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ID: HR19-1340

Presenting author: Alana Klein

Presenting author biography:

Alana Klein is an Associate Professor, Faculty of Law, McGill University, where she is co-convener of the Research Group on Health and Law. She teaches and writes about criminal law, health law, and human rights. Previously, she was a policy analyst at the Canadian HIV/AIDS Legal Network.

Constructions of harm reduction in legal and policy reform: opportunities and risks in drug and sex work advocacy in Canada

Alana Klein

Background: Language and discourse of harm reduction increasingly figures in policy discourse and practice in a growing range of areas in Canada, including illegal drug use, cannabis legalization, abortion, sex work, physician-assisted dying. Harm reduction serves as both a justification for, and a paradigm to guide design of, policies and laws. This project seeks to identify and analyze risks and opportunities faced by advocates in constructing law and policy reform efforts through the lens of harm reduction.

Methodology: This project used participatory mixed-methods design, including media and policy document analysis, statutory and case law analysis, and focus group/interviews with advocates. It analyzed how definitional features of harm reduction varied across institutional contexts in one established area (drug use) and one more emergent area (sex work).

Results: Key elements of harm reduction emerge or recede, or are differently understood, depending on subject matter and institution. For example, community-based actors emphasize and seek to disrupt sources of harm that are societally generated, for example through criminalization and stigma, whereas governments tend to portray sources of harm generically, or as inherent and static. Government actors placed more emphasis on harms to, and participation of, society more broadly, compared to grassroots advocates' relative emphasis on those who engage directly the relevant activity. Government actors tended to have high evidentiary thresholds to implement harm reduction approaches and interventions and maintained higher access thresholds, where grassroots activists emphasized low-threshold interventions based on more diverse forms of knowledge. As a result, "official" constructions of harm reduction were often seen as crowding out, limiting, distorting, or undermining harm reduction and broader advocacy goals of community-based advocates across subject areas.

Conclusion: Some advocates may seek to challenge government understandings of harm reduction, may rely other paradigms to guide their advocacy, or may limit their advocacy to meet state understandings.