Sharps Containers are Red, Tourniquets are Blue: Harm Reduction’s Abridged History and an Ethnography of Contemporary Programs

Abstract

This thesis project demonstrates that harm reduction programs (HRPs) face several struggles, including the erasure of their sacrifices and history, lack of institutional recognition, difficulty in accessing funding resources, and issues with the recognition of their adherence to efficacy by political opponents. The project is critical because HRPs – especially those serving people using intravenous drugs and providing drug paraphernalia – undertake an important service worth highlighting and fighting for in the social and policy spheres. I investigated these issues using ethnographic fieldwork: I conducted unstructured interviews with organizational volunteers and workers while volunteering at four HRP field sites, and conducted one with a harm reduction advocate from the National Harm Reduction Coalition. My ethnography demonstrates how these struggles are closely interconnected, and thus, to combat them, I suggest broadening the measures of success to not just include scientific efficacy but also community-based effectiveness. This shift will better capture the on-the-ground care people give to those who may be considered undeserving under scientific and legal regimes. This recognition highlights the important work HRPs do for their communities, which may in turn increase institutional recognition, funding security, and the ability for their history to be recorded.

Institutional recommendations I advocate include re-evaluating IRB approval criteria for projects incorporating the narratives of people who use drugs (PWUDs). Policy recommendations include (1) repealing bans on the use of federal funding for the purchase of needle syringes and other paraphernalia for HRPs, (2) urging the Federal Government to adopt “(H)arm (R)eduction” (coined by the NHRC and pronounced “Big H Big R”) as the criterion for funding programs in “Harm Reduction Grants”, and (3) prioritizing syringe service programs (SSPs).

Keywords: harm reduction, needle exchange, drug use, federal funding, biomedical efficacy, effectiveness, care