Junkies in the House of the Lord

Abstract

The self-organization and mobilization of active drugs users is historically four decades old, but is rarely noted in the addiction, or drug policy literature. This piece looks closely at three European countries that have had varying degrees of success in organizing injection drugs users as key stakeholders in the development of non-criminalizing drug and reintegrating social policies. Indeed, the core questions here are about whether drugs users organizations can, or do have any impact in the improvement of drug treatment as well as the policies, which ultimately govern their lives. It should be noted that all of the groups studied included a few ex-users and/or non-user allies.

Keywords:

• drug user organizations/activists, health and human rights, drug policy reform movement, coalitions, mobilization

Notes

³ “Harm reduction is a social policy which prioritizes the aim of decreasing the negative effects of drug use” (Newcombe, R 1991), which has previously lived uneasily with the aim of persuading users to abstain. However, as a consequence of AIDS, there was an urgent need to prioritize stopping HIV from spreading. In the United States, licit clean needle distribution (a strategic component of harm reduction) was seen as condoning drug use/addiction.

⁴ The reader is reminded, firstly, that the diagnosis of a “substance use disorder” is a relatively new diagnosis that is based upon a consensus-based taxonomy, which is not empirically informed (American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th ed.; American Psychiatric Association: Washington, DC, 1994; 5^th ed., 2014) In order that any diagnosis be useful for treatment planning, it should “offer,” minimally, three critical, necessary types of information: etiology, process, and prognosis, which are not always known. Secondly, a diagnosis, when demystified, is simply the outcome of an information-gathering process to be used for decision making. Thirdly, the underpinnings for diagnostic criteria can be theory-driven, empirically based, individual- and/or systemic stake holder-bound, based upon “principles of faith,” etc. All too often, the needs or agendas of the classifier (individuals as well as systems) are not adequately considered or noted. Lastly, whereas all diagnoses are taxonomy categories or labels, all labels are not diagnoses. Editor's note.

⁵ Since the end of the 1990s the “DPFU" list, consisting of experienced long-term user activists from Australia, Holland, Germany, United Kingdom, Denmark, France, Canada, and America, has facilitated relevant discussion. Following a “mistake" in the Users’ Voice, where the word “addict" is used, several members of this list conducted a heated semantic debate (for at least a fortnight) about the words used to describe daily users, much of which is felt to be demeaning and hostile toward drug users. As I had made the “mistake," I suggested that we used literal words, for example, daily heroin user; this was accepted as being politically inoffensive among others, e.g. illegalized users.

⁶ The reader is referred to Tilly, C. (2008). Credit and Blame, Princeton University Press, Princeton, NJ, for a stimulating review about the dimensions of both giving credit and blaming, and to Tilly, C. (2006). Why. Princeton University Press, Princeton, NJ, for an analysis of reasons given, and accepted, in the West for why one has or has not done something. The labeling of active or former users, who represent a heterogeneous group of people, rarely, if ever, consider the individual's personal internal as well as external resources as s/he adapts and functions, daily, in a range of contexts, situations, networks, their family, and community as well as organizational systems. Editor's note.

⁷ A key unresolved issue are the lack of adequate generalizable criteria –indicated, contraindicated, irrelevant, and even harm producing –for selecting a specific technique, for a specific goal or set of goals, for a specific person notwithstanding the ongoing ado about “evidence-informed" treatment. Editor's note.

⁸ It should be noted that users groups also exist in Africa, Asia, Australia, Latin America, New Zealand, and North America, but either did not exist at the time of this study or were not included in it because of resource limitations. See http://www.inpud.net/

Additional information

Notes on contributors

Andria Efthimiou-Mordaunt

Andria Efthimiou-Mordaunt, MSc, United Kingdom, is mum to sprightly Millie, and has been working in the harm reduction movement since 1997 in the United Kingdom, where needle exchange (thankfully) was never illegal and we managed to convince our Conservative government in the late 1980s that providing methadone and sterile injecting equipment to drug-dependent injectors would, in the long run, save a huge amount of time, money, and, most importantly, keep the HIV deaths among IDUs comparatively low. Andria's focus was the organization of drugs users: as an X-IDU and AIDS widow herself, she was driven to learn and train so that her personal experience was married with an evidence base that she believed would enable her to support and organize drug users in a more dynamic and helpful way. Andria edits and writes in www.usersvoice.org. She has an MSc in Social Policy and Planning from the London School of Economics, and is currently bringing drug policy reform issues to the OCCUPY Movement in London.