Harm Reduction: A Bottom’s Up Approach?

Abstract

<p>In the 1970s, Hong Kong’s methadone program was at the forefront in Asia, and was soon followed by other non-governmental harm reduction initiatives aiming to minimize the risks associated with injection use of heroin, including peer counseling and outreach. These initiatives remained within the broader abstinence treatment model and prohibitionist regime. The shift in the 1990s to psychoactive drug consumption demanded different strategies and policies, but harm reduction was beyond reach, being seen as potentially encouraging young people’s consumption of drugs and countering its longstanding zero tolerance ethos. Recently, the government has called for research to shed light on the feasibility of harm reduction strategies, responding to ongoing calls from frontline workers and government audits. The government’s position on harm reduction, however, remains steadfast, tied to the end goal of abstinence. </p><p>We uncover the possibilities and challenges of harm reduction in the abstinence and prohibitionist environs. We draw on data from our research where we have developed a local harm reduction training program for frontline workers and relevant stakeholders. The focus in our discussion is on the data collected to develop the training program, in particular, interview data with persons who use drugs and social workers about current drug use patterns, practices and problems in reducing harms/risks associated with use, and challenges the latter face in “doing” harm reduction at the frontline, organizational or larger policy levels. Our end goal is to develop a “bottom up” approach to harm reduction in the context of Hong Kong’s distinct prohibition policies.</p>