Harm Reduction: A New Direction for Drug Policies and Programs

It is refreshing to read a book that is grounded in the real world, is consistent with common sense, and maintains unified coherence while exploring numerous facets of a complex problem. The unifying theme of this book is harm reduction concerning substance usage. The harm reduction approach makes its goal the reduction or minimization of substance-related harm, rather than abstinence. Harm reduction contrasts markedly with the tried and failed prohibitionist solution characteristic throughout most of the twentieth century. Decriminalization or legalisation may be part of a harm reduction program, as might public health approaches, health promotion, and medical care for users. However, harm reduction is an approach that has more extensive implications and is much broader in scope than approaches such as legalisation or the medicalization of drugs from crime to "sickness". This theme recurs in other forms in the section of papers concerned with special populations. These papers also reinforce the point that reduction of harm to those using substances, rather than abstinence is an effective approach. One can generalise a conclusion from these articles that harm reduction is most likely when users make their own decisions about whether to abstain or use and, if using, how much they will use substances; the role of program outreach is to provide the maximum assistance to people to reduce harm associated with their choices, whatever they are. These selections are concerned with special populations, such as Punjabis, pregnant women and those who have recently birthed a child, New York city street youth, prostitutes, older adults, and prison populations.