Harm reduction as anarchist practice: a user's guide to capitalism and addiction in North America

TLDR

Harm reduction in North America has evolved from an illegal, grassroots movement into a depoliticized public health policy, yet remains highly contested with stark national differences. The article aims to trace and critique the historical and political entanglement of harm reduction with public health and biomedical addiction research, ultimately proposing strategies to reclaim its anarchist, user‑autonomous roots. Drawing from regional case studies in Canada and the US, the authors historically trace and politically re‑map the uneasy relationship between the autonomous origins of harm reduction, contemporary public health policy, and the adoption of the biomedical model for addiction research and treatment. The study concludes that harm reduction’s founding philosophy is fundamentally anarchist, and offers tactics for re‑politicizing its future in North America.

Abstract

In spite of its origins as an illegal, clandestine, grassroots activity that took place either outside or in defiant opposition to state and legal authority, there is growing evidence to suggest that harm reduction in North America has become sanitized and depoliticized in its institutionalization as public health policy. Harm reduction remains the most contested and controversial aspect of drug policy on both sides of the Canada–US border, yet the institutionalization of harm reduction in each national context demonstrates a series of stark contrasts. Drawing from regional case study examples in Canada and the US, this article historically traces and politically re-maps the uneasy relationship between the autonomous political origins of harm reduction, contemporary public health policy, and the adoption of the biomedical model for addiction research and treatment in North America. Situated within a broader theoretical interrogation of the etiology of addiction, this study culminates in a politically engaged critique of traditional addiction research and drug/service user autonomy. Arguing that the founding philosophy and spirit of the harm reduction movement represents a fundamentally anarchist-inspired form of practice, this article concludes by considering tactics for reclaiming and re-politicizing the future of harm reduction in North America.