1 Harm Reduction as Anarchist Practice: A Users’ Guide to Capitalism and Addiction Christopher Smith, Luke Dunn, Kathy Rigby, and Jon Paul Hammond Abstract: In North America, harm reduction originated as an illegal, clandestine, grassroots activity that took place outside—or in defiant opposition to— state and legal authority. On both sides of the Canada-‐US border, harm reduction remains to be the most contested and controversial aspect of drug policy, and harm reduction practitioners are engaged in an ongoing struggle for funding, political legitimacy and autonomy. Some critics have argued that the practice of harm reduction has become sanitized and depoliticized in its institutionalization as public health policy. Using case study examples from both Toronto, Ontario, and Philadelphia, Pennsylvania, this paper critically traces the uneasy historical relationship between harm reduction and institutionalization, from its oppositional political origins to present day adoption by public health. Concluding with a theoretical interrogation of the politics of this thing we call ‘addiction’, the paper suggests that harm reduction is a fundamentally anarchist practice. Outline: • Introduction: You may already be an anarchist / harm reductionist • Anarchist Political Theory and the Philosophy of Harm Reduction • Interrogating Institutionalization: Public Health, the Pathology Paradigm and the Depoliticization of Harm Reduction Practice • Re-‐claiming the Future of Harm Reduction as Anarchist Practice • Conclusion: Addiction, capitalism and the ideology of science: A radical critique of the differential experience of harm reduction’s institutionalization in Canada and the U.S. … or… Depathologizing drug dependence: A user’s guide to capitalism and ‘addiction’ Author contact info: Luke:
[email protected] 610-‐996-‐3047 Jon Paul c/o Wende Hammond
[email protected] Kathy: 215-‐289-‐5676 Christopher:
[email protected] 267-‐602-‐6715
2 Introduction: You may already be an anarchist (/harm reductionist) We begin this talk with a playful introduction that provides a sense of background to contemporary anarchist thought, and works to draw out the parallels and similarities between applied anarchism and the founding spirit or philosophy of harm reduction. In this introduction we borrow heavily from a short publication produced by the American anarchist ‘ex-‐workers collective’ Crimethinc entitled Fighting for our lives: an anarchist primer. As we hope to illustrate by the end of this talk, ‘fighting for our lives’ in many ways embodies the spirit and project of harm reduction, from the fight against blood-‐borne disease transmission to the battle to end the war on drugs, to the struggle for user autonomy and independence. For Crimethinc, anarchism is a way of being in the world, a political praxis of everyday life, and not a dogmatic structure characterized by old, dead, bearded Russian guys. Crimethinc’s Fighting for our lives starts by recounting a series of historical moments of people coming together, without coercion, hierarchy, or authority, to mutually support one another in the face of struggle. As Fighting for our lives begins: “In borrowed attic rooms, we tended ailing foreign lovers and struggled to write the lines that could ignite the fires dormant in the multitudes around us. In the last moment before dawn, flashlights tight in our shaking hands, we dismantled power boxes on the houses of fascists who were to host rallies the following day. In Paris, armed with cobblestones and parasols, we held the gendarmes at bay for nights on end, until we could almost taste the new world coming through the tear gas. In Chicago, we created an underground network to provide illegal abortions in safe conditions and a supportive atmosphere, when the religious fanatics would have preferred us to die in shame and tears down dark alleys.”
3 To this partial excerpt from Crimethinc’s list, we would like to add the following: When our friends, children, allies and brothers and sisters were dying in the streets and back alleys from infection and Hepatitis C and HIV/AIDS in the 1980s and 90s, we risked arrest by distributing clean works. When our people were burning and cutting their lips by smoking crack out of jagged broken glass pipes made from toxic materials, we found cheap suppliers of pyrex stems designed for science experiments and distributed them in the streets, sometimes even through dealers. When the media, our friends, families, co-‐workers – and sometimes even our peers and co-‐conspirators – stigmatized us with words such as ‘junky’ and ‘crackhead’ and ‘dopefiend’; when the so-‐called anarchists of the 12-‐step movement barred us from entering or speaking at their meetings; when the authorities declared our everyday lives to be illegal, persecuting us at every turn – evicting us from public spaces and locking us up by the hundreds of thousands – we risked further persecution by forming underground (and sometimes semi-‐aboveground) networks of support, advocacy and mutual aid. When our voices were for so long silenced or excluded from debates surrounding the services purportedly designed in our interests, we formed strategic alliances with other marginalized populations cast-‐out by capitalism such as queer folks, people living with HIV/AIDS, and worked together to create manuals and guidebooks for how to work equitably with users peers, illustrating step by step how governments and organizations can involve and incorporate the perspectives, voices and ideas of people with lived experience of substance use without ‘tokenism’ or other humiliating forms of discrimination. We wrote: Nothing about us, without us (Canadian HIV/AIDS Legal Network, 2008).
4 When, out of desperation or sheer exhaustion, we finally decided to take the advice of medical or legal authorities, becoming semi-‐willing subjects of so-‐called maintenance or substitution ‘treatment’ systems like methadone or suboxone, we soon discovered that their rigid regulations were restrictive, demeaning and oppressive, and we quickly learned ways to quietly cheat and fuck with the system, to keep ourselves well in the best ways we knew how. When we came to recognize that our lives were being governed by out-‐of-‐touch medical ‘experts’, we mastered their language and began to learn to politic. Although we continued to be wary and suspicious to engage them on their terms, we soon started getting invited to the tables of power. We formed the Vancouver Area Network of Drug Users (VANDU), the Vocal New York Users Union (VOCAL), the Toronto Drug Users Union (TODUU), and the International Network of People Who Use Drugs (INPUD). Crimethinc concludes their introduction to Fighting for our lives with the words: “I’m speaking, of course, of anarchists”. From here, Fighting for our lives proceeds to draw common examples from everyday life that point to the existence of anarchist tendencies at the very core of human nature. “You may already be an anarchist…” Crimethinc provocatively suggests: “Whenever you act without waiting for instructions or official permission, you are an anarchist. Any time you bypass a ridiculous regulation when no one’s looking, you are an anarchist. If you don’t trust the government, the school system, Hollywood, or the management to know better than you when it comes to things that affect your life, that’s anarchism, too. And you are especially an anarchist when you come up with your own ideas and initiatives and solutions.” Each of these examples speaks not only to the anarchist origins of harm reduction practice, but also to the various ways that the anarchist spirit of harm reduction persists in spite of its institutionalization by the rigid and inflexible machine of public health.
5 In an effort to cement things firmly in the language and practice of harm reduction, we’d like to add to Crimethinc’s examples the following: If you use any form of ‘illicit’ substance either to self-‐medicate, or entirely for pleasure, you are an anarchist, plain and simple—both rejecting the corporate pharmacopia of the formal medical establishment, and reclaiming pleasure from a society that systematically programs us to derive pleasure only from the consumption of consumer goods are inherently anarchist impulses. Simply put, if you even so much as smoke weed you’re an anarchist. If you’ve ever questioned repressive state drug laws or the opinions of biomedical experts and authorities, you’re an anarchist. If you believe that people who use drugs are human beings deserving of the same compassion, dignity, respect and support as those very few among us whose lives are not in some way ‘wired’, then you are an anarchist—medical and legal authorities created or invented the “addict” as a typology of deviance, and to resist against these violent stereotypical misrepresentations is irrefutable evidence of an anarchist spirit. Anarchist Political Theory and Harm Reduction Philosophy: Unpacking the Relationship Between Biomedicine, Pathology, Capitalism and Addiction Now that we have started to establish the parallels between anarchism and harm reduction, perhaps we can further illustrate this relationship by looking at some of the foundational principles of both. In the case of anarchism, three of the central, fundamental beliefs include anti- authoritarianism, distrust of hierarchy, and mutual aid.
6 First off, anti-‐authoritarianism is the idea that no one system, structure or figure should have ultimate authority or control over individuals. In anarchism, anti-‐ authoritarianism typically manifests as the rejection (or in revolutionary terms, complete abolishment) of any form of state governance and its corresponding decentralized institutions of power, be they religious, legal, medical or otherwise. Second, most types of anarchism are also inherently non-‐hierarchical—that is, against any form of social, political or economic hierarchy, and based on the rejection of social structures that place any one group above that of another. In contemporary anarchism this sentiment is often conveyed in the expression “no gods, no rulers, no masters”. Born out of the recognition that the conventional systems of nurturing and care within capitalist society – the nuclear family, the church, the school system – have not only failed us but moreover become a major source of trauma, horror and violence, the third central principle of social anarchism it that of mutual aid. Here, many anarchist groups base themselves as ‘intentional communities’ that collectively adhere to an alternative vision of everyday life and freedom. As a counterbalance to our discussion of the core values of anarchism, it is useful to examine some of the elements generally seen to be common to the philosophy, if not always the actual practice, of harm reduction. Here, we suggest that maybe the language of harm reduction itself evolved as a masked discourse used to describe an emergent anarchist model of care for capitalism’s most marginalized and oppressed, yet symptomatic victims. Marking harm reduction’s formal shift towards institutionalization, however, we fear that this language may itself have become tainted and transformed. Sometimes seen in anti-‐authoritarian terms, harm reduction is often characterized by its emphasis on defining drug use and this thing we call ‘addiction’ as a health issue and not a legal or moral problem. The only significant flaw in this position, as
7 we will discuss further, is that when institutionalized harm reduction discourse positions addiction as a ‘pathology’ or ‘brain disease’, they are merely shifting hierarchical authority from moral and criminological institutions (the church, the justice system) to medical specialists: the clinical gaze of epidemiologists, addiction doctors, treatment counselors and public health scientists. Here, we want to propose that maybe the contemporary user activist mantra nothing about us without us (Canadian HIV/AIDS Legal Network 2008), shares the same distilled down anarchist spirit as the old feminist slogan our bodies, ourselves. Another central element of harm reduction philosophy is the shift in focus from drug use itself to the harms associated with use. Combined with its ostensibly ‘user-‐ friendly’ and ‘client-‐centred’ approach, this points to the possibility for harm reduction to take a decidedly non-‐hierarchical position, through emphasis on the mandated inclusion of peers and clients in the development and delivery of harm reduction programming. And here it is relevant to raise the question, how many institutional harm reduction agencies funded a ‘client’ or peer to attend this conference? When harm reduction is framed and sold as an ethical issue and a question of human rights, we might see this as a thinly disguised discourse of mutual aid: in harm reduction, we are all users, affected by substance and this force we call addiction both personally and by proximity. To extend this argument by stating what might already be obvious, the philosophy of harm reduction was not dreamed up by paper pushing white collar bureaucrats, but instead by people living and working and dying in the streets; only later was it sold to and then subsumed by the public health machine following the full-‐scale adoption of the addiction-‐as-‐brain-‐ disease model. Where the political waters begin to get truly murky is in the last deceptive aspect central to harm reduction philosophy: that is, it’s supposedly ‘value-‐free’, ‘amoral’
8 stance towards drug use. Surely amoral is better than decidedly moralist, but is taking an amoral attitude towards drugs really amoral, given the highly contested battlefield on which the war on drugs continues to be waged? Australian researcher Helen Keane (2003: 228) clearly articulates this conflict when she writes that: “in a context where drugs are predominantly identified as bad (or even evil) and drug use as pathological, a view that drug use is neither right nor wrong is not neutral, but is itself a committed and critical standpoint”. Pushing this critique, we might suggest that it’s even an explicitly anarchist standpoint. Furthermore, perhaps this supposedly ‘amoral’ aspect of harm reduction really masks something more sinister that has taken place in the process of institutionalization: vicious neoliberalism disguised as anarchist-‐leaning practice, played out on the stage of public health. And here again we find ourselves confronting harm reduction’s central adherence to the addiction-‐as-‐brain-‐disease-‐model. This thing we call ‘addiction’ is not, we would like to argue, a disease or pathology, but instead a direct symptom of the social, political and economic forces of modern capitalism. According to this re-‐ conceptualization, capitalism therefore becomes the site and source of disease, and drug use merely represents an adaptive response to the conditions of inequality and exploitation that make up the landscape and experience of (late-‐)capitalism. This line of thinking, which posits addiction as a direct symptomatic manifestation of capitalist forces, is not new. In 1970, for example, Michael Tabor, a political prisoner and member of the Black Panther Party, produced a short essay entitled Capitalism Plus Dope Equals Genocide. As Tabor suggests, “drug addiction is a social phenomenon that grows organically” from the capitalist system. “The government”, he continues, “is totally incapable of addressing itself to the true causes of drug addiction, for to do so would necessitate effecting a radical transformation of this society”. Conventional drug treatment and rehabilitation programs, Tabor concludes “do not deal with the causes of the problem… [and] deliberately negate […] the socio-economic origin of drug addiction”.
9 As Helen Keane (2003: 231) concludes, critiques of harm reduction’s supposedly amoral standpoint, its reliance on the addiction-‐as-‐pathology paradigm, and its anchoring in the quantitative methods of epidemiology implicitly suggest that institutionalized harm reduction policy has “fail[ed] to bring into being an idealized state of freedom and non-regulation”. Is this “state of freedom and non-‐ regulation” what we might begin to think of as anarchism? Before this utopian revolution happens, however, it is important to continue to work for change within the present system, and it is in this spirit we believe that anarchism happens in front-‐line harm reduction practice all the time, in small and subtle ways that often fall outside the radar of official public health policy. Here it’s worth returning to Crimethinc’s insistence that you may already be an anarchist: “Whenever you act without waiting for instructions or official permission… Any time you bypass a ridiculous regulation when no one’s looking… If you don’t trust the government […] or the management to know better than you when it comes to things that affect your life” you are an anarchist. “And you are especially an anarchist when you come up with your own ideas and initiatives and solutions.” Underground crack kit distribution. Abandoning the even scientifically flawed logic of one-‐for-‐one exchange in favor of straight up syringe distribution. Actively encouraging unsanctioned secondary exchange. Underground naloxone training. Bathrooms inside harm reduction organizations that act as informal, unspoken safe injection sites. Clandestine ibogaine treatment teams operating illegally out of rented hotel rooms. Doctors writing off-‐the-‐books scripts for morphine, diluadid, buprenorphine. We’ve all done it, and some of us have pushed the boundaries ‘too far’ and been punished, fired, or even arrested. In spite of this, we persist, and the fundamentally anarchist spirit of harm reduction continues to shape our everyday lives.
10 Interrogating Institutionalization: Public Health Policy, the Pathology Paradigm and the Depoliticization of Harm Reduction Practice The story of harm reduction’s evolution and public acceptance is a story of compromises and contradictions, conflict and cooptation, revealing evidence of an uneasy relationship with institutionalization from the very beginning. In order to illustrate how the public health machine has co-‐opted, sanitized and diluted the fundamentally anarchist origins of harm reduction practice, we find that the answer to this question points back to the historical conflict concerning how ‘drug/addiction’ is defined and understood, and more importantly, who has control over its definition, and how this control is made manifest. After our examination of the depoliticization of institutionalized harm reduction policy, we explore a series of case study examples from Canada and the U.S., highlighting their distinctly different experiences in the development of harm reduction policy and practice. Prior to being institutionalized as public health policy following the AIDS epidemic of the 1980s, harm reduction originated as an ‘illegal’ activity where activists and politicized front-‐line workers acted in defiance of the law, risking sharp penalties for distributing clean syringes, thus resembling a kind of social movement or activist practice. Critics such as Gordon Roe (2005: 244) have argued that as it was institutionalized, the oppositional political origins of harm reduction became sanitized, leading to a historic tension between those who “see harm reduction primarily as a medical means of promoting health and mitigating the harm to individuals”, and a more political, activist-‐oriented faction who understand harm reduction as “a platform for broader and more structural social change”. In her article Pushing the Point: Anarchism, Genocide and Needle Exchange Nancy Stoller (1998: 101) writes about how the first underground exchange in San Francisco began as “an act of civil disobedience by a group of pagan, hippie anarchists” who slowly entered into an uneasy relationship with city authorities. The original consensus-‐based anarchist principles upon which the group was
11 established were, however, negated and destroyed when the formerly autonomous collective finally ceded and succumbed to institutionalized control. As Stoller (1998: 107) explains, “Prevention Point’s early anarchistic, unfunded phase stretched from 1989 to 1991. Between 1991 and 1994, the organization sought and obtained funding from the city of San Francisco and at the same time was able to maintain a sense of autonomy and self-rule. Eventually, however, Prevention Point was forced to succumb to the demands and strictures of corporate non-profits, which directly conflicted with how prevention point managed itself in its early years. Ironically, Prevention Point’s greatest strength throughout its history – its anarchism and consensus approach to decision making – proved to be its greatest weakness in the power struggles that developed within the non-profit organization that it established in order to have a legal supplier of syringes.” Posing in playful terms the deadly serious question is better than bad good enough?, Gordon Roe argues that institutional harm reduction advocates engage in cooperation and collaboration with state bodies at the expense of ignoring or overlooking the fact that “the health problems they address are substantially created by the ideology of the systems in which they work” (2005: 245). The more activist-‐oriented, politicized proponents, by contrast, tend to see the notion of harm reduction as “a political and moral commitment to altering the material and social conditions of drug users” by placing emphasis on a structural critique involving a “political analysis of ‘risk’ and ‘harm’ as by-products of social, economic, racial or political inequality” (ibid). Continued recourse by public health authorities to cost/benefit ‘bottom line’ arguments in support of harm reduction are often understood as a strategic measure to appeal to fiscal conservatives, where harm reduction is posed as a policy alternative that has the potential to reduce taxpayer burden, restore public order, and improve community safety (Hathaway and Erickson 2003; Keane 2003). Gordon Roe (2005: 245) however argues that the creation of institutionalized public health policies and harm reduction interventions based on the inherently economic
12 cost/benefit logic of the ‘bottom line’ analysis moreover represent the most recent strategic efforts to “minimize risk from, and maximize control over, marginal populations” such as people who use drugs. As Peter Miller (2001: 172) remarks, at the level of policy – which in turn dictates and informs the realities of on-‐the-‐ground practice – harm reduction operates “through the proliferation of drug experts, most often supported by the medical establishment”. Based on this analysis, we might begin to understand institutionalized, depoliticized harm reduction policy as a tool or weapon of the addiction-‐as-‐pathology paradigm that places control over drug users in the hands of bio-‐medical authorities. By aligning itself with the authority of the biomedical establishment, however, contemporary harm reduction policy advances at the expense of an explicitly political critique of the structural forces that generate and perpetuate harm to drug users. In Helen Keane’s (2003: 231) words, harm-‐ reduction-‐as-‐public-‐health-‐policy thus “avoids confronting the very things that produce the most harm for drug users: drug laws, dominant discourses of drug use and the stigmatisation of users”. So where do we go from here? First, we must begin to recognize and account for the ways that harm reduction as institutionalized public health policy has put chains on the fundamentally anarchist spirit of our collective practice. To this end, we now turn to examine examples of practice in both Canada and the U.S. It is important to bear in mind, however, that none of these attacks are personal, but merely reflect a critique of the systems and structures that bind, suffocate and restrict our decisions at the agency and managerial level, and our actions and practices on the ground. Having said that, one of the fundamental tenants of both anarchism and radical feminism is the idea that the personal is the political, and that change begins with a fundamental re-‐conceptualization that takes place at the level of everyday life; this is what Situationist agitators back in the 60s referred to as the revolution of everyday life (Vaneigem 1967).
13 EXAMPLES: •
Syringe exchange: one for one vs. distribution (US / CDN models)
•
The city of Philadelphia’s reluctance, foot-‐dragging and avoidance re. changing PPP’s 10-‐year standing mobile outreach exchange sites to more accurately reflect the shifting user/dealer geography of the city
•
Municipal funding cut for crack kit distribution in Ottawa (perversely, largely due to the published results of a ‘scientific’ survey)
•
Recent provincial funding cuts to NEP services in Alberta
•
‘liquid handcuffs’ and institutionalized dependence (i.e. the ‘ball and chain’, discipline and punishment model of MMT policy Canada and the U.S.)
Re-claiming the Future of Harm Reduction as Anarchist Practice After citing these examples and inciting so much self-‐critique, it would hardly be responsible (or very anarchist) of us not to return to the question where do we go from here? And to answer this question, we need to look at two different models for integrating anarchism – or, rather, the fundamental spirit of harm reduction practice – into the very fabric of our everyday lives. The reclaiming of truly anarchist expressions of harm reduction from the sterile, depoliticized public health machine is, after all, as we’ve tried to hint at throughout this presentation, already happening, in several simultaneous dimensions, both from within and from without. In the first case, harm reduction is being reclaimed by politicized service providers and peers through underground, autonomous acts of resistance to the rigid and inflexible rules of official public health policy, and the establishment of informal, off-‐ the-‐books practices at the agency level. In some respects such tactics that operate beyond the gaze of institutional authorities take place so easily and so often simply because the paper-‐pushing public health authorities who create policy have no conception of responsible front-‐line service provision and the on-‐the-‐ground, street-‐ level pragmatics of harm reduction practice. We can get away with so much, in other
14 words, largely because the soft, comfortable, middle-‐class bureaucrats who dictate and control the terms of harm reduction are seldom willing or able to understand the everyday reality of providing care for substance users whose lives are lived in the streets, and dominated by the harsh, hyper-‐capitalist ‘black-‐market’ economies of power created by the war on drugs. And so we return to the examples cited earlier: Underground crack kit distribution. Ignoring the one-‐for-‐one exchange model in place of syringe distribution. Peer-‐ based naloxone training. Informal safe injection sites inside harm reduction agencies. Anarchist ibogaine treatment practitioners. Rule-‐bending doctors whose compassion and care is expressed in actions that could jeopardize their licenses. We’ve all done it – managers and outreach workers and peers alike – risking punishment, risking our jobs, and risking arrest. And yet we’ll keep doing it, developing new tactics, borrowing, adapting and disseminating new models because it’s the right thing to do; the only thing we can do. At the other end of the spectrum, by contrast, we see clear evidence that the revolutionary spirit of harm reduction persists at the level of organized efforts to change policy. Here, various factions are slowly and subtly working towards radically re-‐orienting, if not outright overthrowing the tyranny of the harm-‐ reduction-‐as-‐puppet-‐of-‐institutionalized-‐public-‐health machine by directly engaging with the monster of the state. From the U.S. Drug Policy Alliance to the Canadian Students for Sensible Drug Policy, and from radical academics to autonomous drug user unions, those involved in this form of struggle span a diverse array of organizations and groups working to get their voices heard and fighting to get seats at the tables of power. In order to begin to re-‐politicize the future of harm reduction as anarchist practice we see several immediate points of departure. First, we need to both formally and informally make room for fluidity and flexibility– to directly and indirectly sanction spaces where harm reduction practice can be adapted and extended beyond the
15 rigidity and restriction of institutional rules and regulations. In the second case, radical policy nerds, user activists and academics need to continue to work towards changing the terms of debate surrounding substance use, harm reduction and this thing we call ‘addiction’ by breaking down stigma, actively challenging the addiction-‐as-‐brain-‐disease model, and critiquing the structural forces, systems and institutions that create and perpetuate ‘harm’. Here, shifting drug research away from its traditional quantitative, epidemiological focus is equally important as working to increase the capacity of user and/or peer involvement in harm reduction research, policy development, service delivery and program evaluation. In re-‐claiming harm reduction and re-‐aligning our practice with the fundamentally oppositional, anarchist origins of the movement, the importance of user autonomy is therefore of paramount importance. In this sense we need to place clients and peers at the very centre of harm reduction practice, re-‐situating people with lived experience of substance use as the driving force behind our passionate engagement with the political spirit of harm reduction. And here we find ourselves returning to the question: how many harm reduction institutions funded a peer to participate in this conference? If you’re one of those people casting guilty glances around the room, maybe it wouldn’t hurt to ask yourself what the fuck this whole thing is all about— in whose interests we conduct this work called harm reduction, and what (or rather who) inspires and fuels your practice. Conclusion: Addiction, Capitalism and the Ideology of Science in Canada and the U.S. or, Depathologizing Drug Dependence: A Radical Critical of the Differential Experience of Harm Reduction’s Institutionalization in North America Looking at the two different tactical models for reclaiming harm reduction as anarchist practice, we might conclude that the American context is characterized by the innovation of practical, tangible (albeit largely underground) spaces of everyday resistance within a decidedly more repressive regime. The Canadian experience, by contrast, has been distinguished progressive policy reform, however politically ‘safe’
16 and ‘scientifically’-‐driven, where efforts by committed researchers has led to the widespread embrace of harm reduction. In Canada, for instance, we have a supervised injection site: people use it, and for the most part it works; it’s not perfect, and many have reason to be suspicious of it, but we fucking have one, if only one. So if we can acknowledge the accomplishments of politicized, grassroots harm reduction practitioners in the repressive context of the U.S. ‘war on drugs’, what are the critical implications of Canada’s comparatively more advanced stage of institutionalized harm reduction, as measured in the cost/benefit terms of the of the institutionalization / de-‐politicization equation? While we commonly celebrate the Canadian experience, perhaps the rapid acceptance and institutionalization of harm reduction as public health policy in Canada needs to be examined in more critical terms. Harm reduction initiatives such as supervised consumption sites, for example, seek to manage urban drug using communities in the interests of ‘public order’, prompting criticism that such programs lack focus on the systemic forces underlying structural violence and social suffering, representing little more than a new form of disciplinary ‘governmentality’ (Roe 2005; Fischer et al. 2004; Foucault 1977). From this perspective, referring back to Roe’s arguments (2005: 245), harm reduction in Canada may have morphed to become a deceptive tool employed by the public health machine to “minimize risk from, and maximize control over” the bodies and behaviours of people who use drugs. Safe/Supervised Consumption Site: As drug users and prospective users of such services, it is the word ‘supervised’ that makes us remain suspicious. Supervision of who and by whom? Whose safety does this model effectively promote and protect and whose harm does it seek to reduce? And what does all of this have to do with the central capitalist notion of ‘consumption’? In light of the ways that drug users are ghettoized, marginalized and evicted from urban spaces, me might therefore propose that the city itself is being redesigned as a site of safe/supervised
17 consumption for tourists and international investment capital, rendering harm reduction as merely another disguised strategy to ‘clean up the streets’. Momentarily shifting away from the North American experience, one example of how policy restriction has encouraged innovation can be seen in the recent development of safe smoking foil in the United Kingdom. While distributing any form of crack harm reduction supplies in England remains illegal, British activists and academics developed a safe, non-‐toxic type of foil designed to efficiently and safely smoke heroin or crack. The published and ongoing research in support of legalizing the distribution of smoking foil is not however free from the central ideological hang-‐ups that plague harm reduction research. Decidedly ‘scientific’, this research is couched in the language of ‘drug route transition’, and ‘discouraging injection’, and thus implicitly driven by quantitative, epidemiological concerns. Resonating with earlier arguments, Peter Miller (2003: 173) asserts that “the claim of amorality due to harm minimization’s ‘scientific’ basis is a moralistic claim in itself, which furthers the standpoint that science and objectivity are preferable to other forms of knowledge”. Owing to it’s perceived methodological objectivity, science – particularly medical science, and even more specifically that which is conducted in the name of ‘harm reduction’ – often positions itself as being the opposite or antithesis to ideology and ideologically-‐based claims regarding drug use and addiction (Hwang 2007). Although the underlying assumptions of scientific research are seldom questioned and assumed to be ideologically neutral, however, the ‘fact’ of the matter is that ‘science’ is always already ideological, in spite of its fundamental inability to conduct an explicitly political critique. Because it clings so blindly to its ostensible objectivity, science can never inhabit an explicitly political position, as ‘facts’ must be allowed to speak for themselves. Furthermore, while quantitative data can construct an argument constrained by the methods of scientific discourse, numbers cannot represent experience, cannot convey the voices and perspectives of research
18 subjects, and is fundamentally unable to engage in a critique of anything beyond the controlled factors involved in a given experiment. Dominated by corporate, industrial and biomedical institutions, it’s easy to conclude that science is a direct expression of capitalism itself. Responsible for both cementing the addiction-‐as-‐brain-‐disease model and propelling the institutionalization of depoliticized harm reduction policy, the quantitative discourse of science can, however, never fundamentally change the terms of debate on this thing we call ‘addiction’. Science, in other words, is functionally incapable of engaging in a structural critique of ‘our narcotic modernity’ (Derrida 1993) that implicates the relationship between drugs, dependence, and the exploitive forces of capitalism that are inscribed throughout every waking moment of our everyday lives. We are not so naive as to believe that social research can ‘fix’ what’s wrong with the harm-‐reduction-‐as-‐puppet-‐of-‐public-‐health machine, or bring harm reduction back to its anarchist origins, but to re-‐emphasize Gordon Roe’s (2005: 243) arguments, we do believe that social research based on true collaborative autonomy with users can actively work towards re-‐politicizing the future of harm reduction practice by engaging in a “direct political critique of the social and legal systems that create harm”. Throughout this talk we have worked to interrogate the explicitly political stakes involved in harm reduction and this thing we call ‘addiction’, tracing the story of harm reduction from its origins as anarchist practice, to it’s infection by the addiction-‐as-‐pathology paradigm and consequent depoliticization as institutionalized public health policy. At the same time, however, we have also importantly tried to emphasize the direct and indirect, subtle and not-‐so-‐subtle, above-‐board and underground ways that the fundamentally anarchist spirit of harm reduction persists and draws strength, evolves and adapts, centrally driven by a condition of collaborative autonomy with the user.
19 As in other forms of activist practice, perhaps harm reduction will always have to face and negotiate the struggles we have outlined in this presentation, innovating tactics that are in time transformed, co-‐opted and turned against us, and then reclaiming harm reduction as anarchist practice by creating new models that can be adopted, adapted and disseminated. Just like that old One Flew Over the Cuckoo’s Nest theme of the lunatics taking over the asylum, however, maybe one day the users will take over the systems responsible for their own wellness (Zibbell 2004). Methadone clients overthrowing the management and taking control of the clinic, giving out take-‐away doses to anyone, for any reason, for any length of time; users running the syringe distribution program, dropping off boxes of works by the thousands; users organizing and coming together to pool their collective resources to ensure safe, steady and affordable supply of their substances of choice. And yes, we do dare to dream. We end today by returning to the assertion that as users and politicized harm reduction practitioners, we are all, in the words of Crimethinc, Fighting for our lives. Playfully rephrasing the terms of this struggle as a scientific equation, if as in Michael Tabor’s (1970) Black Panther manifesto, capitalism + dope = genocide, then borrowing from Nancy Stoller (1998) we might conclude that genocide / anarchism = harm reduction. A closing prayer that bears directly on our collective struggle: “Thank the heavens we have nothing”, write Crimthinc, “help us not to hate the ones we must destroy”. We dedicate this presentation today to Jon Paul Hammond, our dearest friend and critical/creative co-‐conspirator, who was supposed to be here right now, but who died on the First Friday of November in Philadelphia, battle-‐scarred by the drug war, a militant, devoted harm reductionist, political agitator, and queer Quaker anarchist to the very end.
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