Casting light on harm reduction: Introducing two instruments for analysing contradictions between harm reduction and ‘non-harm reduction’

Background: Harm reduction is commonly regarded as complementary to other drug problem responses—as the fourth tier. Yet even core examples of harm reduction such as the provision of injection equipment and methadone treatment have over and over encountered considerable opposition, and harm reduction in its more comprehensive forms continuously stirs up controversy. In spite of this the notion of complementarity is commonly upheld leaving opposition to harm reduction inexplicable and non-researchable. Methods: Teaching experience in multiple settings in which opposing views have surfaced and a review of relevant literature on contradictions involved in drug policy debates have been utilized to analyse and summarize policy contradictions involved implicitly or explicitly in disagreements on harm reduction. Results: Analysing contradictions is a difficult endeavour, but many opposing views appear if you approach the task systematically. For this purpose two instruments have been constructed: ‘The Harm Reduction Inventory’ (25 items) and ‘The Drug Policy Propensity Index’ (11 items). These tentative instruments are presented in full and their potentials are discussed. Conclusion: Harm reduction may in fact represent goals, methods, priorities and understandings which are to a considerable extent at odds with the opposite of harm reduction – here termed ‘non-harm reduction’. This insight may be overlooked if assuming complementarity. To describe and analyse harm reduction by way of juxtaposing opposites seems a feasible and illuminative approach. The instruments provided could perhaps facilitate better understanding of conflicts of vision and contribute towards illuminating policy barriers.