Preface

Harm reduction is now positioned as part of the mainstream policy response to drug use in Europe. However, this has not always been the case, and in reflecting on this fact we felt that the time was right to take stock of how we had arrived at this position, ask what it means for both policies and action, and begin to consider how harm reduction is likely to develop in the future.

This monograph builds on other titles in the EMCDDA’s Scientific monographs series, where we have taken an important and topical subject, assembled some of the best experts in the field, and allowed them to develop their ideas constrained only by the need to demonstrate scientific rigour and sound argument. Our Scientific monographs are intended to be both technically challenging and thought provoking. Unlike our other publications we take more of an editorial ‘back seat’ and we do not seek consensus or necessarily to produce a balanced view. Good science is best done when unconstrained, and best read with a critical eye.

This volume includes a variety of perspectives on harm reduction approaches, together with an analysis of the concept’s role within drug policies, both in Europe and beyond.

Readers may not necessarily agree with all of the arguments made or the conclusion drawn, but we hope it is perceived as a valuable contribution to the ongoing debate on how to respond to contemporary drug problems in Europe.

A number of contributors explore what harm reduction means and what policies it can encompass, as well as charting how the concept evolved. They reflect on the point we have now reached in terms of both harm reduction practice and the evidence base for its effectiveness. A major issue that many contributors touch on is the difficulty of assessing how complex interventions occurring in real world settings can be evaluated, and why conclusive evidence in such settings can be so elusive.

With an eye to the future, we also asked our contributors to wrestle with the difficult issue of how harm reduction might be extended into new areas that are of particular relevance to the evolving European drug situation. Here the empirical base for grounding discussions is far less developed, and a more exploratory approach is necessary.

As a European agency, the EMCDDA has a somewhat unique perspective on the development of the drugs debate within the European Union. It is therefore appropriate for us to make our own introductory remarks about the mainstreaming of the concept of harm reduction at the European level, as opposed to the national one. This development, we would argue, is sometimes misunderstood, as there is a tendency by some commentators to polarise the position and focus exclusively on either the differences, or alternatively the commonalities, that exist between Member States in their drug policies. Europe is closer now than it once was in terms of how it responds to and views drug use, but differences still exist, reflecting national policy perspectives, cultural differences and, to some extent, simply a different experience of the drug problem.

Despite these differences in opinion and experience, there is a general consensus that abstinence-orientated drug policies need to be supplemented by measures that can demonstrably reduce the harms that drug users are exposed to. This consensus is strongest in the area of reducing HIV infection among injectors — although even here there is disagreement on the appropriateness of which interventions might fall under this general heading. It is also the case that the range and intensity of harm reduction services available in EU Member States varies considerably. Therefore, the observation that harm reduction has played an important part in achieving the relatively positive position that the EU has achieved with respect to HIV infection among injectors has to be tempered with the comment that some countries have maintained low rates of infections among injecting drug users where the availability of harm reduction services has been limited.

In summary, considerable debate still exists at European level on the appropriateness of different approaches, and some interventions, such as drug consumption rooms, are still highly contentious. However, Europe’s policy debate in this area appears now to be a more pragmatic one in which harm reduction policies are not automatically considered to conflict with measures intended to deter drug use or promote abstinence. Rather, the consensus is increasingly moving towards a comprehensive, balanced and evidencebased approach that seamlessly includes harm reduction alongside prevention, treatment and supply reduction measures.

This monograph is comprehensive in its scope. It covers interventions that are still controversial and ones that have become so mainstream that many might now find it hard to believe that this has not always been the case. We have included voices from the user community, as activism has historically been an important element in the development of this perspective. The monograph also addresses new challenges for a harm reduction approach, such as alcohol and tobacco use and Europe’s growing appetite for stimulant drugs.

The EMCDDA is grateful that so many experts were prepared to assist us with this work, often tackling new and demanding topics. This task would have been infinitely more difficult if we had not benefited from having a first-class editorial team working on this project. We are indebted to our editors, Tim Rhodes and Dagmar Hedrich, who both played a major role in conceptualising, planning and implementing this project and without whose input this document would have been a far less comprehensive and impressive achievement.

It is important to note that the voices presented here are not those of the EMCDDA or the European institutions. As with other Scientific monographs, the intention is to provide a forum for stimulating debate and collecting high-quality scientific opinion and informed comment on a topic of contemporary relevance. The monographs are intended to be of particular interest to a specialist audience and therefore some of the papers in this collection are highly technical in nature. All papers presented here have been peer-reviewed to ensure an appropriate degree of scientific rigour, but the views expressed by the authors remain their own.

The EMCDDA’s role is as a central reference point on drug information within the European Union. We are policy neutral; our task is to document and report, and never to advocate or lobby. This neutrality is important when we address any drug use issue, as this is an area where so many have passionate and deeply held views. However, it is particularly important when we address a topic like harm reduction, where perspectives are sometimes polarised and there are those on all sides of the drugs debate that see a linkage between this subject and broader issues about how societies control drug consumption. The rationale for our work is that, over time, better policy comes from debate informed by a cool-headed and neutral assessment of the information available.

Many of the contributors to this report are passionate and committed in their views; they also provide a wealth of data, analysis and argumentation. They do not speak with a common voice, and we do not necessarily endorse all the conclusions drawn, but taken collectively we believe they make a valuable contribution to a better understanding of a topic that has become an important element in contemporary drug policies.

Paul Griffiths and Roland Simon
EMCDDA