INTRODUCTION

The concept of 'harm reduction', and the practices which are associated with it, have been developed primarily in the contexts of health education and health care. There is a pressing need that the concept should be expanded to include drug enforcement, criminal justice and the ,penal system. 'When this is done, the principles of harm reducdon Can then be shown to have a surprisingly wide range of applications. The central aim of this chapter is to sketch in the implications of such an approach to illicit drug misuse.

I have said that the range of applications of the principles of harm reduction to drug enforcement is surprisingly large. It is a matter for some surprise because, as things stand, drug enforcement is often thought to be hostile to harm reduction strategies. Harm reduction, as usually conceived, is there to help individuals who use and misuse drugs. Enforcement measures, by the same logic, are there to control the supply of drugs by arresting, convicting and punishing drug users. Harm reduction and drug enforcement therefore stand opposed to each other. I shall argue that this is not necessarily so. Nevertheless, along the way I shall score a few 'own goals' because some of the ways in which drug enforcement is conceived are direcdy hostile to both the individual and collective interest.

I am aware, of course, of that powerful tradition which suggests that in large measure the harms resulting from drug use are precisely a consequence of their illegality. On this view, one harm reduction stance might be to do away entirely with enforcement, through one form or another of legalization or decriminalization. I do not see it this way. Arguments in favour of legalization, which have been quite fashionable in recent years, are merely symptomatic of frustration with the failure of current drug control policies (Pearson, 1989a). It is certainly true that one could envisage a more rational system of regulation of the production, distribution and consumption of drugs — such as the position advanced by Francis Caballero in his Droit de la Drogue which promotes the idea of a 'passive commerce' involving a system of national monopolies and licensing arrangements which fall short of legalization (Caballero, 1989; Le Gendre, 1990).

However, so much of this debate is mere idle talk. Legalization is not going to happen, in any foreseeable future, without a sea-change in international systems of treaties. One can therefore waste a great deal of brainpower and breath in argurnents about legalization. There is undoubtedly a strong case for the decriminalization of cannabis, which has been tried successfully in the Netherlands and which would also release a large arnount of police resources in the British context where more than 80 per cent of convictions and cautions for drug offences are conceded with cannabis (Pearson, 1991). Where dnigs such as heroin and cocaine are concerned, however, it is not self-evident that legalization would be desirable. It would certainly not solve the problems of Third World producer nations, and it would risk unleashing even greater problems of drug misuse in the metropolitan nations.

As a final word of introduction, it is perhaps as well to say where I am coming from in these arguments. What I have to say should be situated within the context of the heroin epidemic which has ripped through many British towns and cities during the 1980s. It is a problem which has been experienced in its most intense form in regions and localities already experiencing multiple social difficulties — high levels of unemployment, housing decay, and other forms of social deprivation (Pearson, et al., 1985, 1986; Pearson, 1987a, b; Parker et al., 1988). This is not to advance a simple-minded and mechanical argument — 'unemployment causes heroin misuse' — but to acknowledge the legacy of the interlocking problems which the heroin epidemic imposed on these already embattled and poverty-stricken neighbourhoods.

Those who work in drugs agencies, necessarily and understandably focus their attention on the needs and interests of the individual drug user. When the needs and interests of this wider community are weighed in the balance, however, then they dust surely carry considerable weight and the emphasis of a fully rounded and competent drug control strategy must shift accordingly. These communities need systems of social defence against problems of drug misuse. One line of defence is provided through effective low-level law enforcement. It offers a means by which to restrain the recruitment of 'not-yet-users' into the system, while also providing a means to encourage existing users to take up treatment options at an earlier stage than they might otherwise have done. If employed within the spirit and practice of 'harm reduction', effective law enforcement need not be the enemy of the drug user; it can be a progressive and humane instrument.

HARM REDUCTION AND THE AIMS OF DRUG ENFORCEMENT

The aims of harm reduction in the criminal justice field can be organized under four broad principles:

The containment of the numbers of new users recruited into the system through effective and focused low-level policing in conjunction with other prevention strategies.

The encouragement of existing users to take 'early retirement' from drug-using careers, and to enter treatment programmes which include maintenance prescribing as an intermediate objective.

The minimization of counter-productive aspects of enforcement strategies through arrest-referral schemes, diversion programmes and other community-based activities which avoid the excessive use of custodial measures and enhance the prospects of rehabilitation.

The minimization of harm to the wider community, by a reduction of crime committed by users in order to sustain their habits.

These principles — directed towards the user, the not-yet-user and the wider community — involve an extension of vision by those who work in drug agencies. I have already noted the way in which their preoccupations and sympathies are understandably and necessarily directed towards individual drug users. What must also be admitted within drug discourses, however, are those wider community interests which cannot be met by services delivered to drug users. This is where focused enforcement efforts can assist in responding to the needs and interests of the vider community, and also to those of the individual drug users.

How might the four organizing principles which I have outlined be translated into a more specific set of aims and objectives, involving targeted sites of intervention and achievable outcomes?

MINIMIZING THE RECRUITMENT OF THE NOT-YET-USER

Where the 'not-yet-user' is concerned, this requires a shift of attention for law enforcement to include not only major trafficking organizations but also lower-level dealing operations and user-dealers (Pearson, 1989a, b). It is far too easy to slip into a comfortable moral rhctoric whereby the major traffickers are identified as the 'villains' of the piece who are legitimate targets for enforcement, as against user-dealers who are seen as the 'victims' of the drug business. This form of rhetoric not only ignores what we know about the active lifestyles of drug users and user-dealers which are difficult to reconcile with victim status (Preble and Casey, 1969; Joluison et al., 1985; Gilman and Pearson, 1991); it is also blind to the fact that it is through these low-level distribution systems that dangerous drugs are made available in vulnerable neighbourhoods, rather than through the so-called 'Barons' and 'Mr Bigs' of the international drug trade.

Effective performance indicators for police work in the sphere of drug enforcement are extremely difficult to formulate (Peamon, 1589b, 1990). Perhaps the best available formulation of an enforcement strategy which aims to limit the recruitment of new users into the system is that provided by Mark Moore (1977) in his book Buy and Bust. Moore admits that he does not know how to eliminate heroin distribution in New York — thus making him out as a sensible pragmatist amidst bizarre North American fantasies of 'zero tolerance' — but that an achievable aim would be to increase the amount of time a novice user takes to score heroin from five minutes to two hours. Moore's approach is one of 'inconvenience policing', which simply means that forms of local policing should be adopted whereby it becomes more difficult to cross the threshold from the not-yet-user to the user. Moore suggests that young police officers might be deployed in drug-dealing areas, for example, posing as novice users and then arresting dealers with whom they made contact. The objective is not to eliminate dealing in such a neighbourhood, but to make dealers wary of strangers: in other words, it is a focused enforcement strategy which merely aims to encourage the local drug market to draw in its horns.

Other aspects of Moore's strategy are more questionable in terms of harm reduction. For example, he suggests that an aim of enforcement should be to keep 'copping areas' on the move in order to further inconvenience novice buyers. However, by keeping dealers on the move this might simply result in widening the local availability of drugs. We know of the 'displacement effects' which can result from police drives in particular neighbourhoods against crimes such as burglary, and which are generally regarded as non-problematic in that they simply shift the problem from one area to another without exacerbating it.

However, in the field of drug enforcement 'displacement effects' are far from benign in that they increase the knowledge and availability of potentially dangerous drugs. It is one of the advantages of focused low-level enforcement strategies, however, that they do make it easier both to specify achievable objectives while also identifying undesirable outcomes of a local tactic (Pearson, 1989b).

ENCOURAGING EXISTING USERS TO TARE 'EARLY RETIREMENT'

As applied to drug users themselves, harm reduction principles require that a central aim of a focused enforcement strategy is to encourage existing users to take up treatment options. This involves a number of related objectives and areas of activity. It also engages with arguments in the realm of moral philosophy about compulsion, civil liberties and voluntarism.

The central requirement must be to encourage users to take up treatment options at an earlier stage in their drug-using careers. Drug services currently operate on a quasi-medical model which assumes the willing compliance of an individual drug user who admits that he or she is in some way sick and in need of help and treatment. Once more, however, this fails to conform to what we know about the active lifestyles of drug users and the high status which they can enjoy within their local community (Gilman and Pearson, 1991). It seems likely, moreover, that drug users make choices to enter into contact with services under one form or another of subtle compulsion — from family, friends, social workers, etc. Targeted low-level enforcement strategies, when allied to rational and non-discriminatory cautioning and sentencing procedures, can offer a means by which the law formalizes these already-existing compulsions and focuses the attention of drug users on the rational choices which can be made available to them in the form of treatment, counselling and other systems of care and support.

Drug enforcement must be conceived of not simply as a constraint on individual liberties, which I take to be the position of conventional liberal moral 'philosophy in the drugs field, but also as a potentially humane and positive force. My own is a crude jurisprudence, no doubt, which aims to constrain people to be free. Medical approaches to drug problems rest on the myth of voluntarism — the motivated, self-acting and willing participant who admits to being sick. But drug users are not like this. They only become like this when they reach what appears to them to be a cul-de-sac in their drug use and their lives. It is often only when they have arrived at this dead-end point that drug users seek help, thus helping to confirm and reproduce the voluntarist philosophy of the medical model, as individuals willingly giving themselves into treatment.

But why should we wait until drug users reach the state of ill-health and low self-esteem that they sometimes do before they seek help? Two ideal-type cases can make the point. First, a man in his mid-thirties who has been an opiate user for twelve years, whose health is extremely poor with ulcerated legs and numerous abscesses. He is very thin and in considerable pain, funds his addiction by property crime and has been imprisoned in the past. Next, a woman aged thirty who is again in very poor health and is a regular groin injector with several open sores and abscesses. She has been using heroin for nine years and has had several detoxification treatments in the past. She is a hepatitis B carrier and funds her addiction by prostitution.

When one takes fully into account the awfulness of the human suffering endured by people in circumstances such as these, it must shift the moral ground in those arguments which are customarily paraded around drug questions concerning civil liberties, the freedom of the individual, and the voluntaristic emphasis of the medical model. What defence of civil liberties is it which allows people to get themselves into such states of wretched ill-health and multiple legal and financial problems?

One final consideration, of course, is that, not uncommonly, drug users are allowed to get into conditions such as these because doctors in their immediate locality are unsympathetic to the idea of maintenance prescribing as a treatment option. While agreeing that maintenance is only one option among many, there should nevertheless be a further legal requirement which is enforced on doctors themselves, requiring them to make available a full range of services and for these to be managed and offered in a balanced progranune of activities. The law can muscle people into treatment options, but the fiill range of options for sometimes difficult and damaged people must be locally available.

MINIMIZING THE COUNTER-PRODUCTIVE EFFECTS OF ENFORCEMENT

The next objective is to minimize the counter-productive harms resulting from some enforcement strategies and sentencing trends. British government policy, as indicated by recent statements from the Home Office (1988, 1990), is currently advocating the expansion of non-custodial community-based programmes for 'less serious' offenders. Specific attention has been given within these proposals to the needs of offenders with drug and alcohol-related problems (Gilman and Pearson, 1991; SCODA, 1990).

These proposals are in fundamental agreement, moreover, with the recommendations of the twin reports of the Advisory Council on the Misuse of Drugs (1988, 1989) on the question of AIDS and drug MiSUSe. There is mounting evidence within Britain's decaying Victorian prison system not only of the widespread availability of illicit drugs, but also of the risks of HIV infection through the sharing of injection equipment and unsafe sex practices (Rahman et al., 1989; Prison Reform Trust, 1988; Carvell and Hart, 1990; Kennedy et al., 1990). It is going to be increasingly difficult to ignore this evidence, giving added encouragedent to the development of non-custodial programmes for offenders with drug-related difficulties, including necessary adjustments to sentencing guidelines. In terms of street-level policing, the lesson would already seem to have been learned from the devastating experience of Edinburgh, where known levels of HIV seropositivity among intravenous drug users was already in excess of 50 per cent by the mid-1980s, that where police use the possession of injecting equipment as a pretext for arrest, this simply increases the likelihood that the drug users will share 'works' and that 'shooting galleries' will be established (Scottish Home and Health Department, 1986: 7; ACMD, 1988: 43).

The emergence of HIV and AIDS has had a paradoxical influence on public attitudes and policy debates towards drug misuse. On the one hand, it has led to the further stigmatization of marginal groups such as homosexuals and drug users. On the other hand, in Britain at least, it has blown gusts of fresh air through the public debate on drug misuse. There is now a growing awareness of the associated risks of not only drug misuse itself, but aLso thoughtless sentencing policies. While there are still pockets of doubt and uncertainty in some professional circles about viewing drug problems only through the prism of HIV and AIDS, which are entirely understandable, there is nevertheless a new fluidity within policy-thinking which must be grasped and turned in the most progressive and effective direction. It is a rare moment when humane considerations coincide with those likely to be most effective.

The expansion of community-based programmes to combat the excessive use of imprisonment will require new ways of working in the drugs field, involving multi-agency strategies which bring together the work of drug services, the police, the probation service and the courts.

Multi-agency work in the criminal justice sphere is never easy, and there are abundant sites of potential and actual conflict between agencies which must be recognized and overcome if effective inter-agency and inter-professional cooperation is to be secured (Blagg et aL, 1988; Sampson et al., 1988, 1991; Pearson et al., 1989, 1991).

There is, nevertheless, evidence of considerable success in the field of juvenile justice where in the course of the 1980s the use of custody has been halved by the development of credible and effective community-based alternatives (Children's Society, 1988). The challenge is to extend this success so as to reduce the excessive and counter-productive imprisonment of young adult offenders, including those with drug-related problems. For these purposes, drug enforcement and sentencing strategies need to be aligned with innovative projects such as syringe-exchange schemes, attempts to gain a more sensitive understanding of the reasons why people share injecting equipment, the exploitation of novel forms of communication in health education such as comics, the development of effective and 'user-friendly' services for women dnig users and for black and other minority ethnic groups, and outreach work with high-risk groups such as drug-using prostitutes (Monitoring Research Group, 1988; McKeganey, 1989; Gilman, 1988; Awiah et al., 1990; Plant, 1990).

The British system of drug control policy, with all its inadequacies, remains a highly flexible instrument which has traditionally combined enforcement efforts with systems of education and health care provision (Pearson, 1991). There is little point at the moment arguing about the most effective forms of community-based intervention, whether in terms of arrest-referral schemes, pre-trial diversion programmes, drug advisory services to courts, bail assistance schemes, custody-exit initia-tives, etc. We simply do not have the experience to know, as yet, the most effective point at which to intervene in the decision-making processes of the criminal justice system. In all likelihood, different forms of intervention will have to be tailored to suit the neecis of different categories of drug users. However, the combined approach of the Home Office non-custodial strategy and the Advisory Council's recomdendations offers a real window of opportunity for the develop-ment of harm reduction strategies. Careful evaluation of different approaches will be necessary at some point, but for the present our aim should be to let a hundred flowers bloom.

REDUCING HARM TO THE WIDER COMMUNITY

If existing users can be encouraged to make contact with services through a strengthened and focused law enforcement effort, this will bring benefits to the wider community. It will reduce the amount of crime conunitted by drug users in order to support their habits. It will help to contain the spread of HIV infection. It will minimize the fiscal implications of the excessive use of imprisonment which otherwise incurs financial penalties against taxpayers and the welfare state.

In addition, drug enforcement at a local level needs to engage in a clear assessment of its aims and objectives, while also identifying the possible unintended consequences of different forms of enforcement. I have already suggested that some forms of policing operation can result in the increased likelihood that drug users will share injecting equipment. Other forms of policing simply move local drug-dealing networks from one neighbourhood to another, thus risking an even wider availability of dangerous drugs such as heroin and cocaine.

In order to deepen our understanding of how to design the most effective drug enforcement strategies, we need to build up case studies of the consequences — both direct and indirect — of different forms of local effort. I will offer three examples of the kinds of necessary consideration.

In one city in the north of England which experienced a sharp increase in heroin misuse during the 1980s, the low-level distribution system consisted largely of user-dealers who operated from their own houses and flats. These were easily identifiable and thus vulnerable to raids by the police. As a consequence, substantial numbers of user-dealers were convicted, while others decided to retire from dealing while the going was good. The outcome in titis city is that drug-dealing has moved onto a different basis. What has emerged is a street-dealing scene, and it is not immediately obvious that this is an improvement on what went before. The earlier system had required dealers to maintain a certain level of security, so that it was only possible to buy drugs if you ' were already known and trusted. It was therefore more difficult for novice users and experimenters to cross the threshold from not-yet-user to user. The new street-dealing scene, on the other hand, involves no formalities of titis kind. It is wide open and anonymous, thus lowering the threshold of entry into the system. The question needs to be asked: would policing have taken the form that it did, if forward-plarming could have foreseen the actual outcome?

The second example has an international dimension, and involves a set of issues which arc likely to grow in importance with the integration of the European community. The phenomenon known as 'drugs tourism' is a consequence of an imbalance in enforcement policies between neighbouring states or regions. There has been a particularly sharp expression of this kind of difficulty in the Dutch town of Arnhem which lies close to the border with West Germany, involving bitter conflicts within the local conununity as German drug users are 'sucked in' along the steep gradients of control and enforcement which exist between Germany and the Netherlands (Ephimenco, 1989). In this context, the Swiss Federal Commission (1989) recently published a report which advocates the de-penalization of all drug offences for simple possession. However, perlups mindful of the Dutch experience, the report also recognized that if such a change in enforcement policy were implemented unilaterally, it would 'bring about drug tourism in Switzerland with all the undesirable effects which this implies' (ibid.: 78). In other words, here it was a liberalization of enforcement strategy which, although it had been considered to have geat merit in terms of domestic policy, had unintended consequences for the wider community.

The question of 'drugs tourism' indicates something of the complexity of integrated drug policy formulation. There are many local and regional circumstances which involve similar considerations. The existence of a specific form of treatment facility in a given locality, for example, can produce an effect not dissimilar from 'drugs tourisni' by attracting drug users from other regions and localities. Drug issues involve all manner of forms of local and regional diversity, requiring specific attention in the formulation of local policies which can otherwise backfire. Recently, for example, an attempt in the north-west of England to prohibit the sale of travel sickness preparations which contain cyclizine (a constituent of the opioid Diconal which was a preference drug for many opiate users) has led to an illicit market in cyclizine in the irnmediate locality (Pearson, et al., 1990). Again, one must ask, was this the intended outcome of the local enforcement attempt at prohibition?

My third example involves a further consideration, which is that the success of local drug enforcement efforts should not be judged simply in terms of the supply and demand of drugs. In this case, a local park had become the focus for low-level dealing. Quite apart from genuine dealing operations, the park had also attracted opportunists who aimed to `rip-off' prospective buyers, armed with cocoa powder in one pocket and a lcnife in the other. Assaults and 'muggings' had also become common, so that the park was quite unusable as a public facility. As a result of a series of police sweeps, the park had subsequently been cleared of drug dealers. However, the police were unhappy about the outcome and judged the operation to have been a failure since they knew that many of the same people were still dealing drugs, although they were now operating from private households. Here we are simply giving the police the wrong message. As a narrowly defuied drug enforcement operation, perhaps it is correct to say that it had failed. However, if a different focus were to be adopted, then the operation had been a major success. The park was once again a place where people could stroll, read a newspaper, push a pram. The operation might only have dented the drug-dealing system, but it had returned an important community resource to public utility.

The underlying principle in these three-case studies is that we need a more highly nuanced set of aims and objectives for drug enforcement strategies. On any reading of the situation, the aim of eliminating domestic drug markets is not an achievable goal (Wagstaff and Maynard, 1988). The question for drug enforcement, as posed by Dorn and South (1990, 186) with a harm reduction model in mind, then becomes: 'What sort of' markets do we least dislike, and how can we adjust the control mix so as to push markets in the least undesired direction?'

A HARM REDUCTION SPECTRUM: FROM THE PERSON TO THE PLANET

Throughout this chapter I have tried to illustrate how the principles of harm reduction have a much wider application than has been usually assumed. It is first necessary to recognize that different kinds of harm can result from drug misuse (Dorn, 1990). There are not only potential risks to health — which are the site upon which harm reduction strategies have been developed — but there are also different forms of social and emotional harm, financial harm, and legal harms such as arrest and imprisonment.

A second requirement is to recognize that harm can result not only to the individual drug user, but also to his or her immediate family and friends, and finally to the wider community. For example, through drug misuse the individual might put his or her health at risk. But he or she might also put the health of other members of the family at risk, which is commonly the focus for intervention by social workers in the field of child care and child protection. Then, there is harm to the wider conununity in the shape of burglaries and other forms of property crime to support drug habits. The accelerated transmission of HIV and AIDS through high risk practices such as sharing injecting equipment and not heeding safer sex advice also positions drug misuse within a public health discourse, rather than one solely devoted to the needs and interests of the individual.

The third and final requirement is to recognize that harm results not only from drug misuse itself, but also potentially from measures taken to combat it. I wish to distinguish here between two different approaches in the field of drug enforcement. On one side there are heavy-handed, scatter-gun approaches to law enforcement which fill the courts and prisons with people who really should be helped, which can result not only in harm to the individual — in the form of unhelpful and irrelevant punishment, or by exposing the individual to unsafe injection practices in prison — but also to the wider conununity in the form of fiscal penalties against tax-payers to build and maintain unnecessarily large prison systems. Opposed to this, one can begin to define a more realistic and focused strategy by which the police direct their efforts against heavy end-users and user-dealers in order to push them into comrnunity-based programmes offering alternative lifestyles.

The principles of harm reduction can even be extended to the global sphere. At this level of consideration there is harm in the form of agricultural resources diverted towards the production of illicit -Cash-crops which prove more lucrative in the global economy, at the expense of food production for a hungry world. International enforcement efforts sometimes compound the difficulty through crop eradication programmes which, while perhaps intended to destroy cannabis crops, also upset the delicate balance of other plant and animal life forms — resulting, for example, in the destruction of bees which are necessary to pollinate licit fruit-crops, thus deepening the problems of farmers and peasants; or unleashing ruinous ecological imbalances which lead to devastating invasions of insect pests. When we hear that international enforcement agencies have recently dreamt up schemes to introduce plagues of monster caterpillars in the Andes in order to check coca plantations, we are faced with a form of biological warfare against the plant itself in the name of the war on drugs.

I shall not, however, waste too many words criticizing current drug policies at international level. They write their own failure, by their incapacity to keep abreast of the changing and increasing drug problems in the cities of most metropolitan countries and in many Third World nations. The war on drugs has been lost, and with heavy casualties on both sides. Indeed, it was lost before it was started. It is a post-colonial debacle in which the central problem is those Third World nations whose economies have become massively distorted by the international drugs trade. If the problem is taken seriously in its global economic scale, it is not a question of sending a few helicopters to Bolivia, but of the restructuring of the economies of maybe two dozen Third World countries. It is a World Bank problem, not a Drug Squad problem.

In conclusion, when we take on board the wider implications of harm reduction, it becomes a vital necessity not only in the sphere of drug control policies, but also in our more global concerns as inhabitants of this planet. It would be totally unrealistic to aim for the
elimination of drug problems as an achievable objective. It would be akin to asking meteorologists to stop the wind. While the wind continues to blow, we need more local forms of defence and shelter against the real hamis which can result from drug misuse. These must be provided in the shape of effective domestic social policies, within which drug enforcement can assude a more focused and relevant form.

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