3. Harm Reduction and Public Health: The place of 'subjugated knowledges'

Most interventions available to people who use drugs (PWUD) are grounded in the basic principles of public health, focusing on concepts of risk and health. However, when people decide to use drugs many factors are considered, with pleasure being one of the most important. This does not mean that PWUD does not value an idea of health, but rather that this is just one of the factors under negotiation when making decisions about their drug use. This mismatch in the definition of health, well-being, and self-care between professionals and PWUD constitutes one of the main obstacles to successful interventions. Even though Harm Reduction emerged as a self-organized movement of PWUD during a moment of crisis, it is currently an intervention strategy promoted mainly by governmental and non-governmental organizations.

Institutional harm reduction focuses almost exclusively on the potential risks of drug use, reinforcing its negative connotations and overshadowing the fact that most people ultimately use drugs as a way to achieve happiness. Despite having constituted a paradigm shift in terms of intervention and the role of PWUD in defining their lives, it still reinforces a hegemonic discourse that inevitably associates drug use with risk. Based on this reflection, we propose a discussion about the present of Harm Reduction and the construction of new approaches for the future.