At all international harm reduction events, drug users consultations and similar meetings, there is always one issue spoken about in joking and hushed terms, but never openly acknowledged - where the drug users who are attending can get their drug of choice. It’s a reality, but the issue of actual drug use is often swept under the carpet at events such as these. There seems to be a Victorian, repressed attitude to it, something that we don’t speak about but something we know goes on.
So it was a breath of fresh air to attend Cheryl White’s workshop on the third day of the International Harm Reduction conference here in Bangkok - Harm Reduction and Pleasure Maximisation - where drug users were open about their using, and more importantly open about declaring that taking drugs can actually be pleasurable. Cheryl, a Canadian, and a drug activist for most of her life, and is not apologetic about enjoying drugs.
We know drugs can be pleasurable, but somehow we never seem to talk about this, always focusing on the negative aspects of drug use, and the need to minimise harm to protect from HIV and Hep C. We don’t talk about the need to minimise harm so we can maximise pleasure.
In much the same way safe sex programs have switched from a disease approach to a sex positive approach, harm reduction programs in the context of drug use need to be more drug positive in order to reflect the true nature of using drugs.
“Harm Reduction has been hijacked”, said Cheryl, “[and] has come to mean harm elimination, on a continuum heading towards abstinence as the ultimate goal, rather than purely being about working with drug users to ensure that their drug use is as safe as possible”. She cited examples of how organisations like the Salvation Army consider themselves harm reductionists to which the audience laughed loudly in disbelief.
Cheryl eloquently asked the question, “What is your relationship with opiates?” This very question challenges our beliefs, because it implies several types of relationships a person can have with drugs, and not all of them are negative - whether that be “habitual and chaotic” or “respectful and enhancing”.
So if we can accept that not all drug users' relationships with their drugs are harmful, the next logical step is to accept that a part of harm reduction can be to maximize pleasure - and to help us do this we need to provide the user with the skills to be able to assess their using and how it fits into their lives, rather than make an assumption that all drug users ultimately want to stop using.
Another aspect that the workshop touched upon was the use of opiate substitution programs – another essential part of a harm reduction approach – but as Cheryl put it, “we give the drugs without the pleasure: what people really want is a prescription for heroin, not methadone. Generally people don’t take methadone because they want to but rather because they recognise their drug use is out of control.”
There was a lot of agreement to this sentiment, but for the non-users in the audience it was very challenging to hear that not all people wanted to get off drugs, but rather wanted their drug use to be successfully integrated into their lives.
‘Pleasure maximization and harm reduction’ are integrally linked, and it is important for us to be challenged by such concepts, looking at our own practice to ensure that we at least acknowledge that there are positive aspects to drug-taking, and incorporate this concept into our work
So it was a breath of fresh air to attend Cheryl White’s workshop on the third day of the International Harm Reduction conference here in Bangkok - Harm Reduction and Pleasure Maximisation - where drug users were open about their using, and more importantly open about declaring that taking drugs can actually be pleasurable. Cheryl, a Canadian, and a drug activist for most of her life, and is not apologetic about enjoying drugs.
We know drugs can be pleasurable, but somehow we never seem to talk about this, always focusing on the negative aspects of drug use, and the need to minimise harm to protect from HIV and Hep C. We don’t talk about the need to minimise harm so we can maximise pleasure.
In much the same way safe sex programs have switched from a disease approach to a sex positive approach, harm reduction programs in the context of drug use need to be more drug positive in order to reflect the true nature of using drugs.
“Harm Reduction has been hijacked”, said Cheryl, “[and] has come to mean harm elimination, on a continuum heading towards abstinence as the ultimate goal, rather than purely being about working with drug users to ensure that their drug use is as safe as possible”. She cited examples of how organisations like the Salvation Army consider themselves harm reductionists to which the audience laughed loudly in disbelief.
Cheryl eloquently asked the question, “What is your relationship with opiates?” This very question challenges our beliefs, because it implies several types of relationships a person can have with drugs, and not all of them are negative - whether that be “habitual and chaotic” or “respectful and enhancing”.
So if we can accept that not all drug users' relationships with their drugs are harmful, the next logical step is to accept that a part of harm reduction can be to maximize pleasure - and to help us do this we need to provide the user with the skills to be able to assess their using and how it fits into their lives, rather than make an assumption that all drug users ultimately want to stop using.
Another aspect that the workshop touched upon was the use of opiate substitution programs – another essential part of a harm reduction approach – but as Cheryl put it, “we give the drugs without the pleasure: what people really want is a prescription for heroin, not methadone. Generally people don’t take methadone because they want to but rather because they recognise their drug use is out of control.”
There was a lot of agreement to this sentiment, but for the non-users in the audience it was very challenging to hear that not all people wanted to get off drugs, but rather wanted their drug use to be successfully integrated into their lives.
‘Pleasure maximization and harm reduction’ are integrally linked, and it is important for us to be challenged by such concepts, looking at our own practice to ensure that we at least acknowledge that there are positive aspects to drug-taking, and incorporate this concept into our work
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