Harm reduction as anarchist practice: a user's guide to capitalism and addiction in North America

Abstract

In spite of its origins as an illegal, clandestine, grassroots activity that took place either outside or in defiant opposition to state and legal authority, there is growing evidence to suggest that harm reduction in North America has become sanitized and depoliticized in its institutionalization as public health policy. Harm reduction remains the most contested and controversial aspect of drug policy on both sides of the Canada–US border, yet the institutionalization of harm reduction in each national context demonstrates a series of stark contrasts. Drawing from regional case study examples in Canada and the US, this article historically traces and politically re-maps the uneasy relationship between the autonomous political origins of harm reduction, contemporary public health policy, and the adoption of the biomedical model for addiction research and treatment in North America. Situated within a broader theoretical interrogation of the etiology of addiction, this study culminates in a politically engaged critique of traditional addiction research and drug/service user autonomy. Arguing that the founding philosophy and spirit of the harm reduction movement represents a fundamentally anarchist-inspired form of practice, this article concludes by considering tactics for reclaiming and re-politicizing the future of harm reduction in North America.

Keywords:

• harm reduction
• public health
• anarchism
• addiction research
• addiction treatment
• needle exchange
• supervised injection facility

Acknowledgments

This article is both dedicated and profoundly indebted to the critical/creative co-conspiracy of Jon Paul Hammond, who died in Philadelphia on 5 November 2010, battle-scarred by the drug war, a militant harm reductionist, political agitator, and queer Quaker anarchist to the very end.

Notes

Notes

1. In spite of its centrality to their organizational structure, owing to acute public discomfort with the term ‘anarchism,’ the group consistently attempted to downplay their political orientation. Featuring on a list of things ‘not to the say to the media’, Stoller (1998, p. 104) noted members were urged to conceal their ‘political leanings, such as anarchism or paganism’.

2. Within 1 year of taking office, Canadian Prime Minister Stephen Harper unveiled the Conservative government's National Anti-Drug Strategy in 2007. Based on a three-prong approach including prevention, treatment, and enforcement, the new Strategy suggested harm reduction was being written out of Canadian drug policy altogether. Moreover, signaling a return to moral-criminological ideologies, responsibility for the new Anti-Drug Strategy was shifted from Health Canada to the Department of Justice (Government of Canada 2007).

3. Martin (2011, p. 34) suggests that ‘[b]ecause no one officially runs AA’, the 12-step movement represents ‘the world's largest functioning anarchy’. Eschewing any formal relationship to biomedical authorities, Robinson (1983, p. 169) notes that AA aspires to remain ‘uninvolved in outside philosophical, political or social issues’. The notion of powerlessness in the first step, however, represents a significant source of contention regarding the ideological underpinnings of the movement, particularly in relation to gender (Valverde and White-Mair 1999, Herndon 2001, Hillhouse and Fiorentine 2001).

4. i.e. the clinical gaze of epidemiologists, addiction doctors, treatment counsellors, and public health scientists.

5. For manuals, best practices and lessons learned regarding user involvement in the development and delivery of harm reduction policy, see: Toronto Harm Reduction Task Force (2003), Mason (2006), Canadian Harm Reduction Network (2008), Canadian HIV/AIDS Legal Network (2008), Cheng and Smith (2009).

6. For example, see Cocteau (2001, p. 20): ‘I therefore became an opium addict again because the doctors who cure – one should really say, quite simply, who purge – do not seek to cure the troubles which cause the addiction; I had found again my unbalanced state of mind; and I preferred an artificial equilibrium to no equilibrium at all’.

7. Stemming primarily from the author's cumulative ethnographic observations at harm reduction and addiction treatment sites in Canada (Toronto) and the US (Philadelphia), further evidence of these phenomena can be found in numerous media references. For controversy surrounding ‘safer crack use kits’, see: Fox News (2010) and Bailey (2010). Concerning syringe conflict, see: Hunter (2009, 2010). Regarding ibogaine, see Alper et al. (2008) and Hamilton (2011).

8. ‘This is a challenge to academics, policy experts and service providers’, reads the VANDU Manifesto for a Drug User Liberation Movement (2010): ‘we do not want to be used as cheap labour, we do not want to be studied while we die, or be turned into clients while resources are given to ‘service’ agencies. We will not tolerate actions that exploit the labour, activist work, or experiences of people who use drugs. Finally, we expect responsible researchers, experts and academics to support us’.