The radical experiment succeeded in reducing AIDS deaths from shared syringes.

This new approach, which was also trialled in Holland, was dubbed ‘harm reduction’ by a young researcher at Liverpool University - Russell Newcombe - in an article in Drug Science published in 1987. There was actually a typo, so the first English mention of ‘harm reduction’ was technically ‘haim reduction’.

Harm reduction was a shift away from both the prohibitionist, police-led response to drug addiction, and the spiritual 12-steps-led approach (addiction is a disease, addicts are helpless but can surrender to a higher power and live a life of abstinence). Instead, harm reduction took a secular, pragmatic approach - drug use is a constant of human existence, and is often fun and healing, although sometimes risky. We should learn to reduce risks rather than trying to eradicate a perennial human activity.

Newcombe himself was an enthusiastic user of drugs, who dealt amphetamine and cannabis as a student.  He saw dealers as not just drug-dispensers but information-dispensers:

like many dealers (and as a budding harm reductionist) he would often advise his customers about how to minimise risks and maximise benefits. We know it might sound weird to some, but many people who sell drugs also practice harm reduction.

Newcombe was passionate about drug education, and thought hard about the best way to educate people about the risks of drugs - using techniques like music, games and cartoons. Here’s one of his cartoons, Willy Whizz.

He also produced comic-book guides to particular drugs, such as this one:

Dr Nuke's Tripology guide, which included a decent section on the risks and side effects of psychedelics

One of the points Newcombe made is drug-taking is a culture (or rather, an assortment of cultures - wine culture, beer culture, shroom culture, weed culture, heroin culture and so on), and while there can be risks to that culture – fetishization and glamorization of the drug experience – drug culture can also be a means for sharing risk-reduction techniques.

The challenge when drug use suddenly grows very fast - as psychedelic usage is at the moment - is whether the culture can keep up and educate the newbies. How can one do that? A social club model is one possible solution, a ‘drivers license’-style exam is another.

In the 1980s, the ‘harm reduction’ approach was adopted by Margaret Thatcher’s government. That’s not as surprising as it sounds - in some ways it’s a neo-liberal approach, which avoids a moralizing attitude to substances and sees them as best regulated by the market and by autonomous individuals who should be free to buy what they want. Milton Friedman, the father of neo-liberalism, believed all drugs should be legalized.

In the 1990s, the gospel of harm reduction spread from Liverpool all over the world, and in the last few years it’s become a central cornerstone of President Biden’s health policy.

After the paywall, how harm reduction became a huge, influential and multi-bilion-dollar global movement, and how its success in influencing policy means it is increasingly becoming a target for political attacks.