Doctor Nicolás Di Biase, who currently hears patients at the Municipal Hospital of Bahía Blanca (Argentina), is a co-founder of the Network of Professionals for the Study of Cannabis (known by its Spanish acronym, REPROCANN) and a member of the Society of Cannabis Clinicians. He has given a talk at Argentina’s first cannabis camp festival, Flipex, about the way of addressing the use of psychoactive substances and health policies on harm reduction and management related to drug use. The physician stressed the importance of understanding there must be no room for criminalising substance use when approaching this matter. Instead, Di Biase urged that focus should be on assessing, evaluating, and limiting harm by using risk reduction techniques.
Understanding Harm and Risk Reduction
This approach sees consumption as a complex phenomenon with many layers and an undeniable worldwide prevalence, and intends to minimise risk and harm associated with drug use instead of neglecting or demonising users, without ignoring or belittling the real danger related to the use of psychoactive substances. The goal is to limit or alter the consequences of using drugs instead of the habit. “This comes as a complement to the usual prevention and treatment interventions. The improvement stems from understanding that the user gets involved with drugs or other substances knowingly and even in spite of demonisation and prejudice. This is not about avoiding the issue, but instead receiving it with open arms,” claims Nicolás.
This paradigm shift described by Di Biase requires a change of mind, especially in people from other generations who have been influenced by the efforts of prohibition and the war on drugs, leading them to associate users with criminals. “This criminalising approach based on moral judgement held by doctors in the 20s and 30s”— explains Di Biase—“defined drug addiction in a way that substance use was deemed an illness or a disease. Doctors, adopting a hegemonic, hierarchical, military, and dominant approach, claimed users of psychoactive substances should be locked up. Now, the harm reduction approach invites everyone to reflect upon abandoning this strategy based on moral judgement and criminalisation; to consider the idea that using a substance does not necessarily mean having a problem,” emphasises the doctor.
The Role of the State in This New Approach
People can use drugs following practices that reduce risks and provide greater care—this is what this approach is all about. Of course, this supposes active involvement on the part of the government, which must implement health policies—instead of tightening up the security apparatus—in connection with substance use. From a state perspective, harm and risk reduction implies identifying and quantifying all factors related to the risks incurred when using substances so that we can anticipate, prevent, and/or limit consequences, with the ultimate goal of moderating this relationship between substance and user.
Efficient Management of Risk and Pleasure: Knowledge is Power
Leaving behind concepts such as limiting and reducing allows us to focus on a more proactive approach, where individuals are able to manage circumstances that may seem beyond control. User education and information is key to improve decision‑making and adopt practices that represent a lower risk and greater care, without neglecting pleasure and the enjoyment that arises from social interactions involving the use of substances. These strategies must be laid on the table so that society has accessible and useful information in cases where the use of drugs is indeed inevitable.
