The Moral Improvisation of Harm Reduction in Abstinence Based Drug Policy Amongst Frontline Drug Workers in Hong Kong

Background:  Despite the Hong Kong government’s requests for further research on harm reduction and its applicability in a ‘local’ non-western context, the region continues to operate a largely prohibitionist, abstinence-based approach to drug use and policy. Operating in this context are frontline drug workers (FDW) who act as a key point of contact between the state and People Who Use Drugs (PWUD). Adopting a street-level bureaucrat perspective, we examine the expanding role of FDWs in implementing drug policy in Hong Kong. 
 
Methods: We conducted 5 focus groups (n=17) with frontline drug workers (FDWs) who work within 5 different organizations and a diverse range of PWUD in terms of drug(s) used, type of use, life stage, and demographics. We seek to understand how they perceive their role in relation to the needs of PWUD, and their perceptions of the barriers to service provision.
 
Results: We illustrate how FDWs’ norms and values shape the delivery of services.  In responding to the needs of clients, FDWs engage in ‘moral improvisation’ wherein harm-reduction principles inform practice. Their approach is shaped by Confucian values which centre familial and social connections, and a liberal emphasis on personal responsibility, autonomy and self-control. FDWs locate barriers to the take-up of services with personal characteristics of PWUD and with the abstinence macro-policy context.
 
Conclusion: The findings reaffirm the importance of FDWs and their role in the process of practising and making policy, the ‘bottom-up’ perspective in drug policy. It furthers the idea that harm reduction is a pragmatic adaptive strategy that can be tailored to cultural contexts, with implications for the acceptability of harm reduction interventions in Hong Kong.