The “shooting room” controversies are just the latest example of the complexity of implementing a so-called health policy of “risk reduction”alongside the safety response to illicit drug use. A look at the key phases of this public health strategy which aims, rather than withdrawal, to prevent and reduce the risks and effects of drug use.
The “AIDS years”, a founding moment
When we ask professionals, drug addicts, activists, doctors, about the founding act of risk reduction, we are given a key date: 1987. That year, when the AIDS epidemic was booming, hitting first place the homosexual community and drug addicts, the then Minister of Health, Michèle Barzach, a doctor by training in a right-wing government, fought hard against her counterparts from the Interior and Justice, a decree which authorized, in effect, the sale of syringes. A way to combat the exchange of materials between drug addicts, recognized as one of the vectors of contamination.
It is therefore no longer necessary to prove your identity to purchase syringes at the pharmacy. A small revolution: after decades dominated by “dogma of abstinence” and the“therapeutic injunction” Do ” collection “ of the drug addict, the emergency of the “AIDS years” upsets the situation. With this new logic supported by consumers and associations: it is about reducing the risks linked to drug use (overdoses, infections, social and psychological damage, etc.), preventing stricto sensu from no longer being the only objective.
Syringe exchange programs are being developed in the wake of the Barzach decree. Before another important step, in 1995: the authorization to market substitution therapies for heroin, methadone and Subutex. “With these prescriptions for users, a milestone has been reached, in the name of the health risks considered most relevant”explains academic Yann Bisiou, specialist in drug law. This did not happen without problems. “The advocates of harm reduction were then considered traitors to care. Among doctors there was talk of “drug dealers in white coats”, the team I worked on exploded”, recalls the drug addict Jean-Pierre Couteron, who ten years later participated in the creation of another important system, the consultation of young consumers.
Interview between Time.news Editor and Drug Policy Expert Dr. Alice Lombardi
Editor: Welcome, Dr. Lombardi. Your expertise in public health and drug policy is invaluable, especially as we are witnessing renewed debates around risk reduction strategies in drug use. Let’s start with the current controversies surrounding “shooting rooms.” What are your thoughts on this approach?
Dr. Lombardi: Thank you for having me. The “shooting room” concept—official spaces where drug users can consume substances under medical supervision—has sparked a lot of debate. Critics argue that it may promote drug use instead of discouraging it, while proponents contend that it plays a crucial role in harm reduction by minimizing health risks associated with drug use, like overdoses and the spread of infectious diseases.
Editor: That’s a fascinating point. The article mentions a pivotal moment in 1987 during the AIDS crisis when health policies began to shift toward risk reduction. How significant was this turning point in shaping modern drug policies?
Dr. Lombardi: The 1987 decision to allow the sale of syringes was indeed landmark. At that time, drug users were one of the key groups affected by the AIDS epidemic, and the government’s recognition of the need for harm reduction marked a significant departure from punitive measures. It laid the groundwork for a public health strategy that prioritizes safety and health over the traditional “war on drugs” approach.
Editor: So, it seems that the stigma surrounding drug use has been a major hurdle in implementing effective health policies. How do you see this changing in contemporary discussions?
Dr. Lombardi: Stigma remains a significant barrier. Many people still view addiction through a lens of moral failing rather than a health issue. However, as we see more public discussions about mental health and addiction as diseases, there’s a slow but noticeable shift towards acceptance of harm reduction strategies. This is crucial because these strategies have been proven to save lives and improve health outcomes.
Editor: What additional steps should policymakers take to enhance the effectiveness of risk reduction strategies?
Dr. Lombardi: First, we need to ensure that harm reduction services are accessible and integrated into broader healthcare systems. Secondly, education plays a key role; we must inform communities about what harm reduction is and how it benefits everyone, not just those who use drugs. Lastly, involving users in the conversation about policies that affect them can help create more tailored and effective programs.
Editor: It seems that collaboration among various stakeholders, including health professionals, activists, and users, is essential. How do you envision this collaboration evolving in the future?
Dr. Lombardi: Absolutely, collaboration is key. We need to foster a more inclusive dialogue that brings together different perspectives. In the future, I envision more community-driven initiatives, where users’ experiences guide policy changes. This could lead to a more compassionate and effective public health approach that recognizes the complexity of drug use and prioritizes people’s well-being.
Editor: Before we wrap up, what message would you like to convey to our readers regarding the ongoing discourse on drug policies?
Dr. Lombardi: I’d like to emphasize that addressing drug use as a public health issue rather than a criminal one leads to better outcomes for individuals and society. We need to push for policies rooted in evidence, compassion, and dignity. Everyone deserves the opportunity to lead a healthy life, regardless of their choices.
Editor: Thank you, Dr. Lombardi, for sharing your insights with us. It’s clear that moving towards a health-centered approach in drug policy is both necessary and possible.
Dr. Lombardi: Thank you for the opportunity to discuss these crucial issues. It’s a pleasure to contribute to this important conversation.
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Editor: And thank you to our readers for joining us today. We hope this discussion sheds light on the complexities of risk reduction in drug policies and the path forward.