« KNOWLEDGE IS POWER » / FOREWORD / BOOK : Psychotropic Drugs, Prevention and Harm Reduction

 

Psychotropic Drugs, Prevention and Harm Reduction.
Editors : Imaine Sahed & Antony Chaufton

FOREWORD / ANNE COPPEL : « KNOWLEDGE IS POWER »


Psychotropes & sociétés (Psychotropics & Societies) gathers work deriving from a long history – numerous publications could fit under this title. However, if most experts as early as the 1970s recognized the close link between the psychotropic uses of drugs and their social context, the will to understand in order to act is relatively recent. This new field of expertise emerged during the 1990s and faced many obstacles. To put this evolution toward a new approach into perspective, it is enough to mention here two seminars that marked research prior to this new paradigm. In 1970, one of the very first seminars on the topic was published under the title Ivresse chimique et crise de civilisation (Chemical Intoxication and Civilization Crisis). The French people had just discovered that a new generation born after World War II was using illicit drugs. How could we doubt the association between “drugs and society” when the consumers themselves claimed credit for an emancipating project? Two decades later, social science researchers were officially approached by the government. A research group, RDG, was created in 1991 and led to the seminar Psychotropes, politique et société (Psychotropics, Politics and Society), in which I took a part. It was a turning point because it was no longer just about establishing the scene, research was responsible for informing the public debate which had been restricted since the 1980s to “laxity or repression”. Defined by Alain Ehrenberg, the RDG program offered to take into account all the psychotropics, whatever their legal status, in all their aspects (production, distribution, consumption), to develop a plurality of centers of expertise with the collaboration of foreign researchers. This program was partly implemented with the creation of the OFDT (French Observatory of Drugs and Drug-addictions) in 1993. In a hurry, the French have hastily tried to catch up, partly to the deficit of public health. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) asked for the development of epidemiologic studies that could be compared from one country to the other but, beyond institutional constraints, a new expertise based on public health policies was going to greatly disrupt both our ways of acting and our ways of thinking.

At the end of the 1980s, the AIDS threat, a fatal and contagious disease, was the turning point. The situation demanded swift and efficient action. The evaluation studies were a reaction to this emergency. They also answered another requirement, as harm reduction policies aim at reducing the adverse health consequences of drug use rather than eliminating drug use, in contrast with the usual objective of the fight against drugs. In the health field, these new approaches were the source of an amazing development of research in France, as well as at the international level, but this development encountered specific obstacles in France. La défaite de la santé publique (The Failure of Public Health Policies), the title of Aquilino Morelle’s book dealing with the contaminated blood scandal, was one of these obstacles. The lack of research in the field of psychotropics was only one specific case of public health deficit, as shown by the series of scandals from mad cow disease to asbestos in the 90s, but the argument justifying public health defiance was specific to the debate regarding the drug issues, as public health measures were accused of being too soft, lenient and lax by many and of being a pretext for social control by others. Another obstacle is a French tradition of social science research which refuses to be at the service of action in contrast to the more pragmatic and empirical Anglo-Saxon social sciences. Field research is traditionally undervalued and, in addition, the issue of psychotropic drug use is still considered as a fringe topic in institutional research fields. Research responding to the demands of action is even more marginal since it is necessarily multidisciplinary. Understanding the meaning of psychotropic drug use implies taking context into account, one of those multidisciplinary words referring both to sociology and economy, to anthropology as well as political sciences. The mistrust towards social sciences feeds off phenomena complexity: what authorizes the researcher to retain one variable rather than another? The answer lies partly in the construction of these new research fields, which developed their own methodology and conceptual tools.

Despite all these obstacles, research has nonetheless experienced a significant development during the last two decades. Thus, the research published here offers a good overview of the different problems that forged the alliance between practitioners and researchers. Without claiming to synthesize, we single out here a first question addressed from different angles the published works, the question of consumer practices. Whether it is harm reduction policies, care or prevention, intervention tools cannot omit the meaning that the user gives to his/her uses. Except for counter-culture movements, uses of illicit psychotropic drugs are not asserted, they are most often undescribed, but drugs that modify states of consciousness always assume the same functions ranging from emancipation to integration, along with, for example, a transition function from one social environment to another in search of a new personal and social identity, or even in order to comply with life’s everyday demands, and finally to escape into intoxication, which also has its own logic. It is the same for legal psychotropic drugs, whose meanings are little studied as they seem obvious. Thus, poly- consumptions are a constant, whether the products are legal or illegal, and, in this respect, taking into account the joint uses of alcohol and tobacco is a necessity for prevention.

Whether licit or illicit, these consumptions must be studied in their context according to the groups people belong to. In youth-directed prevention, peer groups became evident but community approaches are still restricted to fringe practices such as injection. The more ambitious community health approaches combine the different actors not only in diagnosis, but also in action. According to this logic, doing research on drugs analysis, considered as a tool for producing and sharing knowledge, has focused on comparing professional practices and consumption practices. Yet, if the issue of practices is crucial for action, it is confronted by the complexity of the actors’ logics, as noted by the issue of early intervention. Difficulties are both conceptual and methodological, and if research on practices is involved in increasingly numerous works, the quality of the research is still based on the understanding of the situations, which obviously encourages the suspicion of subjectivism or partiality afflicting such qualitative approaches. Public debate demands statistics and the assessment of public health policies complied with this requirement. With undeniable results, such as an HIV infections decrease, harm reduction policies developed a consensus of expertise in France, as well as at the international level. However, it is remarkable that this quantitative approach ignores a critical determiner for results: the actors’ practices. When treating opioid dependence, it was shown that good practices determine results. Despite the lack of research, there is every reason to think that it is the same for all harm reduction or prevention tools. It is still necessary to be given the means to develop this complex research. The quality of practice is a kind of open secret: education, care, outreach, all the actors concerned, whether professionals or beneficiaries of the actions, know what good practices are. As for prevention, it is believed a priori that good practices are those that provoke exchange and reflection, which, for example, are targets of the projection of animated short films. The task remains to identify the determiners of good practices in order to validate and pass them on.

Another issue raised here by some studies is drug supply. This approach is traditionally studied for legal psychotropics, along with the whole range of regulations, from prohibition of sale to minors to marketing strategy limitations. Drug supply in the illegal market is little studied, mainly because access to the field faces specific obstacles, and also because there is a lack of will to learn. The fight against drug trafficking is not assessed according to its results, a fact that Latin American countries devastated by counter- productive consequences deplore nowadays. Therefore, Alain Tarrius’ work on the distribution of chemical drugs to teenagers should be welcomed. The concept of “moral area” developed in this research reflects the strategies of traffickers engaged both in human and drug trafficking in a cross-border geographical area between France and Spain, exploiting the shortcomings of social policies concerning the protection of minors. Another study to be noted is the research on drug users’ self-medication in Dakar, which takes into account the supply of medicines in the illegal market.

This research is part of a set of studies accompanying the implementation of harm reduction services in Senegal. Social sciences, especially anthropological approaches, played a major part in the experimental phase of harm reduction services. However, these approaches are quite regularly marginalized. The role of social sciences is not guaranteed in any way. As noted by one of the articles published here, expertise in the health field clashes regularly with the logics that are contrary to established scientific knowledge, such as the logic of alcohol, tobacco or psychotropic medicine lobbies, collective beliefs and prejudices, or even, regarding illicit psychotropics, the objectives and practices of policies against drugs. Their opponents contrast social sciences to the rigor of fundamental sciences, suspecting them of complacency. Even though they are little subsidized, social sciences still continue to develop: the desire to understand in order to act is tenacious, as reflected by the quality of the works published here.

 

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