Human-rights driven models of ‘care’ trump punitive measures across diverse harm reduction settings

Expanding understandings of ‘care’ presents new opportunities to improve harm reduction across diverse sectors, say criminology researchers from UNSW Law & Justice. 

Adopting harm reduction practices underpinned by principles of care and mutual aid is critical to creating safer nightlife and festival cultures, says Dr Phillip Wadds, a criminology expert from UNSW Law & Justice.

Harm reduction aims to minimise the negative social, legal and health impacts of drug use, drug policies and drug laws. In nightlife and festival settings, these harms can include sexual violence, assault and drug-induced deaths as well as the criminalisation and stigmatisation of drug users. 

“While Australia is committed to a harm minimisation strategy [supply reduction, demand reduction and harm reduction], there has been, and continues to be, an overwhelming focus on supply-and-demand reduction with much less focus on harm reduction in nightlife and festival settings,” says Dr Wadds.

“For example, there is a heavy emphasis on typically punitive legislation and intense policing tactics despite a growing body of evidence that indicates these policies and approaches can increase or exacerbate harms.”

History has demonstrated time and again the failure of prohibitionist and punitive policies to achieve their stated objectives, he says.

“We need a different approach, one that acknowledges the ongoing use of alcohol and other drugs and focuses instead on prioritising care over policing, working with affected communities to foster nightlife and festival cultures less conducive to harms.”

Dr Phillip Wadds

Dr Wadds researches the night-time economy, music festivals, alcohol and drug-related harm, urban governance and policing. His research prioritises and partners with those impacted by regulatory policies. 

His report, Safety, sexual harassment and assault at Australian music festivals (2019), conducted in partnership with Dr Bianca Fileborn (University of Melbourne) and Professor Stephen Tomsen (Western Sydney University), provided world-first evidence of sexual violence at festival events as well as practical prevention strategies for organisers, service providers and patrons. 

Its recommendations included changes to festival policy and management, such as providing clearer messaging around sexual violence, increasing avenues for on-site reporting and support services, training staff on responding to sexual violence reports, and increasing female event staff, as well as environmental changes, such as providing ‘chill out’ spaces, instituting regular patrols or emergency contact points in camping grounds, and enhancing lighting, particularly in isolated areas.

There is also a need for cultural change, the report found. “We need to continue our efforts to make festival line-ups more gender equitable and diverse, and encourage pro-social behaviour, such as bystander intervention, and an ethics of care among festival patrons,” Dr Wadds says.

Since the report, Dr Wadds has been working with government, industry and other stakeholders, including non-government harm reduction service providers, to implement the recommendations and reduce harms experienced in festival and nightlife settings. 

The research has informed the NSW Health’s Guidelines for Music Festival Organisers: Music Festival Harm Reduction (2019). Dr Wadds also provided critical advice to the Review into Sexual Harm, Sexual Harassment and Systemic Discrimination in the National Music Industry (2022). 

The report’s recommendations have been variously implemented by festival organisers nationally, including leading promoters Secret Sounds (who present Falls Festival and Splendour in the Grass) and Fuzzy Productions (who present Harbourlife, FieldDay and ListenOut). It received the Adam Sutton Crime Prevention Award for research demonstrating pragmatic solutions to Australasian crime problems that promote tolerance and inclusion.

Dr Wadds is currently working with the Australian Festival Association on an evaluation of harm reduction services and programs and the production of best-practice guidelines that will support the industry to improve festival outcomes into the future.

Saving and improving the lives of people who use drugs

These kinds of mutual aid models of harm reduction that focus on whole-of-community needs also have significant health and social benefits for people who use drugs, says Dr George ‘Kev’ Dertadian. Broadening our understanding of ‘care’ to include promoting greater security, safety and a sense of belonging can reduce mortality rates and improve the lives of people who use drugs, says the social researcher from UNSW Law & Justice. 

“Reducing the prevalence of blood borne viruses (BBVs) and overdose as well as associated violence and crime have long been markers of success for harm reduction facilities. This focus on the health and safety [of people who use drugs] is a very scientific and measurable way of talking about impact,” he says.

“[However] the capacity to save lives, to reduce BBVs, is inextricably linked to how people feel safe [and] connected to community. They’re not separate conversations.”

Dr George 'Kev' Dertadian

Dr Dertadian conducts field-based research in partnership with people who use drugs, including the non-medical use of pharmaceuticals and injection drug use. Prioritising the experiences and needs of people who use drugs is vital to creating an informed policy response, he says. He advocates for non-carceral responses to drug use, with a particular focus on harm reduction. 

In Australia, trends in opioid overdose deaths are suggestive of an emerging overdose crisis. The opioid-induced death rate peaked in the late 1990s, largely due to heroin, prompting the opening of Sydney’s Medically Supervised Injection Clinic (MSIC) in Kings Cross. While rates were lower in the early to mid-2000s, opioid-induced deaths have increased over the last five years to significantly higher than ten years ago.

Research has shown stigma within health care settings acts as a significant barrier for people who use drugs to access health care, says Dr Dertadian. “Communitarian or human rights models of ‘care’ can counter feelings of shame that so often place emotional distance between service providers and people who use drugs,” he says. “For example, MSIC saves lives, connects clients with treatment and social services, and serves as a refuge from daily experiences of harassment and violence.”

Dr Dertadian’s most recent study of conceptions of overdose, based on qualitative interviews with staff and clients of MSIC, found a more nuanced understanding of overdose improves the experience and health outcomes of people who use drugs. 

“By expanding conceptions of overdose, staff were able to respond earlier to ‘cues’, such as drops in clients’ blood oxygen levels or atypical behaviour after they’ve injected, and intervene with care responses outside traditional emergency protocols,” he says.

This reduced the need to administer naloxone, a drug used to reverse opioid overdoses that can be violent and disruptive to mental and physical states in large doses, he says. By contrast, the research found its gradual administration in peer-led harm reduction settings enabled effective responses to overdose. 

“Expanding our understanding of ‘care’ to consider the quality of experience of people who use drugs can facilitate more effective harm reduction. Measures around mortality – this has to be part of the landscape of how we talk about these things, because mortality matters, but it can’t be the only way we talk about these things,” he says.

Harm reduction needs to engage with people who use drugs without judgement, coercion and discrimination, and without requiring they stop using drugs as a precondition of support, he says. 

A second drug consumption room for Sydney

MSIC has had no drug overdose deaths on its premises in its 20 years of operation. It has saved the lives of more than 10,600 people who overdosed on the premises. Yet it remains Sydney’s only drug consumption room.

“South-Western Sydney contains roughly the same proportion of people who inject drugs as the inner city. This, together with the rapid gentrification of Sydney, its difficult transport networks where many people who use drugs experience stigma and harassment, demands a second drug consumption room in South-Western Sydney,” he says.

“A city as large, expansive and diverse as Sydney, and with its sizeable number of injecting drug users, should have the benefit of another of these facilities.”

Dr George 'Kev' Dertadian

Harm reduction for people who use drugs should support more than just a “bearable life”, as Lebanese-Australian social anthropologist Professor Ghassan Hage describes it, he says.

Professor Hage writes: “The bearable life is a viable life, but it can be seen as the product of a search for the absolutely minimally-viable life, the just-bearable life.” By contrast, humanitarian models of harm reduction acknowledge the rights of people who use drugs to full and rich lives, Dr Dertadian says.

Written by Kay Harrison

Researchers