For an emancipatory policy of risk reduction

Harm reduction (RDR) is today a pillar of public policies aimed at drug users. It is embodied in practices such as the distribution of sterile equipment, opioid agonist treatments, lower-risk consumption rooms, overdose prevention or psycho-social support. Resulting from a so-called pragmatic turning point in the fight against HIV/AIDS in the 1980s, in order to limit contamination, it appears as a model of health rationality and respect for human rights.

But this consensual presentation masks the political contradictions that have run through the RDR since its beginnings. Built as a compromise between public health and social control, it was integrated into the heart of a system for managing uses, without calling into question the relationships of domination that structure them.

This is why it is urgent today to ask the following question: how to think about left-wing risk reduction? That is to say, an RDR which does not simply reduce individual damage, but which attacks the social structures which produce it. An RDR that links health, autonomy and collective emancipation. An RDR which is not the health cover of a policy of order, but a tool to fight against exploitation, racism and marginalization.

A story between survival, self-support and institutional control

The RDR in France was born in the urgency of a catastrophe: that of the HIV epidemic in the 1980s. Faced with the surge in contamination among people who use injecting drugs, community and medical actors set up syringe distribution systems, including illegally. This dynamic precedes institutionalization: the free sale of syringes was only authorized with the decree of May 13, 1987 (known as the Barzach decree), which repealed the 1972 ban, then was made permanent in 1989. From this period, associations disseminated prevention tools directly aimed at people who use drugs.

This logic of reducing harm, initially breaking with the prohibitionist logic, ended up being partially integrated into the institutional field at the beginning of the 1990s. The government plan of September 21, 1993 marks a first turning point, with the financing of methadone places (a treatment for opioid addiction) by example. In 1994, several circulars authorized the prescription of methadone in specialized centers, then a press conference by Simone Veil in July 1994 declined risk reduction measures (exchange programs, city-hospital networks, extension of treatments). This dynamic resulted in an official framework in 1995, with the decree of March 17 and the authorization to place methadone on the market.

This institutionalization took place in a context of strong political tensions. At the beginning of the 1990s, policies oscillated between health opening and repressive toughening. The Quilès-Broussard plan (1992-1993) was accompanied by police operations targeting people who use drugs and the associations that support them. These contradictions illustrate the double logic that runs through the French RDR: progressive health recognition, but constantly limited by imperatives of public order.

Thus, this recognition was never complete. RDR remains confined to the margins of the health system. It is underfunded, underendowed, regularly threatened. In 2026, the medico-social addiction sector, like the entire associative sector, is going through an acute crisis: shortage of staff, reduction in budgets, lack of recognition. On this last point, the example of the reception center for drug users of the AIDES association in Paris is telling. Faced with a mobilization of local residents hostile to risk reduction measures, the Île-de-France Regional Health Agency decided to close the physical reception of the center in April 2025. The actors of the RDR are called upon to do more with less, to manage ever more audiences precarious, in increasingly degraded conditions.

The public legitimacy of the RDR must often be based on arguments of social utility (reduction of nuisances, lower health costs, public tranquility) rather than on principles of justice or rights. In March 2026, a column from the Federation of Solidarity Actors and the Addiction Federation described solidarity as “a response for the tranquility of cities”. Lower risk consumption rooms, for example, have remained in France under experimental status since 2016, despite largely positive results highlighted by a report from INSERM in 2021 then a joint report from IGAS and IGA in 2025. Their maintenance also depends on their ability to prove that they do not disturb not.

From then on, the RDR risks becoming an instrument of political neutralization by reducing the most violent effects of repression without calling into question the prohibitionist architecture. It manages poverty without fighting it and makes uses safer but not necessarily freer. It pacifies where there should be politicization.

The drug user: political figure of marginality

The political treatment of drugs is based on a double dynamic: repression of the margins and tolerance of the elites. While drug consumption is widespread across all social classes, it is precarious, racialized, young, homeless users who concentrate police, judicial and social violence. The case of the criminal fixed fine which punishes the consumption of narcotics is a striking example. As of 2020, an associative collective highlighted that “it has been widely documented for years that it is certain categories of consumers who are regularly arrested, in particular people of color or from neighborhoods, the privileged classes having their products delivered, outside the radars of the street police »

This is no coincidence. The stigma of drugs functions as a vector of social control. It allows certain groups to be designated as deviant, dangerous, unsuitable. It justifies their distancing, their confinement, their invisibility. It renews racial and class boundaries in urban space.

In Paris, for example, the media and police construction of the “crack figure” has shifted from a West Indian dealer in the 1990s to a Senegalese consumer in the 2020s. This shift is not trivial: it shows how drugs are used to racialize public space management policies. The “cleaning” operations of the crack hill, the evictions, the anti-traffic orders (an order from the Paris police headquarters has been in force since June 2023 banning the gatherings of crack users in many streets in the North of Paris), everything combines to make the consumer a problem of public order, not a matter of care or law.

RDR, in this context, is often used as a pacification tool. It allows you to manage the symptoms without questioning the causes. It provides consumption materials, substitution treatments, sometimes accommodation, but says nothing about the logic of stigmatization and the causes of the risks taken by drug users.

Thinking about left-wing risk reduction means refusing this depoliticization. This affirms that the risks linked to drugs are not primarily a health or safety problem, but a revealer of social violence. It is therefore possible on this subject to quote Jean-Pierre Couteron who speaks of an addictogenic society. This concept designates a social environment which structurally favors addictive behavior by weakening social bonds, increasing vulnerabilities and promoting a culture of immediacy and performance.

Drug use is therefore a social phenomenon and the reduction of risks which responds to it can therefore only be political. Left-wing risk reduction must therefore recognize that users are political subjects, bearers of a situated experience of marginalization, and that they must be at the center of the policies that concern them.

What can the left do to change drug policy?

The French left, in its various components, often remains uncomfortable with the question of drugs. Even the most progressive forces hesitate to make a clear statement on decriminalization, legalization, recognition of users’ rights. The subject is seen as electorally risky and morally ambiguous.

We then observe an often paradoxical discourse: drug consumption is denounced as alienating, as a symptom of unhappiness, even as a marker of neoliberal individualism. It is thought of as a problem to be solved, a behavior to be corrected, a deviation to be prevented. The logic remains hygienic, paternalistic and focused on reducing consumption.

However, this approach prevents us from seeing that drug use can be ambivalent, multiple, and sometimes political. They can be a way of surviving in a capitalist world whose pressure becomes unbearable, a strategy of self-care, a festive practice, a refusal of productivist norms, an attempt to escape pain or violence. These different aspects of drug consumption are discussed in self-support forums for drug users such as psychoactif.org. They can also be painful, marked by addiction. But in all cases, they deserve to be heard, supported, not judged.

A truly emancipatory left should defend the right to use without promoting it, access to safe products, to dignified care, to information, to autonomy. It should support forms of self-organization of users, recognize experiential knowledge (knowledge and know-how derived from the lived experience of people who use drugs), promote the regulation of all substances outside the capitalist framework, including when it is reproduced by drug traffickers. It should also link this fight to that against insecurity, racism, forced psychiatrization, the breakdown of public services.

Politicizing the RDR: self-support, deinstitutionalization, emancipation

There is another history of the RDR than the institutional one presented above: that carried by the people who use drugs themselves. Since the 1990s, in France, collectives like Asud, Act Up, Techno Plus, or Psychoactif, have developed an RDR by and for users, based on self-support, horizontal transmission, criticism of the healthcare system and the penal system.

Internationally, examples such as the Drug User Liberation Front in Vancouver which organized a store selling verified drugs at cost without cutting products to combat the overdose crisis, the Catalan Cannabis Social Clubs, based on principles of self-management, self-production and sharing, show that it is possible to build alternative models of care, production, sharing, outside of commercial and repressive logics. In the Netherlands, junkiebonden, associations of drug users taking note of the government’s refusal to help them preserve their health, emerged in the 1980s as a response to the stigmatization and marginalization of drug users, including by organizing drug treatment programs themselves. opioid agonists. They campaigned for more humane policies and contributed to initiatives such as needle exchange programs and substitution treatments. These actions have been crucial for the implementation of risk reduction policies in the Netherlands.

These practices lay the foundations of a political RDR, not centered on the reduction of individual harm but on the collective transformation of living conditions. They are based on principles of mutual aid, social justice, deinstitutionalization of knowledge and care practices.

The left-wing RDR draws inspiration from these experiences to build an emancipatory political horizon. It supports user groups, promotes their knowledge, demands the lifting of bans, an end to repression, free treatment, universal access to rights. She campaigns on drugs as in general for a public health that is not managerial, but democratic, transformative, anchored in struggles.

Conclusion

Risk reduction is not neutral. It is crossed by political choices, tensions and contradictions. It can be a tool for social pacification or a lever for emancipation. It can accompany the established order or contribute to subverting it.

In its institutional form, the French RDR is too often confined to technical management of marginality. It reduces risks but does not reduce injustice.

This is why left-wing harm reduction is necessary. An RDR which assumes its conflictuality, its radicality, its anchoring in social struggles. An RDR that not only treats individuals, but seeks to transform the structures that oppress them. An RDR which is not afraid to say that the problem is not use, but poverty, repression, exploitation.

This is, perhaps, the future of a truly progressive drug policy: not to reduce the damage of an unjust world, but to bring about another, fairer world.