Normalization and harm reduction: Research avenues and policy agendas

doi:10.1016/j.drugpo.2009.11.005

International Journal of Drug Policy

Volume 21, Issue 2, March 2010, Pages 137-139

https://doi.org/10.1016/j.drugpo.2009.11.005 Get rights and content

Abstract

An affinity between the evidence and arguments for drug normalization and the policy and programme directions favoured by harm reduction is often assumed but seldom critically examined. This commentary looks at parallels and contradictions emerging with respect to different cultures, social settings, types of problems and responses where the match is less than perfect. Mounting evidence of normalization has also led to backlash in some countries and the mobilization of forces reaffirming prohibition. We call for further research on normalization that focuses on substance use, risks, harms, and social context across a broader spectrum of the population, and in a variety of cultures. By emphasizing the most serious harms experienced by persons in the smallest segments of drug using populations, harm reduction often has neglected broader research and policy suggestions that might be implemented to benefit controlled, recreational drug users. Future policy development with respect to normalization will require more research and more serious discussion of its implications for informing the transition toward a global public health approach to substance use.

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Conflict of interest statement

The authors have no competing interests to disclose. Support to CAMH for salary of scientists and infrastructure has been provided by the Ontario Ministry of Health and Long Term Care. The views expressed in this Commentary do not necessarily reflect those of the Ministry of Health and Long Term Care.

Acknowledgements

We are grateful for the stimulation and input provided by the other investigators of the 4 province “Drug Normalization and Stigma” study: Mark Asbridge, Serge Brochu, Marie-Marthe Cousineau, Cameron Duff and David Marsh.

Partial support for this project has been provided by an operating grant from the Social Sciences and Humanities Research Council of Canada.

References (15)

A.D. Hathaway et al.
Harm reduction headway and continuing resistance: Insights from safe injection in the city of Vancouver
International Journal of Drug Policy
(2008)
D. Nutt et al.
Development of a rational scale to assess the harm of drugs of potential misuse
Lancet
(2007)
Beckley Foundation. (2009). The Beckley Foundation Global Cannabis Commission Report. Accessed on line September 06,...
S. Blackman
Chilling out: The cultural politics of substance consumption, youth and drug policy
(2004)
Y.W. Cheung
A brighter side: Protective and risk factors in the rehabilitation of chronic drug abusers in Hong Kong
(2009)
C. Duff
Drugs and youth cultures: Is Australia experiencing the normalisation of adolescent drug use
Youth & Society
(2003)
ESPAD
Alcohol and other drug use among students in 30 European countries
(2001)

There are more references available in the full text version of this article.

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CommentaryNormalization and harm reduction: Research avenues and policy agendas

Abstract

Section snippets

Conflict of interest statement

Acknowledgements

International Journal of Drug Policy

Lancet

Chilling out: The cultural politics of substance consumption, youth and drug policy

A brighter side: Protective and risk factors in the rehabilitation of chronic drug abusers in Hong Kong

Drugs and youth cultures: Is Australia experiencing the normalisation of adolescent drug use

Youth & Society

Alcohol and other drug use among students in 30 European countries

Commentary
Normalization and harm reduction: Research avenues and policy agendas