Better understanding the history and the current state of harm reduction in Europe and exchanging on best practices is thus a helpful and salutary initiative, as we also need to remain vigilant together. Conservatism and populism across the continent translate into direct threats on the gains we have made with harm reduction.
It is Europe’s experience that has established the comprehensive and undisputable body of evidence of the effectiveness of harm reduction interventions in preventing HIV infection and hepatitis; HIV infections among people who inject drugs is no longer an issue in Western Europe.
However, significant shifts have been taking place in recent years in the European and global drug scene and the global debate on drug policy in terms of public discourse and policy implementation. I believe it is time to revisit some of our terminology and have methadone be acknowledged and named as the most effective treatment for opioid dependence, rather than seeing it as a “substitute” (something many countries would not accept) and/or “just” a harm reduction tool.
When reading this collection of reports, I also wonder whether it is not time for the harm reduction movement to distance itself somehow from medicine and HIV and take a more political stance. Reducing harm is also fighting poor policies; it is about advocating for decriminalization of use and low-level non-violent actors in the drug trade and for changing the roles and behavior of law enforcement. Finally, reducing harms is also increasing our efforts to prevent overdoses as it appears so needed in the US and Canada with the growing availability of fentanyl and moving faster to test the insuffi- ciently explored ways of preventing harm from other new synthetic drugs.
Michel Kazatchkine is president of PISTES (Swaps and vih.org publisher) and member of the Global Commission on Drug Policy.
(This issue is also available in French: «Swaps Europe 1: La réduction des risques en pratique»)