Sunday, March 25, 2007

Harm minimization & effective drug policies

Harm minimization (HM) drug policies focus on reducing the harmful consequences of drug use rather than attempting to directly limit use itself.

To the extent that drug users factor in expected harms when they make decisions to use illicit drugs one can reasonably suppose that reducing harms will, in itself, increase use. Thus a larger group of people will use drugs after the HM policy is introduced but, if the intent of policy is realized, they will each individually be exposed to lower expected harms.

It is unclear a priori that HM policies will necessarily reduce aggregated social damages.

If users before the policy are n with individual expected damages d and after the policy they are N greater than n with individual expected damages D less than d then the change in total social damages with implementation of the policy is nd-ND = n(d-D) + D(n-N) which can be positive or negative. Debate over the value of HM hinges on the sign of this last expression. This resolves into two effects: (d-D) which measures the extent to which individual damages will fall and (n-N) measuring the extent of the induced demand increases. Pro-HM thinkers claim (d-D) is relatively large numerically while anti-HM supporters suppose (n-N) is large numerically.

Two comments:

1. There are comparable issues in social welfare policy outside the drugs area. Providing unemployment assistance reduces the financial hardship faced by the unemployed but increases incentives to live on the dole, increasing allowances to single mothers reduce the disadvantages their babies will face but increases the number of such babies, and so on.

2. Those opposed to HM favor strongly prohibitive policies which have symmetric though opposite policy effects. A stringent legal penalty will reduce numbers using from n to N’ with N’ larger than n but damages per illicit drug user are likely to rise (because of induced higher prices, increased needs to commit crime) from d to D’ with D’ larger than d. Again the net effect on social damages depends on nd-N’D’= n(d-D’)+D’(n-N’) with supporters of prohibitive policies claiming the positive term n-N’ dominates and with opponents claiming the negative term d-D’ is more important.

Debates over the value of HM policies often turn into shouting matches about the size of these effects based on strong a priori claims and little evidence. Indeed evidence is difficult to get so this type of response is hardly unexpected. One reason evidence is hard to come by is that the markets in which drugs are sold is illicit so observations of policy effects are difficult to come by.

That anti-HM brigade who emphasize the demand effects of HM – the effect of policies in driving increased use - can easily be boxed into an ethical corner. If one believes that harm reduction has strong demand effects, and opposes HM measures on this account, why should medical assistance be offered to those facing the prospect of overdose death and why should one distribute ‘fits’ by means of safe injecting rooms and so on? Taking the anti-HM position to its logical extreme would involve leaving overdosing addicts to die because the implied harm acts as a disincentive to use.

Few would seek to push things this far but opposition to such policies as use of safe injecting rooms involves precisely this type of tradeoff. It is an awkward and difficult issue but there are grounds for limiting the extent of social approval given to the consumption of dangerous drugs and for facilitating the means for their safe consumption.

I’ll pursue these ideas issue further in future posts on HM as a basis for drug policy.


Sinclair Davidson said...

There's missing word in the second paragraph, sentence begins 'If one believes that harm reduction ...'

I think that's exactly right - the empirical evidence informing the trade-offs are lacking.

Sinclair Davidson said...

Would you believe, I too have a missing word - second last paragraph.

conrad said...

I agree that HM arguments often turn into shouting matches (your police cost more than my advertising...). However, unless one actually looks at these trade-offs, then you are always stuck in a position of doing the same as now, which is not neccesarily the best position.

I tend to think a lot of the shouting matches are generally political versus scientific since most people don't understand what often amounts to models of quite complex behavior prediction. In addition, I think that many people have hardline positions on things like drugs that they aren't willing to change no-matter what the evidence (both for and against).

derrider derida said...

Most advocates of harm minimisation cite empiric evidence - often rigorous studies and experiments. It's generally the people promoting the War on Some Drugs who resort to scare campaigns and bluster.

Which is why I think the harm minimisers are almost certainly right.

hc said...

I don't often see that evidence Derrida. In the debate on safe injecting rooms all I see is evidence that no-one has overdosed in a clinic. Where is the evidence that usage does not increase?

That is just an example but I would welcome advice from you to the contrary - where evidence has been provided that HM measures do not drive demand.

Shawn said...

Isn't harm reduction about putting an upper bound on damage rather than reducing overall damage? I guess that's what you're saying. So, is reducing total damage important? For instance if for some weird reason everyone on earth scratched their arm until they bled that would cause quite a bit of damage because there are billions of scratches, but we heal easily and ultimately who cares? If a handful of people scratched themselves until they ripped open a major artery that would be problematic and we should think about ways to stop that.

Similarily, if you could make meth as safe as coffee so what if everyone is hooked?

Other than the lame analogy, do ya dig? :)

Trainspotter said...

crazy crazy man. read this while stoned and it made so much sense. but the equations were nutso.


Drug policies? Who pays them? The tax payers who do not use drugs?
Private vices payed by "public money".

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