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.