Let’s talk about pleasure: harm reduction by any other name

As a doctor who works with people whose lives have been severely affected by drugs, I realize that changing behavior, even when it is devastating to the individual, is very difficult. Part of the problem, as far as I see it, is that as a society we pay relatively little attention to people who use drugs until they either break the law or develop health problems.

The only form of prevention most governments consider is prevention of initiation of use. Such an approach, although valid and useful, means that the part of the community who are most at risk of developing problems (people who already use drugs) are devoid of any assistance in helping them monitor and self-regulate their consumption to reduce the risk of crossing that blurred boundary that divides problematic from non-problematic drug use. While a more honest discourse addressing harm-reduction strategies for users of all drugs is becoming more acceptable and available through the web-based user forums and drug information sites such as erowid, drugs-forum and blue-light, there is still a long way to go.

Pleasure drives drug use, not the avoidance of harm

I founded the Global Drug Survey (GDS) in 2011; in 2015, more than 100,000 people filled out our survey in 10 different languages. Our mission is to help people who choose to use drugs do so more safely and to provide independent, objective and credible information to individuals and their communities. Through our research and apps, GDS aims to help communities craft the most effective public health responses to the use of drugs, including alcohol and prescription medications.

The notion of engaging people in a conversation about harm reduction and discussing strategies that ‘allow’ them to continue to get pleasure from their drug use is still rather uncommon among drug-treatment services. I believe that if you can encourage behavior change that reduces risk but does not diminish pleasure, you are more likely to see your advice adopted.

The GDS has started that dialogue with the development of the GDS Highway Code, the world’s first harm-reduction guide voted for by people who use drugs (the people who are most trusted by other people who use drugs). It not only ranks different harm-reduction strategies by the proportion of users who normally adopt it and how important they perceive each one is in reducing risk of harm, but uniquely rates different strategies on the impact they have on drug-related pleasure. The headline conclusion is that safer drug use appears to be more enjoyable drug use. It has been downloaded over 80,000 times and translated into French and Portuguese.

The Highway Code shows how many respondents use this particular harm-reduction strategy as well as how much it reduces risk and enhances pleasure. Staying well hydrated was the #1 strategy used by MDMA users.
The Highway Code shows how many respondents use this particular harm-reduction strategy as well as how much it reduces risk and enhances pleasure. Staying well hydrated was the #1 strategy used by MDMA users.

Consequences not consumption

Another approach is to focus on possible social consequences of substance use. When it comes to alcohol, many interventions look at things like calories, units and health risks, which might not be as meaningful for younger people. Supported by findings from GDS2015 that social humiliation is in the top four motivators for changing drinking patterns, GDS has developed a microsite quiz for young drinkers.

After a brief survey, the "One too Many" app gives you an ARSE score.
After a brief survey, the “One too Many” app gives you an ARSE score.

The one too many app free at onetoomany.co is a novel way of getting young people to think about their drinking. While most digital interventions focus on how much you drink, one too many asks about behaviors that matter to young people. In just 20 questions covering things like losing your phone, passing out, or ending up in bed with someone you wish you hadn’t due to your drinking, one too many gives people a unique ARSE (Alcohol Related Social Embarrassment). And because we don’t always know what we are like when we are drinking, one too many allows you to send a link on Facebook and Twitter so your friends can anonymously give you an ARSE score (only you ever see the scores others give you). Over 200,000 people have got their ARSE score so far, and it’s about to be trailed and evaluated by a team at Oxford Brookes University.

GDS hopes that by compiling the world’s biggest database of drug use and by assessing both levels and patterns of use, our apps can provide critical, evidence-based feedback on health risks adjusted for a person’s unique medical, behavioral and familial history. We hope all of our work helps people use drugs more safely, so they remain a source of pleasure not pain to them, those they care for or their communities.

adam-winstock

Author: Dr. Adam R Winstock MBBS, BSc, MSc, MRCP, MRCPsych, FAChAM, MD
Founder and Director, Global Drug Survey; Consultant Psychiatrist and Addiction Medicine Specialist, SLAM NHS Trust; Senior Lecturer, Kings College London

Twitter:
@globaldrugsurvy
@drugsmeter

(Author’s note: Want to help contribute to this research? We will be launching GDS2016 in November, 2015 with focuses on psychedelics, safer MDMA dosing, drug vaping and drug tourism. We are hoping to increase our Canadian participation this year, so don’t hesitate to contact me if you would like to help us spread the word.)

 **Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Harm reduction in recreational settings

When we hear the term “harm reduction,” we often think of supervised consumption services, needle exchanges or clean crack pipes. These are all important, life-saving measures, but is there a way harm-reduction can be applied to more casual substance users, such as the student who takes MDMA at a music festival, or the guy who likes to have a few beers after work or on the weekend?

About 15 years ago, I moved to Victoria from a small town in northern Canada to go to university. Almost immediately, I was introduced to the electronic music community. Soon, I was spending many a weekend dancing the night away at bush parties, sweaty halls or cramped basements. The scene was vibrant, welcoming and offered opportunities to experience all kinds of new things—including drugs I had never heard about before. Suddenly, I was seeing people ingest things with names I couldn’t spell or pronounce. I had a lot of questions: what did these drugs do? Where did they come from? Were they safe?

Luckily, there was an easy way to get some answers. At almost every one of these parties, there was a booth decked out in Christmas lights and beaded bracelets. A hand-painted banner was draped across the front that read “IslandKidz.” Modeled after the Dancesafe movement emerging around the same time in the U.S., the booth and its tireless volunteers were on hand to give out balanced information on various substances, hand out safe sex supplies, test pills or powders for adulterants, or just be a sober person to talk to if you were feeling overwhelmed or needed a safe space. They weren’t there to condone or condemn you for using drugs; it was your choice, and they believed you had the right to accurate information in order to make an informed decision.

An old photo of the IslandKidz booth in action.
An old photo of the IslandKidz booth in action.

I couldn’t believe that a service like this existed. (And, it turns out, we were lucky to have it; many other similar organizations weren’t able to operate with the relative ease that IslandKidz did at the time.) It made me feel empowered and respected, not vilified or dismissed—as many in that subculture often felt, whether they chose to use drugs or not. I didn’t know it then, but this would be my first encounter with harm reduction—and it would be far from my last. I would eventually end up volunteering for IslandKidz, driving down countless logging roads and spending many a late night chatting with partiers, handing out info flyers, and scraping mystery pills to see what they might contain.

Harm-reduction organizations like this appear to be making a comeback these days; look at groups like Karmik in Vancouver, ANKORS in the Kootenays, DanceSafe across the U.S., or Toronto’s TRIP Project. But they are far from the only harm-reduction measure trying to reach recreational substance users. In this series, we will hear about a website offering safer-use limits for illicit drugs developed by users themselves, a report that became a touchstone for almost every media article on festivals this summer, and some advice on ways to possibly avoid “bad” ecstasy. We hope these pieces help expand your idea of what harm reduction can be.

 

amanda photo

Author: Amanda Farrell-Low, Research Assistant, Centre for Addictions Research of BC

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC