This time we will delve into the philosophy of risk reduction to understand the pillars on which RdRcannabis program is based. Even though effectiveness of this sort of prevention projects has been sufficiently proven, it is not rare that people scorn the public administration supporting programs that invite substance users to design their own. Accompany us in this tale through the path we have come from the starting point to the foreseeable finish line.
To ponder what risk is to life gives room to very interesting and deep ponderings. Be calm! The goal of this post lies not in the sphere of existential philosophy. As it is apparent, there is not an only way to perceive risk, each person assesses risk in their own way. As it is, the same activity will be judged of low or high risk depending on the person. What’s more, the same person may judge risk of an activity differently depending on the moment of life. Some people are more in the vein of experiencing risk, those known in psychology as sensation-seeking; at the other end, there are persons full of fear, locked down at the mere idea of daily activities such as boarding an airplane or riding a lift. As a matter of fact, there is not a better way to describe such existential uncertainty than to slightly twist the verse written around 1635 by playwright Pedro Calderón de la Barca:
What is life? A frenzy. What is life? An illusion, a fiction, a shadow; and the largest good is small; that all life is a risk, and risks remain their own.
Focusing on the area of drugs: the issue of risk reduction is moderately new taking into account that psychoactive substances exist since hills are hills. That applies the most if we think strictly of the first time that somebody wrote “risk reduction policy”. That is, since drugs exist risk reduction has been in use, though not under this exact label. Risk reduction has been exerted both with legal and with illegal drugs; its underside is pleasure augmentation: one cannot exist without the other. Precisely related to pleasure stand some of the major moral taboos of society. To unlock this conundrum we may refer to Aristotle, who devoted lots of attention to the issue of virtue, which he described as the “mid term” between two extremes. For him, somebody was equally vicious being timorous as being intrepid. Because of that, it fell onto reason to keep the exacting vital balance, since virtue is not cowardice nor recklessness, but courage. So, which is the conclusion of it all? That life is what happens while you are busy managing risks and pleasures. And that if you speed a bit too much or freeze from fear, you miss it. It is said that this was the epitaph on someone who died from balconing in Majorca.
The fact is that the modern institutional answer to the “drugs problem” came in the seventies. In that moment, authorities considered the user a passive object isolated from their social context. The bottom-line inspiring use prevention programs was total abstinence. In the eighties, the association between drugs and crime came into vogue, which has been alive to the present. When AIDS and hepatitis related to injected heroin came onto the scene, it was apparent that prevention based on moral standards was a failure. Some northern European countries with a more pragmatic stand on public policies thought then to deliver harm reduction programs. These were not construed as alternatives to prevention, but in an attempt to take users one step further who did not fit anywhere in sociosanitary care based on an emerging system of drug addicts attention demanding total abstinence.
Harm reduction prioritized reducing the negative effects of using drugs rather than avoiding consumption. Examples of these programs were the offering of hygienic material for injected consumption, access to methadone, facilities for assisted consumption of drugs, etc.
In the nineties, social alarm decreased relating with drug consumption as compared with the former decade while, side by side, synthetic drugs like MDMA became popular. Also alcohol and cannabis use rose in recreational spaces. These were the years of dance culture, promoted, among others, by low and repetitive rhythms. Drug use was little by little normalised, far away from the social stigma it carried in the past, which reinforced the risk reduction lookout (RdR).
The book that better captures what RdR is in our context was published in 2013 and is entitled De riesgos y placeres. Manual para entender las drogas (Martínez D. P, & Pallarés J.). It is a collective work carried out by thirty-six professionals with lots of clinical experience as well as research. Their approaches were merged in some of the foundational projects of drug risk reduction, like Grup Igia, Energy Control, Ailaket, Edpac, Spora, Arsu Festa, ICEERS, FAC, etc.
The tenets of RdR, just as explained in the book, are as follows:
- Acknowledging the positive and negative effects of drugs
- Working with what there is (different types of consumption) and not with what there “should be” (total abstinence)
- Taking into consideration that there is a non-problematic use of drugs and that a large majority of consumers are concerned about their health
- Ascertaining that ignorance is a risk; therefore, better educate than punish or show uppity attitudes if what we want is to reach the target consumer
It is articulated on these four points and addressing social cannabis clubs that RdR was born. And it did so following the National Strategy of Prevention: consumption of drugs and associated problems (Gencat, 2008), where it is stated that a general goal is “to acknowledge and disseminate actions of RdR as a strategy based on evidence of effectiveness, necessary and a top priority with the consumer population” (p. 333).
The fact that in the late eighties the public administration steered away from prevention programs based on abstinence brought home that the main reason for people to use drugs is to disinhibit themselves, to have a good time and in a quest for pleasure. Ascertaining that the prime reason to consume is the positive effects of consumption belied to a large extent preventive programs based only on fear and catastrophist messages. Because of that, users (“peers”) were incorporated into the design and execution of reduction of risks and damages programs. All of a sudden, conversations multiplied and variables such as dose, power/toxicity, frequency, difficulty in access, preparation of consumption (hygienic or not), via of administration, poly-consumption, after-use cares, physical and mental state and context of consumption emerged as variables in the equation that may affect risk in the quest for pleasure.
In the folder of cannabis kept by the main authority in risk prevention and reduction, the European Observatory of Drugs (European Monitoring Centre for Drugs and Drug Addiction), they file physical and mental health problems, as well as social and economic. Moreover, according to studies, there is more probability for these to evolve if use of cannabis starts at a young age and if it becomes regular and long-term. Therefore, the main goals of sanitary and social care approaches to consumption should include:
- preventing use, or delaying beginning of use from adolescence to young adulthood;
- preventing occasional cannabis consumption climbing up into regular;
- reducing most harmful ways of use;
- offering actions, including treatment, to users for whom consumption has become problematic;
- reducing chances that users either drive after consuming cannabis or take part in other activities where cannabis intoxication may increase accident hazards
If we were to contrast these against social cannabis clubs (CSCs) model, it is instantly apparent that CSCs, being privileged facilities for contact with consumers, hold the potential for shaping most of the European Observatory’s premises. So it is that a task that institutions devoted to prevention find hard executing comes because legal risk of consumption makes users seclude, hide or mistrust information when it comes through distrusted channels.
Everybody knows that CSCs’ mission is not to preach on prevention in schools as to delay initiation, nor to work with teenagers who are already using. By law, CSCs’ target public are over-18s’, and most do not accept members under 21 by way of self-regulation. However, there are no better facilities to spot problematic cases or suggest a referral to specialised treatment. And, it goes without saying, CSCs are the
appropriate facilities to offer risk and harm reduction programs –starting off with burnt cannabis, especially when used with tobacco.
This is the frame where RdRcannabis saw the light. A program born out of the pull of the manpower running -or collaborating in- the Catalan CSCs which, thanks to the support of the Ministry for Health, offers material and educational resources tailored to meet the needs of the target public, as well as training to trainers (workers and representatives of CSCs). RdRcannabis is willing to learn about the different realities coexisting in the ecosystem of CSCs, and invites you to be a piece in this network made to fit the traits of the CSCs model.
You are all welcome!
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