A brief overview of illegal drugs regulations: harm reduction or law enforcement?
Harm reduction refers to policies, strategies and practices that aim primarily to reduce the harms associated with the use of psychoactive drugs in people unable or unwilling to stop (Hyshka et al., 2012). On the other hand, Law enforcement broadly refers to any system by which some members of community act in an organized manner to enforce the law by discovering, deterring, punishing persons who violate the rules and values governing that society (Beletsky et al., 2013; MacCoun and Reuter, 2001). In discussing whether the principles harm reduction or law enforcement should be the focal point for drug policy, this essay will evaluate evidence across different geopolitical contexts from the lens of Lacey’s (1998) efficiency/inefficiency theory, which posits that interventions should only be deployed if their positive outcomes outweigh their negative effects. It will argue that the amalgamation of both approaches as suggested by Beyrer (2012: 1) could be productive, but delivery at ground level could be challenging (Hyshka et al., 2012). In viewing both approaches as a polarised image of ‘Beauty and the Beast’, as Wilcox (2005: 255) would say, this essay will argue that their union in drug policy could yield different slices of realities across geopolitical spaces that could undermine efficiency, because what reflects on drug regulation is politically determined (Stevens, 2011) as is what counts as efficiency.
The fundamental assumptions of both paradigms is a crucial entry point that could deepen understanding as to which paradigm should be the central focus for drug policy. According to Erickson et al.’s (1997) generalization, unlike law enforcement, treatment and “[H]arm reduction programs are not dogmatic and coercive structures” (p.9), built on evidence-based knowledge about drugs/drug use and considers drug users as active individuals capable of taking decisions Law enforcement assumes also that offenders have some degree of autonomy, or there would be no ‘mens rea’ and responsibility justifying punishment rather than treatment. In contrast, law enforcement views IDUs as passive entities; primarily deviants and prone to acquisitive crimes, whereas, harm reductionists regard drug use naturally and IDUs as sovereign citizens (Tammi and Hurme, 2007). Therefore, in order to view evidence from the lens of Lacey’s (1998) theory as aforementioned, how these distinct principles are achieved in practice across different nations, will be where this essay will henceforth lean its weight.
Treatment and harm-reduction is an effective outreach tool for the prevention of blood-borne diseases such as HIV/AIDS (Beyrer, 2012). This is because, the sharing of injecting equipment is a norm among IDUs and wherever there are IDUs, there is risk of transmission of blood-borne viruses - BBV (Jardine et al., (2012:1). This strength of harm-reduction is evident in the Netherlands and Britain during the advent of HIV/AIDs in the 1980s, because albeit IDU was a common practice, the spread of BBV was controlled (Stimson, 1998). The underpinning being that these nations have realized, as suggested by Erkelens and Alem (1994) that “striving to a drug-free environment at all costs is an unrealistic goal” (p. 93) and have clearly implemented harm-reduction, which facilitated the distribution of needles to IDUs via Needle Exchange Programme (NEP) and, methadone maintenance treatment - MMT, etc., (MacCoun and Reuter, 2001). This in turn, reduced the spread of HIV/AIDS in the Netherlands and Britain (Ritter and Cameron, 2006). The Dutch and the UK case studies are persuasive illustrations, from the lens of Lacey’s (1998) efficiency theory mentioned, therefore the principles of harm-reduction should inform the regulation of drugs.
However, despite evidence to the contrary, the principles of law enforcement were encouraged at the expense of harm-reduction in America. Consequently, HIV/AIDS incidence reached epidemic proportion (Beletsky, et al., 2013:7). As asked by Nadelmann (1993: 37), “[W]ho in their right mind could oppose the notion of harm- reduction?” According to Cooper et al., (2005), that the political context of the USA - Regan Administration in the early 1980s, could be in its ‘right-mind’ and still oppose the notion of harm-reduction. The underpinning idea being that, prior to the advent of HIV/AIDS, the USA drug policy was primarily control-oriented (Berridge, 2002). Therefore, as Anderson (2002) points out, harm-reduction principles were unconceivable within the existing policy-frame of the USA. This echoes Stevens’s (2011a) assertion that “[W]hat counts as evidence is itself a politically loaded discussion” (p. 286). This highlights the impact of social facts on policy at the expense of evidence. Therefore, whether drug regulation should be based of the principles of harm-reduction or law enforcement depends on the social facts of the specific geopolitical space, albeit benefits of the former outweigh the latter from Lacey’s (1998) theory. It reminds us on Garland’s (2001:132) theory of culture of control, the policing of drug use ‘ Arguably, socio-political forces shape policy, which may be evaluated differently by varying perspectives.
However, although the Canadian Government adopted harm-reduction initiatives like the Netherlands/Britain in the 1980s (Hankins, 1998), harm-reduction was impotent in stopping the HIV/AIDS epidemic (Wood and Kerr, 2006). According to Wood and Ker (2006: 841), local Canadian politicians are implicated in this impotency of harm reduction. The politicians placed more emphasis on the acceptability of programme to non-users at the expense of harm-reduction, because to be tough on IDUs has often been seen as a vote winner by the politicians. Manifestly, police crackdowns were also deployed to create the image of aceptibility in the eyes of non-users, which translated into an increase in IDUs risk behaviours and coursed massive preventable harms (Wood et al., 2003). This highlights that the political frame of a geopolitical space shape to a great extent the inclusion or otherwise of the principles of law enforcement or harm reduction, regardless of the principles themselves in terms of Lacey’s (1998) theory of efficiency mentioned.
However, the principles of harm-reduction could make staff at ‘ground-level services’ vulnerable to intentional or otherwise discrimination, in assessing addicts’ as underserving or deserving. According to Lipsky’s (1980: 390) theory, “street-level- bureaucrats give in to stereotyping, all which serve agency purposes”. This suggests that, according to Finlay and Sandall (2009: 124), such ‘a model of care possesses the potentiality for unintended consequences’, which could impact negatively of addicts and undermine efficiency. Besides, limitation of harm reduction lies deeper than this. From a Foucaultian perspective, treatment interventions ignore “the social processes that underpin inequalities in health problems” (Carroll, 2013: 41) but address only the symptoms (Stevens, 2011b). Although the principles of harm reduction is built on the humanistic perspective (Rogers, 1980), it fails to address the key determinant of psychological distresses and motivations of drug abuse, which could be largely due to social inequality and deprivation often ignored or even denied in drug regulation arena. Therefore, for harm reduction to equate its philosophical rhetorical claims, it should be expected to do more than treating the symptoms of deep-rooted issues in social inequality.
On the contrary, the cost of law enforcement on ‘war on drugs’ is greater than its benefit, because it creates racial segregation (Alexander, 2012). Support for this idea is found in Beckett’s (2006: 105) study, which posited that “race shapes perception of who and what constitute drug problem, [as well as] the organisational response to that problem”, resulting in ‘racial profiling’ (Lynch, 2011). Consequently, moral aggression is often projected more on minority groups than the white majority (Duster, 1970). Evidently, the FBI (2010) reports that African Americans are about 33% more likely to be arrested for drug offences than whites. Similarly, Eastwood et al. (2013) found that blacks are 34% more likely than whites to be charged for having cocaine in their possession in Britain. Therefore, based on the above, it is reasonable to argue that law enforcement should not be the focus of drug policy, because it reinforces racial discrimination, which puts strain on and induce noxious stimuli in already-deprived groups (Agnew et al., 2008). In turn, this could make crimes and drug abuse more conducive and suggest that the principles of law enforcement should not be the focus for drug policy.
Closely related to this is the stigmatization of drug users. Law enforcement often creates social isolation (Wilson, 2010), affix stigma (Goffman, 1963) on already marginalized drug users. This is evident in Bakromov and Levy’s (2013) study in Russia, which found that the “Tajik migrants who inject drugs are at double jeopardy for social marginalization from Russian society as minority and also from their own Tajik communities as IDUs” (p. S35). Consequently, it elevated their crimes rates and intensified preventable risk behaviours among drug users. This invokes Park’s (1928) theory - the dilemma of the marginal man, who exists in dual cultures but unaccepted in none.