Embracing a Sociologically-Informed Harm Reduction to Better Support People who Use Drugs
Background: Sociology literature addressing substance use in the Canadian context is primarily focused on treatment approaches and broad claims about the role of society in addiction. This scholarship relies heavily on biomedical models that emphasize treatment approaches and largely ignore the role of harm reduction as a response to broader socio-cultural influences on patterns of substance use. International principles of harm reduction recognize that abstinence is not an end goal for all people who use drugs; therefore, steps should be taken to reduce the likelihood and severity of harms by modifying use behaviours, the provision of sterile equipment, and the opportunity to remedy the socio-cultural drivers of harm. Harm reduction advocates have been pushing for a recognition of harms beyond the individual sphere to include harm incurred via capitalism, colonialism, the patriarchy, racism, and more. There is a constellation of factors that create harms for people who use drugs. By situating sociological thought at the nexus of addiction, harm reduction, and the wider socio-cultural drivers of use, harms experienced by people who use drugs will be reduced.
Methods: A search was conducted of academic databases ProQuest, JSTOR, Taylor & Francis, and Sociological Journals using a combination of keys words [substance use, addictions, sociology, harm reduction] and search strings published in English language and excluded terms [pain management, cancer, HIV, FASD]. Results were screened for relevance resulting in the analysis of 68 articles. The selected articles were categorized into three emergent themes that capture the primary focus of the article: sociology of medicine (n=21); sociology of addiction (n=26); and conceptualizations of harm reduction (n=21).
Results: Sociology of medicine literature focuses on the socio-cultural factors that contribute to the variance in health outcomes related to sex/gender, ethnicity/race, and socioeconomic status of the individual. The sociology of addiction literature characterizes the disease pathway to substance dependence or addictive behaviours. The unfortunate shortfall of this scholarship is its focus on individual experiences and analyses of systems level harm without tangible actions to address the situation. Literature on the conceptualizations of harm reduction assess the role of harm reduction interventions at the individual level, but importantly provides potential pathways for larger system-level interventions that change the material circumstances of whole populations.
Conclusions: In response to the current state of the literature, the proposed sociologically-informed harm reduction framework, allows for the capture of the interplay between theory and practice that assists system planning and provides a model for future sociological inquiry.
