Table Of ContentPUBLIC HEALTH IN THE 21ST CENTURY
C A
RITICAL PPROACHES
H R
TO ARM EDUCTION
C , I ,
ONFLICT NSTITUTIONALIZATION
(D -)P ,
E OLITICIZATION
D A
AND IRECT CTION
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P H 21 C
UBLIC EALTH IN THE ST ENTURY
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PUBLIC HEALTH IN THE 21ST CENTURY
C A
RITICAL PPROACHES
H R
TO ARM EDUCTION
C , I ,
ONFLICT NSTITUTIONALIZATION
(D -)P ,
E OLITICIZATION
D A
AND IRECT CTION
CHRISTOPHER B.R. SMITH, PHD
AND
ZACK MARSHALL, MSW
EDITORS
New York
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CONTENTS
Introduction vii
Part One: Critical Harm Reduction Policy: From Oppositional Social
Movement to Institutionalized Public Health Policy 1
Chapter 1 Who Needs Naloxone? 3
Nancy D. Campbell
Chapter 2 Low Threshold Methadone Program: 13 Years of Experience
in Portugal 23
Paulo Lopes, Hélder Trigo, Rodrigo Coutinho, Emília Leitão,
Nuno Miguel and Jorge Oliveira
Chapter 3 Law Enforcement and Public Health: How North Carolina Became
a Leader in Harm Reduction Policy Change 41
Lisa de Saxe Zerden, Corey S. Davis, Tessie Castillo,
Robert Childs and Leilani Attilo
Part Two: Critical Harm Reduction Practice: Autonomy, Ideology,
and Evidence-Based Interventions 53
Chapter 4 Power, Politics and the Production of Harm: A Critical Look at
the Intersecting, Yet Unequal, Roles of Scientific Evidence, Power,
and Politics in the Provision of Harm Reduction Services for People
Who Smoke Crack 55
Lynne Leonard and Andrée Germain
Chapter 5 Rethinking Harm Reduction and Pregnancy: A Study of Women’s
Expectations and Experiences of Specialist Maternity Care and
Opiate Substitution Treatment 73
Fiona S. Martin
Chapter 6 “And the World's Alright with Me”: Harm Reduction and Survival
at Blockorama 95
Syrus Marcus Ware, Keisha Williams and Nik Redman
vi Contents
Chapter 7 What’s Glitter Got to Do with It?: Re-Imagining Harm Reduction,
Youth Decision-Making, and the Politics of Youth Engagement 113
Sarah Switzer, Tumaini Lyaruu, Kamilah Apong, Ocean Bell,
Lydia Hernandez, Proud Goddess McWhinney,
Carver Manuel-Smith, Fonna Seidu, Sarah Pariah and Andii Bykes
Part Three: Critical Harm Reduction Philosophy: Depoliticization,
Direct Action, Drug/Service Users’ Experiential Knowledge 135
Chapter 8 Everything About Them, Without Them: Sex Work and the Harms
of Misrecognition 137
Laura Winters
Chapter 9 Expanding the Mission of Harm Reduction: A Public Health
Population and Its Members’ Perspectives Towards Health 169
Kelly Szott
Chapter 10 Recognition, Exploitation, or Both?: A Roundtable on Peer Labour
and Harm Reduction 185
Liam Michaud, Robyn Maynard, Zoë Dodd and Nora Butler Burke
Chapter 11 Harm Reduction Hipsters: Socio-Spatial-Political Displacement
and the Gentrification of Public Health 209
Christopher B. R. Smith
About the Editors 231
About the Contributors 233
Index 243
INTRODUCTION
Not unlike most aspects of my relationship to academia, this book is the product of sheer
serendipity — a happy accident, of sorts. Drawing from my cumulative research-based
exploits among harm reduction practitioners, activists, and people who use drugs in Australia,
Canada, and the U.S. (namely Melbourne, Toronto, Vancouver, New York, and
Philadelphia1), a few years ago I began composing a manuscript that would eventually come
to form the final chapter of this collection, entitled Harm Reduction Hipsters: Socio-Spatial-
Political Displacement and the “Gentrification of Public Health.”
Throughout the many different drafts, revisions, and iterations of this manuscript, I
received a number of strange and interesting comments, responses, and rejection letters,
owing in large part to what one journal editor described as the “highly polemical” nature of
the work. Almost without exception, friends and/or colleagues to whom I sent various
different versions of this manuscript responded with almost the exact same tone of grave
concern: “you don't think that I’m a ‘harm reduction hipster’ do you?” My standard response
was that I merely sought to gain critical feedback from my peers and critical/creative co-
conspirators, insisting that the arguments weren’t directed at anyone in particular. Some
individuals with whom I shared early, unpublished drafts of the work even went so far as to
concede their status as “harm reduction hipsters” in a tone of wariness intermingling with
defeat. As I implicitly suggest at several points throughout the chapter, however, this is
something that a 21st century hipster would rarely—if ever—actually do.
Overhearing my initial thoughts on the subject prior to even beginning to sketch out my
arguments in writing, at least one prominent Canadian harm reduction advocate and drug
policy reform activist interjected, insisting that the “mainstreaming” of harm reduction could
only ever be a good thing, irrespective of the (decidedly hipster) demographics of those
jumping on the bandwagon. My immediate counter to this assertion was that the
“mainstreaming” of harm reduction was not in and of itself an inherently “bad” thing. The
primary focus of my critique, as I went on to explain, was that popular acceptance of harm
reduction policy and practice often came at the expense of diluting, sanitizing, or negating the
fundamentally oppositional political origins of the harm reduction movement in North
America. This argument in many ways extended from an earlier article I published regarding
1 Starting in January 2010, I completed a two-year Postdoctoral Fellowship funded by the Social Science and
Humanities Research Council of Canada (SSHRC) at the breeding ground for privilege and elitism that I
affectionately came to refer to as the “Poison Ivy League” – that is, the University of Pennsylvania – under the
supervision of internationally renowned medical anthropologist Dr. Philippe Bourgois.
viii Christopher B. R. Smith
the “cost/benefit” analysis of harm reduction as measured in terms of the close,
interdependent relationship between institutionalization and depoliticization (cf. Smith,
2012).
In response to my submission of a much earlier and less developed draft of this piece, one
of the top-ranked, international “addiction” journals decided “not to send it out for peer
review,” adding that the manuscript had been found “not suitable for publication.” “I must
confess that it is difficult to know what to recommend,” concluded a senior associate editor in
true (albeit aging) harm reduction hipster form.
After receiving numerous polite — and some not so polite — rejection letters from
various “addiction” journals, I eventually became swept away by other projects, forcing me to
temporarily shelve this work. Several months later, however, in response to a Call for Papers I
received from Nova Science Publishers regarding an edited collection provisionally entitled
Harm Reduction: Principles, Perceptions, and Programs, I dusted off the manuscript, made a
few additional, last minute revisions, and submitted it for consideration in the proposed
collection. Upon receiving a pleasantly surprising and unexpectedly prompt notification of
acceptance, I then contacted Nova to inquire as to who was responsible for editing the book.
Even before receiving a response to this query, I received the page proofs for the chapter,
which I promptly added to the list of publications corresponding to my profile on the nerdy
academic social networking websites I have somewhat hesitantly, reluctantly come to
frequent. Shortly thereafter, I was informed by a Nova representative that the proposed book
for which my manuscript was accepted had not yet been assigned an editor. Given my
longstanding academic and professional research involvements, advocacy work, and activism
in the general field of harm reduction—from Canada to Australia, to the U.S., and the U.K.—
I therefore offered to serve as editor for this collection, and within less than a week I had
signed and returned the formal contract.
Particularly given the fact that everything really and truly did happen in reverse, I felt it
was imperative to carefully explain this order of events for fear of being perceived as an
opportunistic, flagrantly self-promoting academic, a tendency that has become all too
common in the age of the neoliberal, corporate university. To clarify in no uncertain terms,
therefore, my paper was accepted for publication before I took on the role of editor.
Having said that, ever since adding the title and abstract for this article to the publications
listed on my academic social networking profiles, Harm Reduction Hipsters has generated
significant international interest. According to the most recent statistics the abstract has been
viewed more than 320 times during a 10-month period by scholars from more than 44
separate countries, encompassing North and South America, Europe, Scandinavia, Australia,
East and South Asia, Africa, and the Middle East.
Coincidentally, the acceptance of this article and my contractual appointment as editor to
this collection took place simultaneous to the final stages of negotiation for the position I now
occupy as Assistant Professor in the School of Social Work at Memorial University of
Newfoundland (MUN), located in St. John’s, Newfoundland, the most eastern city in North
America. Shortly after relocating to Newfoundland, as I was preparing for my first teaching
term and beginning the slow process of acclimatizing not only to a new city, but also to the
culture and character of a new academic institution, I received an unexpected email from a
doctoral candidate in MUN’s Division of Community Health and Humanities (Faculty of
Medicine) who was familiar with some of my published work in the area of harm reduction.
Knowing next to no one in St. John’s, and eager to begin mapping out the harm reduction and
