This critique will attempt to argue for and against Buning in 1993. 'If a person is not willing to give up his or her drug use then we should help them in causing less harm to himself or others'.

However Harm reduction is not just restricted to needle exchanges, certain   components promote basic rudiments of education. For example eating a meal before drinking, protecting the stomach from harm caused by alcohol. The objective of harm reduction is educating the individual (actor), which will    cause less harm to the community (the stage).

"The true champion of harm reduction is not necessarily anti-drugs nor necessarily pro-drugs. He or she expresses support, opposition or indifference to a proposed public or personal approach or a proposed legal or social response solely on the basis of the extent to which it increases or decreases the amount of harm consequent upon the drug in question…Thus the champion of harm reduction is neither for nor against increased civil rights for drug users; neither for or against increased availability of drug substitution or drug free programmes; neither for or against the legalization or decriminalisation of drug use; neither for or against diversions from the criminal justice system–except insofar as one or other of these choices influence the nature and extent of harms consequent upon use." (Strang, 1993: 3-4)

Strangs sentiments lead the, the author to interpret harm reduction as a way of reducing the avoidable risks to the drug user and the wider population and accept pragmatism

In contrast using the just deserts model rejects this ideal, which allows drug users to make informed choices, which are unlawful, and treatment providers to deliver safe ways of experiencing drugs.

The apparent flaw in this ideal is its ultimate aim, in terms of government policy. Because of this some harm reduction strategies have ultimate goals of achieving abstinence, from drugs. However the foundations of harm reduction recognises some drug users are not prepared to give up drugs.  Buning  (1993:1). Said  “If a person is not willing to give up his or her drug use, we should assist them in reducing harm to himself and others”.

Buning would suggest true champions of harm reduction would allow drug users to access services, which are willing to work in a non-judgmental fashion. He realises we no longer live in times where we fear both divine and secular judgement, however in its place we live in an era where morality is prescribed to the concept of drug taking even though one time this was lawful. Buning would argue prescribing moral codes to drug users is unhealthy because if users are made to feel inapt and are judged by their actions they may not access services and cause harm to themselves by sharing needles, passing on BBV, causing harm to others.

What emerges with the concept of harm reduction being considered a contempory drugs policy is should drug users have the choice in making decisions for themselves, surrounding their drug use, as this is their free will or should we coerce drug users into treatment and force abstinence as this protects society.

This notion reflects John Stewart Mills and his concept of liberty.  Because ‘the only time power can be exercised over any individual is if they are causing harm to others, morals and values are not a sufficient warrant’. Cited in Gossop (2000:167). Mills would have supported Buning because drugs policy is plagued by morality, which causes the harm to society. In addition, Jeremy Bentham the founder of utatilirism would maintain ‘happiness is for the greatest number’, and would say because only a minority of people use illegal drugs, happiness should be considered for the non-drug using community. To demonstrate we need to remember that drug users and non-drug users are two fragments of the same population that make up society. Therefore, happiness should be considered for the drug free as they make up the majority. However, Bentham also believes that the pleasure/happiness was brought about by doing ‘good’ deeds because it brings about pleasure and minimises the pain factor of life.  Bentham believed that due to this it is the government’s duty to impose social policy that encourages people to act for the good of society because if individuals are left to their own devices they act in their own self-interest.  . Therefore, Bentham would advocate the implementation of harm reduction in the form of needle exchanges because of BBV from IDU’s however he would also maintain harm reduction should aim towards abstinence because of for the happiness for the greatest number. Mills on the other hand who promoted the concept of liberty would argue most policies are implemented to curb the liberty of individuals, however drug use is only self serving e.g. getting high. Policy is not aimed at taking away liberty but as stated, it is imposed to restrict the liberty of those not acting for the good of the community. Therefore, we have to remember wider society is being affected by the minority.

What has emerged from needle exchanges are IDU’s have accepted and internalised this process and understand this is a safer way to   inject drugs. So in effect, if the state tells us what is right or wrong we internalise, which becomes our norms and values.

So if harm reduction were implemented into society with out the aim of abstinence, for example heroin maintenance then Bentham would say society would accept this policy.  Mills may have said the state wishes to infringe on liberty, but BBV are a sufficient warrant to impose restrictions, he too would accept harm reduction with the aim of abstinence.    

To demonstrate the process of internalisation is too look at needle exchanges. When needle exchanges were implemented some right idealists thought such an action would promote an increase drug use, however when society was nourished with the consequences of needle sharing i.e. HIV/AIDS society accepted needle exchanges to stabilise BBV. Macgregor (2000: 141) edited by Coomber  (2000) suggests HIV and AIDS saved the drug services. If HIV/AIDS were not in existence, the concept of needle exchanges would never have happened. The rationale for harm reduction; was to protect society from IDU’s because they were considered high risk of transmitting BBV through needle sharing.

In spite of this, recent studies in the United Kingdom and North America have shown the largest rising population of HIV/AIDS sufferers are heterosexuals, non-drug using individuals. Between 60-100% of heterosexual, acquire though an IDU and 40% of IDU’s are in relationships with non-drug users. Riley et al (1999). One possible explanation for this is, drug agencies have found when clean needles are given out, the demand of condoms decreases.  Drunker (1997) cited in Riley et al (1999). These findings can suggest two possible explanations for a decrease of condoms. 1) IDU’s are given a false sense of security; by thinking, because they are no longer sharing needles they are less likely to contract the virus. In effect the intervention becomes counter productive because a decrease in the use of condoms. Alternatively, treatments providers are so focused on promoting needle exchanges, because they have internalised HIV/AIDS is spread by IDU’s and have overlooked the fact that HIV/AIDS is contracted through sex.  

Because the harm reduction model is hard to measure, as an effective intervention the author will turn to a pilot study in a Swiss prison. It is debatable as to whether this is the most coherent way to conceptualise harm reduction as an effective strategy, however what is justifiable for using this example is the population under study is contained within the penal system and as a result can be measured over a period of time.

The genesis began in Oberschongrun, when a doctor who was not authorised gave out syringes to IDU’s. Nelles and Harding (2000) edited by Shewan et al (2000:30). The doctor swapped used needles in exchange for new ones. As one may expect there was some concerns as to whether inmates may use needles to attack staff and other prisoners. However even though the study has not been scientifically evaluated, reports have confirmed that there has been no attacks on inmates or staff, no overdoses, no new abscesses, no drug related deaths or an increase in drug taking. Nelles (2000) Because of the success even at this stage are anecdotic medical staff are so convinced of its value they are prescribing heroin.

Because of Oberschongrun, Hindelbank a facility for female offenders emulated the same idea.  Staff at Hindelbank reported a disproportionate number of offenders were using drugs, sharing needles and a HIV was prevalent. The study was carried out over 12-months. In addition to giving out needles, they encompassed a variety of other frameworks, which included lectures, discussion groups, socio medical counselling and leaflets. Nelles et al (2000) Cited in Shewan & Davies (2000:31).

In its evaluation, they found that after the mixture of methods reduction, minimisation and prevention saw a stabilisation in drug use. Using the prison experiments as examples for harm reduction prove they have some value, even if the results show a stabilisation in drug use and BBV.  

 

As drug using is illegal, the abstinence module is widely prescribed within the prison population, and is the ultimate goal aimed within some treatment agencies. Philip Bean has recognised the contradiction.

   

Bean (2002:72) suggests that harm reduction can be an effective tool for some however; harm reduction the criminal justice system ignores continued drug use, and deems it unlawful. This was highlighted in Merseyside where drug users if caught were cautioned so long as they attempted treatment. The local police adopted a laissez faire approach to illegal drugs and were encouraged not to patrol the drugs agency. Riley et al (1999). However, bean argues, Ignoring criminal acts goes against the principles of the criminal justice apparatus.

For example the ‘just deserts’ model would say if abstinence is followed, the offenders would become non-offending because they cease taking drugs and will not break the law and the non offending drug users will not get the chance to enter the criminal justice system because they cease drug use.

Using the just deserts model, it could be suggest this concept is coherent, thus runs along side the goal of the criminal justice structure. Harm reduction module is not tangible as there is profound confusion with its logic. Bean (2002:72)

Beans criticism of the harm reduction module makes sense, because on the one hand the government is increasing the sentences tariffs for drug sellers, coercing drug users into DTTO’s and the recent ‘three strikes and out’; policy, and on the other hand reclassifying cannabis in to a c category. Resulting in the drugs message becoming fragmented.

However, this move was not to assist drug reformers, but to reduce the stress placed on the police force and criminal justice system. This is the same reason why harm reduction was considered. HIV/AIDS from IDU’s was spilling into the non-using community.

Although Bean has made a plausible point what would have made his argument robust is if he suggested harm reduction even though we are unable to measure it scientifically, has become elaborated and embedded by service providers and has woven its way into structure and delivery. Thus encouraging the drug user to accept what they are doing is unlawful and potentially damaging to health but not seeing its consequences it terms of criminality.

Instead of stating ‘harm reduction allows the use of less harmful drugs in preference of those more harmful’. Cited Bean (2002:72). In regards to health for IDU’s the ‘just deserts’ model would argue BBV are the just deserts of continued criminality. This is perhaps the reason why some crime control orientated policies allow for harm reduction with the goal of abstinence because HIV/AIDS will affect non-drug using, law abiding citizens.

 

After reviewing the literature, the conclusions drawn from the arguments are of great complexity 

The Swiss prison experiment was a convincing argument for harm reduction, because they also incorporated a prevention message, even if they have only stabilised drug use and HIV/AIDS by having needle exchanges and providing heroin to its inmates.  

Even though some may be cynical of the harm reduction model, it is a powerful mechanism for spreading facts surrounding drugs and is an effective tool for lessening the spread of HIV/AIDS, by having needle exchanges. However acknowledging research carried out by Drunker (1997) have proved harm reduction has it limitations in this area.

What can be said is despite efforts to widen lawful avenues with which to deter drug users from the offset, the state apparatus is weak and have lacked effective control. Bean has recognised its contradictive atmosphere. By suggesting harm, reduction has no place in society because drug using is unlawful. What is a potential intervention is to allow IDU’s to receive heroin on prescription, without the aim of abstinence, this act would become lawful, and then harm reduction would be logical in the criminal justice apparatus.  

Because of this Harm, reduction as an evidenced based, effective intervention will remain contentious. However, a possible explanation for this is recognising harm reduction is hard to measure because ultimately society rejects harm reduction in favour for abstinence, harm reduction in essence has not been given a fair chance because the long term goal with some treatment providers is allowing harm reduction in the first instance but having abstinence as the goal. In order for harm reduction to be taken seriously, by society the state has to implement harm reduction using Bunings interpretation. When the state changes policy, individuals internalise the norms and values, which will reflect on society.  The concept of internalisation has been the crux for this critique.

As to weather the state should assist drug users causing less harm to themselves and others by giving them choice to exercise their free will, is a continuum after all drug users are the minority and happiness for the greatest number is what policy makers strive for.  

Bean  (2002) Drugs and crime Willan publishing Page 72

Birke et al (1990) An analysis of the abstinence violation effect in a sample of illicit drug users British journal of addiction 1990 85 1299-1307

Buning (1993) Fifteen years of harm reduction: A reflection international journal of drugs policy 1993 3(4) p197-197

Buning (1991) innovative approaches in AIDS prevention among drug users international journal drugs policy 1991 2 (6) p10-12 7 refs.

Eric Single (2000) The effectiveness of harm reduction and its role in a new framework for drug policy in British Columbia

Gossop (2000) living with drugs fifth edition page Ash gate arena press page 167

Harding In the control of drugs and drug users reason or reaction? Ed by Coomber (1998) Harwood academic press page 225

Martinson (1974) what works questions and answers about prison reform the public interest vol 35 22-54

McGregor Pragmatism or principle? Continuity and change in the British approach to treatment control in the control of drugs and drug users reason or reaction Ed by

Coomber (1998) Harwood academic press Page 141

Nelles et al (2000) in Drug use and prison an international perspective Ed by Shewan and Davis (2000) Harwood academics publishers Page 30-31

Presentation to the National Federal/Provincial/Territorial Meeting on Injection Drug Use, Vancouver, January 31, 2000

Riley et al (1999) Ed by Incardi and Harrison in Harm reduction national and International perspectives Sage publications 1999

Shiner & Newburn (1996) the youth awareness programme an evaluation of peer education drugs project London drugs prevention initiatives, Home Office page 61

Spriut et al Dutch drug policy and cannabis Ed by Marlow et al (1999) in Young people drugs and community safety Russell House publishing page 50

Strang et al (1994) heroin addiction and drugs policy the British system oxford university press page 345

Strang, J. (1993) Drug use and harm reduction: responding to the challenge. In: Heather, N., Wodak, A., Nadelmann, E., O’Hare, P. (eds.) Psychoactive Drugs and Harm-reduction: From Faith to Science. London: Whurr Publishers. Page 3