For a renewed harm reduction model (2025)

In the early 1990s, the spread of HIV among heroin injectors prompted a shift in drug policy internationally, including in France. This led to the emergence of a new policy known as Harm Reduction (HR) and related tools, including needle exchange programmes, opioid substitution therapy programmes to manage illicit opiate consumption, as well as reception facilities and support systems for the most precarious People Who Use Drugs (PWUDs). This new policy is based on the assertion that drugs have always been there and will always be a part of society, and that we have to live with them and not try to eradicate them. Promising PWUD emancipation, the advent of HR was accompanied by the birth of peer-support groups for unrepentant PWUDs, who decided to speak out in the public arena for the first time. Thirty years on, the authors assert that this promise has not lived up to expectations. More specifically, the cohabitation of an institutionalized, bureaucratized HR with the criminalization and stigmatization of drug use has worked against PWUD emancipation. As PWUDs, users of the addiction care system, peer workers and managers of addiction and HR facilities, the authors discuss the tensions between HR and the continued criminalisation and stigmatisation of drug use in France. Using the PWUD internet platform Psychoactif and the related peer-support group, both of which they created, the authors share their experiences and reflect on their practices to propose a renewed model of HR which reconnects with the civic and emancipatory roots of HR: a rights-based model that enables PWUDs to regain their power to act and escape the alienation caused by the stigma of drug use. [Author's abstract]