Nevertheless, harm-reduction advocates claim that the user can be responsible by employing the same general principles applicable to the use of alcohol:
avoiding hazardous situations, excessive doses, and hazardous
combinations of drugs; avoiding injection; and not using drugs at the
same time as activities that may be unsafe without a sober state.
Drug use can be thought of as an activity that can be simultaneously
beneficial but risky, similar to driving a car, skiing, skydiving,
surfing, or mountain climbing, the risks of which can be minimized by
using caution and common sense. These advocates also point out that
government action (or inaction) makes responsible drug use more
difficult, such as by making drugs of known purity and strength
unavailable.
Principles
Duncan and Gold argue that to use controlled and other drugs responsibly, a person must adhere to a list of principles. They and others argue that drug users must accept:
- understanding and educating oneself on the effects, risks, side effects and legal status of the drug they are taking
- measuring accurate dosages, and take other precautions to reduce the risk of overdose when taking drugs where an overdose is possible
- taking a small dose first when taking a new drug
- if possible, chemically testing all drugs before use to determine their purity and strength
- attempting to gain the most pure and high-quality drugs laced with no cutting agent at best such as by buying on darknet markets
- using drugs only in relaxed and responsible social situations as altered consciousness can be inappropriate in potentially dangerous or unknown settings
- avoiding driving, operating heavy machinery, or otherwise situate themselves directly or indirectly responsible for the safety or care of another person while intoxicated and discouraging persons from operating a motor vehicle while intoxicated
- having a trip sitter (or "copilot") when taking hallucinogenic drugs
- using recreational drugs in moderation, setting reasonable limits on the consumption and not allowing drug use to overshadow other aspects of their life (i.e. financial and social responsibilities)
- taking the smallest dose of a recreational drug that will produce the desired effects
- avoiding mixing or combining drugs, especially unknown drugs and drugs with known dangerous interactions
- not trusting someone else with the responsibility for your health and safety
- knowing basic first-aid techniques and taking responsibility for applying them appropriately in cases of drug emergencies
- avoiding the injection of drugs
- recognizing that one's own drug-taking behavior and attitudes in the presence of others will influence others, especially children
- abstaining from drug use when inappropriate for reasons of health and physical fitness such as during pregnancy
- respecting an individual's decision concerning drug use
- providing alternatives of acceptable social-recreational behaviors within a group for others and avoiding drug use to become the only motivation or focus of the social situation
- understanding the individuality of response
- being aware of the complex influences of set and setting on psychoactive drug experiences and acting accordingly
Some proposed ethical guidelines include:
- never tricking or persuade anyone to use a drug;
- being morally conscious of the source of the drugs that a person is using.
Duncan and Gold suggested that responsible drug use involves
responsibility in three areas: situational responsibilities, health
responsibilities, and safety-related responsibilities. Among situational
responsibilities they included concerns over the possible situations in
which drugs might be used legally. This includes the avoidance of
hazardous situations; not using when alone; nor using due to coercion or
when the use of drugs itself is the sole reason for use. Health
responsibilities include: avoidance of excessive doses or hazardous
combinations of drugs; awareness of possible health consequences of drug
use; avoiding drug-using behaviors than can potentially lead to
addiction; and not using a drug recreationally during periods of
excessive stress. Safety-related responsibilities include: using the
smallest dose necessary to achieve the desired effects; using only in
relaxed settings with supportive companions; avoiding the use of drugs
by injection; and not using drugs while performing complex tasks or
those where the drug might impair one's ability to function safely.
Responsible drug use is emphasized as a primary prevention
technique in harm-reduction drug policies. Harm-reduction policies were
popularized in the late 1980s although they began in the 1970s
counter-culture where users were distributed cartoons explaining
responsible drug use and consequences of irresponsible drug use.
Criticism and counterarguments
Health and social consequences
Drug use and users are often not considered socially acceptable; they are often marginalized socially and economically.
Drug use may affect work performance; however, drug testing
should not be necessary if this is so, as a user's work performance
would be observably deficient, and be grounds in itself for dismissal.
In the case of discriminate use of amphetamine, similar drugs and some other stimulants, work capacity actually increases, which in itself raises additional ethical considerations.
Illegality
Illegality
causes supply problems, and artificially raises prices. The price of
the drug soars far above the production and transportation costs. Purity
and potency of many drugs is difficult to assess, as the drugs are
illegal. Unscrupulous and unregulated middle men are drawn, by profit,
into the industry of these valuable commodities. This directly affects
the users ability to obtain and use the drugs safely. Drug dosaging with
varying purity is problematic. Drug purchasing is problematic, forcing
the user to take avoidable risks. Profit motivation rewards illegal
sellers adding a cutting agent to drugs, diluting them; when a user, expecting a low dose, procures "uncut" drugs, an overdose can result.
The morality of buying certain illegal drugs is also questioned given that the trade in cocaine, for instance, has been estimated to cause 20,000 deaths a year in Colombia alone.
Increasing Western demand for cocaine causes several hundred thousand
people to be displaced from their homes every year, indigenous people
are enslaved to produce cocaine and people are killed by the land mines drug cartels place to protect their coca crops.
However, the majority of deaths currently caused by the illegal drug
trade can only take place in a situation in which the drugs are illegal
and some critics blame prohibition of drugs and not their consumption
for the violence surrounding them.
The illegality of drugs in itself may also cause social and economic
consequences for those using them, and legal regulation of drug
production and distribution could alleviate these and other dangers of
illegal drug use.
Harm reduction
Harm reduction
as applied to drug use began as a philosophy in the 1980s aiming to
minimize HIV transmission between intravenous drug users. It also
focused on condom usage to prevent the transmission of HIV through
sexual contact.
Harm reduction worked so effectively that researchers and
community policy makers adapted the theory to other diseases to which
drug users were susceptible, such as Hepatitis C.
Harm reduction seeks to minimize the harms that can occur through the use of various drugs, whether legal (e.g. ethanol (alcohol), caffeine and nicotine), or illegal (e.g. heroin and cocaine).
For example, people who inject illicit drugs can minimize harm to both
themselves and members of the community through proper injecting
technique, using new needles and syringes each time, and through proper
disposal of all injecting equipment. Smoking a 700 mg tobacco cigarette
or cannabis joint (with the attendant heat shock, carbon monoxide, and combustion toxins) can be avoided by serving individual 25 mg "single tokes" in a miniature pipe or using a vaporizer.
Other harm reduction methods have been implemented with drugs such as crack cocaine.
In some cities, peer health advocates (Weeks, 2006) have participated
in passing out clean crack pipe mouthpiece tips to minimize the risk of
Hepatitis A, B and C and HIV due to sharing pipes while lips and mouth
contain open sores. Also, a study by Bonkovsky and Mehta reported that,
just like shared needles, the sharing of straws used to "snort" cocaine
can spread blood diseases such as Hepatitis C.
The responsible user therefore minimizes the spread of blood-borne viruses such as hepatitis C and HIV in the wider community.
Supervised injection sites (SiS)
The provision of supervised injection sites, also referred to as safe injection sites, operates under the premise of harm reduction
by providing the injection drug user with a clean space and clean
materials such as needles, sterile water, alcohol swabs, and other items
used for safe injection.
Vancouver, British Columbia opened a SiS called Insite in its poorest neighbourhood, the Downtown Eastside.
Insite was opened in 2003 and has dramatically reduced many harms
associated with injection drug use. The research arm of the site,
run by The Centre of Excellence for HIV/AIDS has found that SiS leads
to increases in people entering detox and addiction treatment without
increasing drug-related crime. As well, it reduces the littering of drug
paraphernalia (e.g., used needles) on the street and reduces the number
of people injecting in public areas. The program is attracting the
highest-risk users, which has led to less needle-sharing in the Downtown
Eastside community, and in the 453 overdoses which occurred at the
facility, health care staff have saved every person.
In the Netherlands,
where drug use is considered a social and health-related issue and not a
law-related one, the government has opened clinics where drug users may
consume their substances in a safe, clean environment. Users are given
access to clean needles and other paraphernalia, monitored by health
officials and are given the ability to seek help from drug addiction.
Due to the project's initial success in reducing mortality ratios
and viral spread amongst injection drug users, other projects have been
started in Switzerland, Germany, Spain, Australia, Canada and Norway. France, Denmark and Portugal are also considering similar actions.
On festivals
As drugs are very prevalent in festival culture more and more consider taking measures for responsible usage there. Some festival organizers have chosen to provide services meant to inform about responsible drug use and testing drugs for the disposal of dangerously laced ones. As a result, some have reported a significant reduction of the workload of festival's medics, welfare team and police officers.
