Harm Reduction
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a talk presented by Michael R. Aldrich, California AIDS Intervention Training Center

August 21, 1993

Harm reduction means reducing the harm of drug use to the user and society.

Harm reduction recognizes the reality of the world rather than trying to operate in myths and fantasies. It recognizes that people in all societies have used drugs in many different ways for many thousands of years. It recognizes that a "drug-free society" is a myth. It sets up goals that are practical, workable and achievable, unlike the unachievable goal of a drug-free society.

Harm reduction asks, What do users want? It is based on the perspective of the user, rather than missionary work, trying to force the perspective of the missionary on the user. It means ethnography rather than law enforcement.

Harm reduction means outreach, taking social and health services to people on their own turf and on their own terms. It also means making the system more accessible and more user-friendly rather than defining the user as an enemy be defeated.

Harm reduction is future-oriented, rather than past-oriented. It involves real drug education for young people about the benefits as well as the harm of drug use, education about how to use drugs intelligently. It means making safer drugs for future users rather than trying to keep them from using drugs at all.

Harm reduction means making less harmful options available. If we make coca tea available, most people will choose that form of cocaine over more harmful forms like crack, as a matter of simple survival. People can make choices that reduce the harm to themselves and to society.

At the same time, harm reduction means treatment on demand-- making a wide range of treatment options available to people who get into trouble with drugs It means helping the drunk or the junkie get services, rather than throwing the drunk or junkie or crackhead or speed freak in jail.

Harm reduction means reducing the harm to police, too. It means that if a cop goes to pat someone down and gets stuck with a needle, the chances are much less that the cop will become HIV infected if the needle has been cleaned with bleach or has been obtained from a needle exchange.

Harm reduction is focused on public health. Harm reduction means changing the attitudes and behavior not only of users but also of doctors, police, politicians, and public health officials. It means redefining the concept of public health from old 19th century concepts to new 21st century concepts. The emphasis is on community health rather than on agency agendas.

In San Francisco it was quite a struggle at first to get health officials, treatment programs, politicians, and the criminal justice system to recognize the value of outreach and needle - exchange; we have been blessed by the fact that police and aid understand this. The result has been that unlike New York and many other cities where outreach was minimized and needle exchange was a joke, in San Francisco we have kept HIV contained at less than 15% among injection drug users for the past six years.

Harm reduction recognizes what users have been telling us for years, that "drugs of abuse" can also have great medical value, starting with marijuana. San Francisco voters have taken a big step in this direction already with passage of Proposition P in 1991; 800/o approval is the largest vote in favor of marijuana in the history of the world.

Harm reduction also means learning innovative techniques from what works in other countries. We can learn from the Netherlands, for instance, that making (he marijuana market separate from the heroin and cocaine markets greatly reduces the harm to society Marijuana legalization, whether up-front or under the table by simply not enforcing the laws, is an essential part of harm reduction.

We can learn from Australia that it is a public health measure to have a government van drive way out in the country to deliver needles, alcohol wipes, healing creams, and AIDS prevention information to drug users in their own homes. This is a very different attitude from having police helicopters doing Vietnam search and destroy missions and confiscating users' homes

We can learn from Frankfurt that having a city drug policy coordinating group like the one that Werner Schneider heads, including top-level health and criminal justice officials, is a lot more effective than having police, prosecutors, AIDS offices, drug treatment agencies, social services, and health departments all pursuing different agendas and fighting each other over funding. The same applies to cities, states, and the Federal government coordinating harm reduction activities.

We can also learn from Frankfurt an even more provocative idea about changing the definition of a "shooting gallery" from a dark and hidden place to a "health gallery" where outreach workers, medical staff, and HIV specialists are available to drug users on their own turf and on their own terms. A place where people can learn how to shoot up safely and take responsibility for their own health, with access to a whole range of health and social services.

The same concept could apply to crackhouses, with a particular focus on stopping the spread of tuberculosis and AIDS and STD's. The same could apply to psychedelic dance clubs, providing a safe environment in which psychedelics can be taken, with experienced "guides" and perhaps a medical team like Haight Ashbury Free Clinic's rock medicine group available to help people if they are having bad trips.

All these local concepts could be used at the state and Federal levels as well. The first step in harm reduction at the national level will be to take the power to schedule drugs out of the hands of the Justice Department and return it to the medical and scientific community where it belongs.

We are talking about an evolutionary change in the concept of what health care and social service means in the 21st century. In the near future, drugs are going to be much better, more potent and more dangerous; specifically targeted neurochemicals that almost everyone is going to want. Smart drugs and gene-tailored drugs for performance, memory and intelligence enhancement, drugs to prolong life and improve the quality of life: and even, if science fiction is correct, drugs that improve access to cyberspace or virtual reality system

If we gear future drug policy to the abuse of 19th-century drugs, as we do now , our policies will be irrelevant, but if we learn the policies of harm reduction that can be achieved, we will have a much better chance of surviving the 21st century.

Thank you for your time and consideration.

Presented to the California Drug Policy Coalition California NORML International Drug Reform Conference, Fort Mason, San Francisco, 8-21-93.

Michael R. Aldrich, Ph.D., is program coordinator of the California AIDS Intervention Training Center which trains community health outreach workers for the State of California; and curator of the Fritz Hugh Ludlow Memorial Library, the nation's largest private collection of drug literature, P.O. Box 640346, San Francisco, California 94164-0346, USA.

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