Abstract
The incorporation of harm reduction into public policy has tended to be framed as replacing the dominance of criminal legal approaches to drug use with public health frameworks. However, little consideration has been given to the ways in which continued reliance on, and proximity to, the state remains problematic for the communities most harshly impacted by carceral systems. Reflecting on this tension, we draw on the work of community organizer Shira Hassan and her call for a return to the liberatory politics of the “original harm reductionists.” This paper explores the similarities between what Hassan refers to as Liberatory Harm Reduction and the long-standing traditions of Black, Indigenous, and people of color community organizing to defund the police and abolish prisons. Liberatory Harm Reduction and abolitionist movements share a structural analysis that the cruelty and racism of the carceral system is not evidence that it is broken, but rather that it is working as intended—to secure and (re)produce a social ordering of society based on colonial, raced, classed, and gendered systems of power. The paper brings together Liberatory Harm Reduction and abolitionist theorizing to invite deeper thinking around how much contemporary harm reduction results in differential and often unconsidered harms. In the paper, we ask what kind of public health harm reduction could be considered liberatory, and, by extension, what kind of harm reduction practices belong on the road toward, what Mariame Kaba calls, the abolitionist horizon? We explore these questions through case studies on diversion, peer-led safe spaces, and prison-based needle and syringe programs to demonstrate the issues, tensions, and liberatory possibilities of harm reduction across the spectrum of proximity to state apparatuses.
Introduction
As harm reductionists who work in critical criminology, we have long been concerned with examining the interface between state carceral systems and community. In and across our domains of work (teaching, research, and community engagement), we have grappled with how to advance harm reduction objectives without tacitly supporting the concentration of power and authority to state systems and organizations which so often produce harm. Overcoming this challenge is not straightforward. We know this because we are engaged in this work. We work with harm reduction service providers and communities who are constantly required to operate with this tension. The scaling of harm reduction initiatives in the contemporary social, political, and economic landscape necessitates a level of sustained resourcing that often requires state investment and infrastructure. Relationships between harm reduction organizations and government agencies are often understood as strategically critical, both to advocate and have a voice at the table, but also to see legislation and other required reforms implemented to advance harm reduction initiatives and objectives.
However, once harm reduction services are integrated into state systems of governance and control (including state health and criminal legal systems), the ceding of authority by harm reduction representatives often results in unintended and harmful consequences. It is an argument of this paper, that these harms are differentially experienced. We have seen, documented, and written about these tensions in previous work (Dertadian & Askew, 2024; Wadds & Dertadian, 2025). This paper aims to build on this formative thinking by developing a more theoretically informed analysis that engages with the works of liberatory and abolitionist thinking to explore these tensions. We ground these discussions in contemporary case studies, some from what is now called Australia (where we live and work) and others from different parts of the world to demonstrate some of the challenges attending developments in harm reduction specific to local contexts, but which we believe have resonance with many international domains.
Our position in this paper is not to say that state-run or supported harm reduction does not or cannot deliver important harm reduction outcomes, of course it does, but rather we offer an antagonism to consider more deeply the range of impacts that much contemporary harm reduction policy can have—the often unintended consequences that make possible new mechanisms of surveillance and control (Michaud et al., 2023) that widen the net of criminalization with differential impacts on multimarginalized, racialized and already targeted people. 1 And so the aims of this paper are two-fold: to first explore and develop a way of thinking about harm reduction that more fully considers the principles of abolition, and; secondly, to articulate policy examples that demonstrate the issues, tensions and liberatory possibilities of harm reduction across the spectrum of proximity to state apparatuses.
From Community to Public Health Harm Reduction
We start this paper with an overview of the transitions that have occurred internationally in harm reduction since its emergence, and, in particular, how early, liberatory forms of harm reduction might be differentiated from dominant contemporary practice—what we will be referring to as public health harm reduction. In the drugs field, reference to “harm reduction” is most closely tied to a series of practices and initiatives that arose during the HIV/AIDs crisis of the 1980s to support affected communities (Riley & O’Hare, 2000). Around this time, scholarship defining harm reduction strongly emphasized the role and function of public health approaches in harm reduction theory and practice (see Erickson, 1995; Wodak, 1995 for examples). Subsequent scholarly debates around what does or does not constitute harm reduction have commented on the broadening of the term to include abstinent-oriented approaches and even supply and demand reduction policies that form part of national drug policy apparatuses (Lenton & Single, 1998; Single, 1995). As part of these debates, harm reduction literature in the early 2000s noted that harm reduction was functioning as a-political (Hathaway, 2001), as well as exploring how and what constitutes the political project of harm reduction (Keane, 2009; Moore & Fraser, 2006). What much of this literature does not feature, however, is the longer history of smaller-scale, community-level practices among different racialized, minoritized, marginalized, and targeted people (Smith, 2012).
This longer history is closely tied to the movement politics of the times from which it emerged, including a close association with racial justice (Bassett, 2016) and the gay and trans rights movements (Chatzidakis et al., 2020) of the civil rights era. In North America, harm reduction emerged in solidarity with the revolutionary politics of the Black Panthers and Young Lords campaigns to demand community-led health care, including around access to drug-related services (O’Brien, 2019). Harm reduction was also realized in practice by trans women of color, and those doing street-based sex work, who developed some of the most enduring public health initiatives which were at the time entirely “unsanctioned” (Stanley, 2021). These initiatives included the distribution of unused needles among known networks of people who use drugs to “deal with yellow jaundice and abscesses from shooting heroin” (Inciardi & Harrison, 1999, p. 48) and the introduction of informal “shooting galleries” as illustrative of the “professional skill [of] surviving on the street” necessitated by the “breakdown of both the public and private sectors in inner-city communities” (Bourgois, 1998). This mutual aid work was born of an explicit resistance to the involvement of state agencies in the lives of people who had been abandoned by society, including, but by no means limited to, those subject to drug stigma.
Mainstream public health recognition of the need to engage in harm reduction as a much-needed response to the HIV crisis first began with medical staff and researchers contributing to the unsanctioned efforts of collectives of people who inject drugs and their attempts to keep each other safe. In the early 1980s, for example, reports started to emerge out of San Francisco Hospital that “doctors and nurses would leave a 10-pack of syringes in view of someone they knew to be injecting drugs and walk out of the room” (Inciardi & Harrison, 1999, p. 49). During the same time, reports also emerged of researchers in the field in Brooklyn and elsewhere who began actively distributing unused injecting equipment to research participants to facilitate a slow in the rate of the transmission of HIV: “my colleague [an academic and activist]… and I started handing out sterile needles and syringes from the boot of his car” (Maher, 2002, p. 322). As the crisis deepened throughout the decade, so too did public health campaign efforts to partner with collectives of people who use drugs and to integrate practices of harm reduction into mainstream state-based service delivery (Cotton, 1994; Des Jarlais, 1995). As part of the mainstreaming of such services, by the 1990s many informal collectives of people who use drugs had transitioned into state-funded peer user organizations in parts of Europe, Canada, and Australia (Crofts & Herkt, 1995). These organizations have since been at the forefront of work to embed harm reduction in government policy in many parts of the world.
While the HIV crisis resulted in a proliferation of services and practices that were designed to make drug use as safe as possible, it also meant that harm reduction as public policy became increasingly inseparable from medicalized and clinically oriented approaches. Indeed, in contemporary harm reduction discourse and practice, medical knowledge and expertise has become an almost ubiquitous element of, and central authority on, harm reduction delivery. The dominance of this medical framing often leaves out, downplays, or, in the worst cases, erases the mutual aid work of the Black, gay, trans, and sex worker collectives who developed many of the principles and practices that were the foundation of harm reduction, long before the HIV crisis. While there has been recent scholarly focus on both the challenges and importance of elevating lived experience as part of harm reduction projects (Stowe et al., 2022; valentine et al., 2020), this paper is in part a response to recent calls to re-engage with the liberatory politics of what Shira Hassan (2022) refers to as the “original harm reductionists.” We wish to reflect on how the harm reduction work and services that have proliferated since the emergence of public health harm reduction would benefit from being (re)examined from the position of the communities who first developed them.
Liberatory Harm Reduction
In her recent book “Saving Our Own Lives” Hassan develops a definition of what she refers to as “Liberatory Harm Reduction” through conversations with community organizers and activists working in the space. She highlights the long history of liberatory forms of harm reduction, linking it to decades of community organizing and revolutionary practice. In conversation with those who have been engaged in these movements, Hassan describes Liberatory Harm Reduction as community organizing and service delivery that involves a “bold commitment to name and dismantle oppression” (p. 43), which is enacted through “a community of self-taught radical activists who [are] learning how to save ourselves from state-sanctioned violence” (p. 44). Through this liberatory lens, drug prohibition is framed as deeply connected to broader systems of power and forms of oppression that uphold this oppressive infrastructure. Hassan's conceptualization of harm reduction is concerned with “transforming the root causes of the oppression that increases the risks of illness, death, and incarceration in our communities” (p. 31). She notes that this requires a politics of solidarity with colonized peoples, trans liberation movements, squatters rights campaigners, proponents of Disability Justice, anti-capitalists, those in the sex trade and those who experience Islamophobia (Hassan, 2022, p. 23). It is in its commitment to solidarity with criminalized communities that Liberatory Harm Reduction draws its most stark contrast with its public health counterpart.
In centering liberation, Hassan sees one of the key tasks of harm reduction as “building collective power through the unabashed and unconditional support of self-determination and bodily autonomy” (p. 31). As we have previously highlighted, this task requires a fundamental reordering of the hierarchies of knowledge that too often structure relations in this domain (Wadds & Dertadian, 2025). It involves placing the needs and expertise of people who use drugs, and the communities they are part of, above (or at minimum, level with) the authority of professional and regulatory actors that are so often deferred to as the experts on drugs and public safety. It also means supporting and empowering people and communities of people who use drugs to live their lives safely. This need is particularly acute under current drug policy regimes which isolate people who use drugs from supports and networks critical to their care. Liberatory Harm Reduction, therefore, emphasizes the importance of holistic and social care in order for people who use drugs to have their basic needs, like access to food and shelter, met. This kind of community organizing further facilitates the development of chosen family and kinship networks.
In Hassan's conversation with Kelli Dorsey, a Black woman involved in the sex trade in the US South, she explains: What most people in public health don't understand is that harm reduction practices are the way we Black people make home. We feed people, we figure out how to be different, love different, and fight while sharing a table, a living room, and making a life that is better for all of us together. (p. 31) We believe that We Do What We Have to Do to Survive, and we don't question why someone is involved in the sex trade or street economy, instead we ask them what they think they need to stay safe, feel supported, and take care of themselves. (YWEP Mission Statement, np)
Hassan's articulation of Liberatory Harm Reduction also has links to conceptualizations of harm reduction in the contemporary drugs field which have moved beyond public health, including human rights arguments. Here, advocates position prohibition as a moral constraint on the universal principal of bodily autonomy, and therefore see harm reduction as legitimately invested in explicitly political endeavors like campaigns to decriminalize drug possession and the provision of a legally regulated drug supply (Ezard, 2001; Hathaway, 2001). There have also been conceptualizations of harm reduction as a communitarian project (Fry et al., 2005) with the capacity to position it in partnership with anti-drug war campaigners “at the forefront of offering an alternative political and social imaginary” (Zigon, 2018, p. 2) around drug policy. Others have explored the social justice possibilities of harm reduction as serving to address the “root causes” (structural and institutional) of drug-related harm (Pauly, 2008).
This paper foregrounds the grass-roots community organizing and activist-led conception of harm reduction outlined above and seeks to explore its relationship to the long-standing calls of Black, First Nation and people of color organizers to defund the police and abolish prisons. It is important to note here that, in practice, there were (and still are) issues relating to the delivery of harm reduction services in and through community. However, the focus of this paper is on the principles underpinning harm reduction service delivery, and so we ask: what tools can abolition provide for (re)imagining contemporary, at-scale harm reduction as a liberatory project?
Towards the Abolitionist Horizon
Given the shared focus on power, state oppression, policing, and other systems and tools of surveillance, we see much value in bringing together articulations around Liberatory Harm Reduction with abolitionist thinking and literature (Levenson et al., 2023; Robinson, 2020). It is worth noting here that abolition is both a set of practices (campaigns, organizing efforts, and so on) and a theoretical body of literature, and this paper will engage different parts of these traditions. Abolitionists have argued that the cruelty and racism of the carceral system (policing, prisons and other systems of punishment and surveillance) is not evidence that it is broken, but rather that it is working as intended—to secure and (re)produce an ordering of society based on colonial, raced, classed, gendered and ableist systems of power (Kaba & Ritchie, 2022; Rowe & Dowse, 2023; Saleh-Hanna, 2008; Spade & Belkin, 2021). As noted above, this is an analysis of state systems that abolition shares with liberatory traditions of harm reduction—that, if liberation is the goal, this system is not fit for purpose and cannot be reformed. This logic has led to debates in abolitionist activism and scholarship around what constitutes reform that expands the carceral state and that which provides genuine transformative justice for communities most harshly impacted by state intervention (Gruber, 2023). These debates, and their potential uses for deepening our understanding of Liberatory Harm Reduction will be explored here.
Abolitionist literature and community organizing has long grappled with complex questions around how to simultaneously dismantle carceral institutions and build new institutions and social worlds that produce less harm (Davis et al., 2022). One of the key conversations and points of disagreement in the movement is what constitutes abolitionist change, and, in particular, the role of reform in the criminal legal system in achieving this change (Alexander, 2020). For example, abolition has been critical of reformist movements that seek to use carceral logics in claiming to keep communities “safe” (DesLandes et al., 2022). Viewed from the perspective that police, courts and prisons are designed to produce/maintain a colonial and capitalist ordering of society (see Neocleous, 2021, 2025), the proliferation of categories of crime designed to criminalize an increasing number of harms is a strategy that can only keep certain kinds of people safe—those who are white, have capital to protect, and so on. Reform that strengthens carceral institutions, makes them (seem) safer and more palatable, is then critiqued for “tinkering at the edges” of harmful institutions in ways that ultimately maintain and expand the system (Acheson, 2022; Vitale, 2017; Ware et al., 2014)—they do not address, nor are they concerned with the “root” (or structural) causes of harm. These are often termed “reformist” approaches, because they maintain commitment to the current criminal legal system, but advocate changes that purport to improve the policies and institutions associated with the carceral state. A reformist approach leaves out of view the social and economic conditions that drive, for example, interpersonal violence in the drug market or overdose and the transmission of blood-borne viruses and therefore refuses to see or deal with the harms of carceral approaches. In this way, reformism tends to support the expansion of police powers and the funding of policing institutions (Vitale, 2017). The need to fund the seemingly ever-expanding role and personnel of the state police also have flow on effects in relation to the building of new prisons, and the conditions of prisons. These expansions cause harm, much of which is unrecognized or undiscussed in public (health) discourse. By contrast, abolition is committed to dismantling the current criminal legal system, and imagining new social systems and institutions that minimize the presence of harm and violence, and which look for new ways to address harm without creating more harm.
The distance between reformist and abolitionist approaches can result in hard lines being drawn between changes to legal systems (reformist) and efforts to dismantle them (abolition) —yet these are not mutually exclusive tasks. This point has sparked much discussion about what kind of reform should be opposed for its capacity to increase the power and resources of the carceral system, and an articulation of what André Gorz has termed, and Ruth Wilson Gilmore (2022) has popularized as “non-reformist reforms.” Nonreformist reforms have been described as “deliberate change that does not create more obstacles in the larger struggle” (Gilmore, 2022, p. 22) and “reforms [which] aim to undermine the prevailing political, economic, social order, construct an essentially different one, and build democratic power toward emancipatory horizons” (Akbar, 2023, p. 2507). These “reforms” are changes to the system that reduce the power of the state, undermine systems of control and surveillance of the lives of criminalized people, facilitate community capacity to prevent and address harm, or, as Mariame Kaba (2021) has said, are reforms that are on the road “towards the horizon of abolition.” Kaba's articulation of the abolitionist horizon avoids the hard lines noted above, and provides a framework for generative thinking about the conditions of possibility related to social change, criminal legal institutions and alternative forms of accountability. We are consequently encouraged to ask: “how do we think about reforms that don’t make it harder for us to dismantle the systems we are trying to abolish?” (Kaba & Duda, 2017).
With this question in mind, it is important to note here that our approach, and that of the community organizers from which we take our inspiration, is not to oppose the concept of reform itself, but rather to support and encourage kinds of reform that can produce liberatory outcomes. For us, issue is to be taken with reformism, not reform per se. There is, in our view, a legitimate concern among abolitionist thinkers that reforms which improve the conditions of carceral institutions can be used to justify the ongoing use of, for example, prisons as a way to control the lives of people who use drugs. This paper is seeking to take these concerns seriously and navigate them via a grounded conception of abolition that sees it as a long-term goal (abolitionist horizon). We see in Kaba and others’ articulation of the abolitionist horizon the potential to make sense of what contemporary drug and alcohol harm reduction can be reconciled with liberatory frameworks. In the case studies that will follow, we explore case studies of forms of harm reduction that we see as more or less compatible with the long-term goal of decriminalizing and decarcerating drug use.
In this paper, we are seeking to advance the field's theoretical understanding of harm reduction and its relationship to the practice of harm reduction. Indeed, the fusion of Liberatory Harm Reduction and thinking on the abolitionist horizons was chosen for its capacity to respond to popular critiques of abolition itself. These critiques have largely centered on claims that abolitionist theorizing does not imagine or provide alternatives to criminal legal and/or state-based responses to harm in general, and drugs in particular. In this article we seek to counter some of these critiques by drawing on traditions in drug scholarship that use the work of key theorists [e.g., use of the work of Foucault (Keane, 2009), Latour (Duff, 2013), Barrad (Poulsen, 2015), Mol (Seear & Mulcahy, 2024) and more] to advance new understandings of policy and practice. In this paper, we do this by engaging with theorists who have a closer connection to the key subject matter (prohibition, criminalization, and state-systems).
Exploring Harm Reduction Across the spectrum
In the following section, we provide three case studies of policies or interventions intended to reduce harms for people who use drugs. We position and discuss each case study in relation to their compatibility with liberatory and/or abolitionist objectives. In exploring the relationship between contemporary harm reduction and liberatory and abolitionist praxis, we pay close attention to how contemporary initiatives facilitate or reduce proximity to the state. We start with the example of diversionary programs as a contemporary example of harm reduction that is less compatible with these principles. Our next case study, peer-led safe spaces, is provided as an example which is more consistent with liberatory and abolitionist aims. The final case study, prison needle and syringe programs, is included to illustrate the tensions and contestations that Liberatory Harm Reduction faces in a world in which people who use drugs must continue to navigate prohibition and its infrastructure (police, prison, and other systems of surveillance). Across all three case studies, the ambition is to demonstrate the complexity of implementing contemporary harm reduction, or, more specifically, at a time where economic imperatives have seen a growing reliance on state authority and resourcing. The intention of this discussion is not to shut down lines of thinking or denigrate people who are committed to alternative models of harm reduction. Rather, we hope to open up conversations about the role of the state, its harms and intentions, and what its involvement means for different communities and people who use drugs.
Diversionary Programs and Fines
Our first case study for examining the relationship between harm reduction and the role of the state is diversion. We provide an overview of what diversion means in general, and then data and examples from local contexts to demonstrate the points being made. Diversion programs have frequently been presented as a progressive reform to limit the criminalization of people who use drugs (see Bacon, 2024 for an example) and have often come in the form of targeted/selective programs, like those only accessible to young people. Diversionary schemes, like cautioning and cooperative models between harm reduction service providers and police, have long been included in harm reduction history and scholarship (see Riley & O’Hare, 2000). Most diversionary schemes operate under a principle that traditional criminal legal processes and punishments do not address what are deemed to be underlying causes of criminalized behavior. In doing so, diversionary schemes functionally acknowledge that traditional criminal legal processes and punishments are not the best place to achieve desired social outcomes for many people and will not reduce the recurrence of behaviors deemed causative of criminality. While the goal of limiting criminalization is certainly compatible with liberatory frameworks, the way this has been operationalized requires scrutiny. In practice, most drug diversion programs rely on discretionary decision-making by police around what drug use will be charged with a criminal offence, and what will not. Two key examples of diversionary initiatives that have been framed as “harm reduction” are the use of “on-the-spot” fines and court diversion schemes.
The adoption of civil rather than criminal penalties for drug possession has, over time, come to be framed as part of a broader suite of harm reduction (see Lenton & Single, 1998) and harm minimization initiatives (Parliament of Australia, 2024). As a recent example, in the Australian state of New South Wales, non-criminal penalties via “on the spot” $400 fines, formally called Criminal Infringement Notices or CINs, have been deployed at music festival events for low-weight MDMA or other drug possession (Sutherland et al., 2021) for harm reduction against the backdrop of an otherwise hyper-regulatory environment (Wadds & Dertadian, 2025). Since initial introduction in NSW in 2019, the CIN scheme (now called the Early Drug Diversion Initiative [EDDI]) has been expanded to include options for recipients to “pay” for their fines via engagement in tailored drug and alcohol intervention programs. Under this amendment, failure to complete the health intervention results in the original fine/ monetary penalty being enforced by the state (in this case, Revenue NSW). Again, like most diversionary schemes, access and therefore benefit of these schemes are entirely up to police or court discretion. The context of deployment of this “harm reduction” technology is important to explore to understand the broader effects of this policy. Music festivals in Australia are increasingly expensive to attend, with the average ticket price of a large commercial festival (the most popular and heavily policed events) being $204 in 2024 (Creative Australia, 2024). The ability to afford attendance to a single or multi-day event with its associated expenses relating to food and drink reflects a level of disposable income that immediately differentiates this group of people from other communities of people who use drugs (Wadds et al., 2022). The general population of a music festival event, noting some exceptions (see Wynter et al., 2025), is also not criminalized or hyper-policed in their everyday lives. Again, this point is not to say that reducing harm by way of introducing non-criminal sanctions is not a good harm reduction initiative or outcome for those attending festivals, it is, but that there are many unintended consequences that problematize the conceptualization of this technology from a Liberatory Harm Reduction or abolitionist perspective.
In many ways, these programs can be characterized as a policy applied largely to “experimental,” nondrug-dependent drug use among people with the capacity to pay fines. While CINs have been the subject of many evaluations in NSW, these tend not to collect data on or account for matters of race and class. This is particularly problematic when considering the way fine schemes have been applied outside the music festival setting, as well as in domains outside of drug use and possession. Long-standing research has highlighted the pronounced impacts that the use of on-the-spot fines has on “the usual suspects” in Australia (Boon-Kuo et al., 2021; Brown et al., 2017; Lansdell et al., 2012; Mabin, 2023; Schwartz, 2024) and abroad (Bing et al., 2022; Jones, 2018), including economically disadvantaged and un/ under employed people, people experiencing homelessness as well as children and young people. There is now a large body of evidence to show that the individuals who frequently come into contact with the criminal legal system often fit into one, if not many, of these groups (Brooks & Lorange, 2024). The expansion of infringement systems in Australia has led to a blurring of civil and criminal procedures, with research showing infringement notices can result in increased imprisonment for fine default (Brown et al., 2017; Quilter et al., 2024). Another core and important critique of the rising use of on-the-spot fines is the removal of due process from decisions around drug possession, essentially empowering police with the power of the courts (Brown et al., 2017). In fact, challenging these police decisions involves court attendance, which again exposes people affected to greater levels of potential harm. The concentration of harm across these groups demonstrates that the use of CINs as harm reduction can be seen to only benefit those with the capacity to pay, those who are already far less likely to experience criminalization, stigma, and other mechanisms of state surveillance and control.
Similar to the use of fines, court diversionary programs involve highly differential effects. For example, in NSW, there is concrete evidence of drug diversion programs resulting in highly racialized outcomes. Evaluations of the use of cannabis cautions in NSW have found that, between 2013 and 2017, 40.03% of non-Indigenous people found with amounts eligible for the policy were provided with a caution, while only 11.41% of Indigenous people found with eligible amounts were provided with a caution. Not only were First Nations people less likely to receive the benefit of the policy, they were also found to be “more likely to be prosecuted than cautioned, compared with their non-Indigenous counterparts” (Weatherburn & Thomas, 2022, p. 253), and to be more likely to be imprisoned as a result of these prosecutions.
A core argument of this section is that fundamental to the issue with diversionary programs is the reliance on police and judicial discretion in decision-making around the use of fines or deferral to schemes. Here, there is a contradiction at play. As highlighted, both diversionary options discussed (court diversion schemes and fines) have been consistently found to disproportionately harm multimarginalized people and communities. It is also important to note that police officers have always been empowered to exercise discretion in the normal course of their work (Beckett, 2016; Grewcock & Sentas, 2021), and so in reality formal diversion schemes that legislate new forms of police discretion simply signals official support for a practice that is already wide-spread. Abolitionist activists and scholars have long indicated that policies which rely on and reinforce the discretion of police result in the intensification of state intervention in the lives of Black, Brown, First Nation and other people of color. In this way, diversionary schemes can be seen to represent a straightforward example of initiatives which facilitate the expansion of police powers and resources and which we see as consequently incompatible with Liberatory Harm Reduction practice (DesLandes et al., 2022). The critique here is not that diversionary schemes cannot or do not have benefits in terms of reducing criminalization, but that these benefits are not equally distributed and ultimately are based on the same racialized biases that have long influenced policing practice.
When applying an abolitionist lens in analyzing the use of diversionary schemes, these harms are to be expected. Under contemporary prohibition, drug laws no longer specify racial categories whose drug use is to be policed over and above others, though the targeting of racialized communities is the consistent outcome of the expansion of the drug war. Importantly, according to the history of liberatory approaches which have sought to free people who use drugs from the harms of state violence, the way police make decisions about who, where and how to police (police discretion) is the problem that harm reduction is trying to address.
Peer-Led Safe Space Services
An example of harm reduction that we see as more closely aligned with liberatory and abolitionist objectives are “safe space” services. While there are many different forms of safe space programs operating around the world in spaces where people regularly use drugs, the focus of this section will be on peer-led services as opposed to more health-focused services, which are run by first-aid officers and paramedics/paramedicine students (St. Johns Ambulance, for example) or others run by community and religious organizations. A critical distinction between peer-led and other types of safe space services relates primarily to the people delivering the services. While some people working in health-based or religion-affiliated safe space services may have lived or living experience of drug use, they advertise themselves and operate in distinct ways (at least within the Australian context) from explicitly peer-led services. Peer-led services, as the name suggests, are primarily staffed by people who use or have used drugs, and usually come from the communities they are servicing. While most safe space services are generally dedicated to the delivery of non-judgmental, proactive care for people using drugs, there are operational differences that distinguish the types of safe-space services listed here. Health-based and religious services, for example, do not tend to have dedicated and intentional trip-sitting services 2 like peer-based services and also tend to have lower thresholds for escalating care than peer-based services.
Particularly common in nightlife and music festival settings (Wadds et al., 2023), safe space services generally involve the provision of a static “safe” location where people who are using drugs can go to seek support to manage a range of issues including adverse drug responses. They provide a place to chill out, to speak with someone about what they are experiencing, to charge a phone, to get basic first aid or to seek other support. In providing these services, safe space programs act as an important intermediary between community and higher-level care which we know many under the influence of drugs are often reticent to do (Doran et al., 2020, 2021; MAKE Associates, 2017; Page et al., 2022; Wadds et al., 2023).
Often paired with static sites are roving volunteers who walk through public spaces where people use drugs and/or are intoxicated and intervene in situations of potential harm. The presence of such services has the benefit of providing early, prosocial care for people in need, regardless of their drug consumption, and provides an opportunity to de-escalate conflict or potential conflict so as to not require more formal intervention from police or other security actors (Wadds et al., 2023; see also MAKE Associates, 2017; Taylor et al., 2020). The provision of this care has been documented to significantly reduce the need for police intervention in situations of intoxication (Doran et al., 2020, 2021; MAKE Associates, 2017; Taylor et al., 2020; Wadds et al., 2023; Ward et al., 2018). A study from Cairns, in North Queensland, Australia, found that serious assaults during high-alcohol hours significantly declined after the introduction of a safe space service with a one-month lagged impact (B = −1.66, 95% confidence interval −3.02,−0.30). Another study by author two of this paper reported on an economic evaluation and found that each dollar invested into a safe space programs returned an estimated $2.67 in community benefit, including through reduced alcohol and drug-related harm (Doran et al., 2021). The same research documented the relationship between the provision of safe space services and the reduction of formal police interactions with people who were intoxicated in public (Wadds et al., 2023). Similarly, a study of 45 safe space programs operating across the UK found that safe spaces offset public sector costs (including police, ambulance, and hospital) by as much as £9.31 for every £1 pound spent on the services (MAKE Associates, 2017).
As services that have evolved from early community-led harm reduction initiatives delivered at festivals and raves where community members proactively support the safety of people using drugs in shared spaces (see Wadds & Dertadian, 2025), it is the contention of this paper that this is a model of care that more closely aligns with liberatory praxis. Rather than relying on or expanding the role of police in settings in which drug use occurs, peer-led safe spaces rely on the discretion and expertise of those with lived and/or living experience of drug use (who are also qualified and/or well trained in the provision of this care) to manage potential harm (Carvalho et al., 2019). They operate under principles of least intervention (Valente et al., 2019). If someone is obviously intoxicated, in a state of distress, or just needs a friendly, experienced, nonjudgmental ear to talk through their experience with, they can seek and find this care in peer-led safe space services (Piatkowski et al., 2025). In doing so, they routinely interrupt the opportunity for police to unnecessarily intervene and de-escalate situations of potential conflict in ways that make the presence of serious harm (and therefore the need to call the police) less likely (Chang et al., 2021).
They also have an anti-stigma approach that is critical in providing triage for escalated levels of care. As noted above, people who use drugs are reluctant to engage in help-seeking out of fear they will get into trouble, be judged negatively because of their drug consumption, or because they have had previous negative experiences of engaging supports (police, security, other public authorities) (see Fileborn et al., 2020, 2019; Page et al., 2022; Wadds et al., 2023). Reluctance in seeking help in situations of potentially adverse responses to drug use has a significant impact on overdose prevention (NSW Coroner's Court, 2019; Page et al., 2022). Harm reduction that relies on peers who understand and acknowledge this concern, and will work collaboratively with you to make a decision about the need to seek medical care are vital to overcoming these barriers. Peer-led space spaces also reduce agitation and increase levels of patron receptiveness to higher-level care as needed, a process that again can reduce the likelihood of conflict occurring when people are in distressed psychoactive states and presented with medical or security interventions. In this way, we see such services as doing the work of harm reduction on the abolitionist horizon precisely because such services operate in an environment that, while recognizing that police and formal medical care remain a core part of the current health and safety landscape, work to reduce the reliance on police and formal medical interventions.
Prison Needle and Syringe Programs
Our final case study is Needle and Syringe Programs (NSP) in prisons, which have long been called for by people living in prison in many parts of the worldChu et al., 2016; Van Hout et al., 2024). There are 11 countries in the world that have an NSP in at least one prison, including Canada, Germany, Iran, Kyrgyzstan, Luxembourg, Moldova, North Macedonia, Spain, Switzerland, Tajikistan, and Ukraine (Lasco et al., 2024). Although most of these services have not been subject to evaluation, the few that have in Canada, Germany, Spain, and Switzerland will be discussed below, alongside relevant evidence about NSP more broadly and their public health impacts. When reflecting on this example, it is important to recognize the different ways in which abolitionist and liberatory frameworks might approach this issue: on the one hand, prison NSP may be viewed as a reformist reform that works to make prisons seem safer and therefore a more palatable response to drug use; and on the other hand, it could be viewed as a non-reformist reform that challenges carceral approaches to drug use in a carceral setting. We have included this example precisely because it poses difficult questions around harm reduction and abolition.
Prisons are sites of significant harm (Behan, 2022; Irwin & Owen, 2005). Nothing that is done to tinker with their operation will ever make them safe spaces. However, there is nuance here that is also worthy of exploration. The tragic reality is that there are millions of people around the globe in prison whose drug use or dependence has directly resulted in their incarceration. These (and other) people also continue to use drugs in prison, often in ways that can increase the levels of harm experienced (Austin et al., 2023; Piatkowski et al., 2025; Small et al., 2005). It is well documented that these harms are not just related to, or experienced by, people who use drugs in prison, but also by prison and health care staff. Indeed a core reason for the limited roll-out of prison NSPs in Australia and internationally has been the documented safety concerns by (and strong union resistance on behalf of) people working in prisons (Davey, 2015; Francis, 2011; Graveland, 2020; Johnston et al., 2024; Whitten et al., 2023). However, the fact remains that illicit drug use, as a prohibited practice, is heavily surveilled and punished in prison settings. Such punishment drives drug-using practices underground, making access to unused equipment more difficult and, consequently, promotes consumption practices more likely to result in disease transmission (Piatkowski et al., 2025). In a report capturing the lived and living experiences of people who have injected drugs in prison Piatkowski and colleagues (2025, p. 4) note that: “Stigma, fear of punishment, and punitive institutional cultures further discouraged help-seeking and fueled unsafe practices, such as rushed injecting and hidden substance use.” As we discuss below, there are flow-on effects from this punitive regime, the worst of which involves the entrenchment of cycles of incarceration that make movements towards abolitionist and liberatory horizons more difficult. Working towards an abolitionist horizon demands a consideration of both the immediate impacts and the long-term possibilities of interventions.” As we discuss below, there are flow-on effects from this punitive regime, the worst of which involves the entrenchment of cycles of incarceration that make movements towards abolitionist and liberatory horizons more difficult. Working towards an abolitionist horizon demands a consideration of both the immediate impacts and the long-term possibilities of interventions.
When reflecting on the delivery of NSP services in prison, it is worth acknowledging both the evidence of the surveillance that is enabled by prison NSP and the evidence of the public health advantages of prison NSP. In a setting of such incredibly close individual surveillance, disciplinary control, and punitiveness, it has been found that fear of punishment as well as stigma from others living in prison and prison staff are major barriers to accessing prison NSP services (Lafferty et al., 2024). Privacy is a consistent and persistent concern (Kronfli et al., 2025; Michaud & van der Meulen, 2023; Moazen et al., 2020). Service requirements like mandatory registration for people using prison NSP only serve to compound reluctance to engage (Stöver & Hariga, 2016). A documented issue with mandatory registration requirements for service users is that details of registrants have been displayed in public places within prisons with consequent impacts on broader staff relations with people utilizing prison NSP services (Kronfli et al., 2024). In the prison setting, where minor deviations from the rules can result in further criminalization via the extension of sentences, the risk that NSP becomes a place to find and punish people who use drugs is a serious and ongoing concern. Despite these issues, communities of people who use drugs, many of whom are trapped in prison because of the ubiquity of the carceral system in their lives, continue to advocate for their implementation (Van Hout et al., 2024). Public health evaluations of prison NSP have also demonstrated significant declines in needle sharing and rates of seroconversion for a range of BBV (Dolan et al., 2003; Rutter et al., 2001). With this tension in mind, we ask: how might prison NSP form part of longer-term strategies to decarcerate communities of people who use drugs?
How the legal system treats a person's serostatus, or their role in transmitting a BBV, is also relevant to the forms of carceral control that apply to people who use drugs. When reflecting on the possibility of prison NSP being part of longer-term abolitionist strategy, the evidence around the criminalization of BBV globally (Chen, 2016) provides a compelling point of entry. Positive serostatus for a range of BBV that are associated with drug use (like HIV, Hepatitis C, and so on) have also been associated with increased surveillance by state authorities (whether in prison or not) (Anderson et al., 2020; Gill et al., 1995; Mehta et al., 2011). People with a positive serostatus have been demonstrated to have high unmet legal needs, which “generat[es] ‘severe’ impact on health” (Carter et al., 2023, p. 706) and facilitates the criminalization of HIV and other communicable diseases related to drug use (Csete et al., 2023). A primary mechanism for criminalizing serostatus is when legal liability is attached to transmission (Francis & Francis, 2012). Recent calls to decriminalize serostatus and disease transmission (Bland, 2024) are emblematic of this issue, and provide a clear example of the role that prison NSP—a service established for the express purpose of slowing the spread of BBV—could play in removing opportunities to (re)criminalize people who are both in, and have left, prison. Reductions in BBV in prison also mean reductions in BBV in the community—once people leave prison—which subsequently reduces the opportunity for criminal laws to be applied to, and for police to target, people who have left prison.
It may also be worth considering how engaging harm reduction services in prison may impact the likelihood that people leaving prison engage with services on the “outside.” Here, trust, familiarity and confidence in services (Lafferty et al., 2023), established through engagement with prison NSP, may serve to promote a continuation of use in community (for an example of this effect in relation to prison opioid replacement therapy see Larney et al., 2012), an important link found in studies looking at pre and post release factors (Doyle et al., 2022). These are particularly critical supports for people leaving prison and may form a central argument for the use of NSP in prison from an abolitionist perspective.
This case study has both problematized and explored the way in which prison NSP operate from a harm reduction perspective. There are many challenges in delivering care for a highly stigmatized and targeted community in a hyper-punitive environment. In the example of diversionary schemes, we detailed a case study of a harm reduction initiative that, in principle, are good, but which has significant shortcomings and harms consequent of implementation. In the case study of peer-based safe spaces, our argument was that it works from a liberatory perspective because it aligns principle with practice. In this case study, a fundamental issue is that liberatory principles can never be realized for people in prison. But when working towards an abolitionist horizon, the objective must be to advocate for the provision of services that are designed to reduce the reach and hold of the carceral system. Key to this abolitionist praxis here is reducing the number of people in prisons and the political and administrative need for prisons to exist. Put another way, on the way to abolishing prisons, you need to first empty them.
Conclusion
At the core of what we have argued in this paper is that while many harm reduction initiatives are good in principle, their operation often produces harm in ways that may not have been considered upon implementation. It has been our claim that introducing harm reduction without simultaneous reduction in the role of police/carceral systems ultimately undermines capacity to achieve the full potential and intended outcomes of these policies. We have noted that a key pattern throughout the history of harm reduction has been the ceding of ownership and authority for the provision of harm reduction services to state agencies. While these are often celebrated as wins for the harm reduction movement, they have also produced distinct and pernicious consequences for targeted, marginalized, and racialized communities.
In both criminology and the drug and alcohol field, the concentration of drug-related harm in racialized and minoritized communities is frequently positioned as an intractable problem—one that seems to persist even when we see the expansion of public health harm reduction initiatives. In this paper, we have sought to reorient this framing, to highlight the role the state plays in processes of racialization, criminalization and stigmatization, and to stress that scholars cannot continue to view problems with class and race disparities as intractable when they continue to rely on the systems that create these disparities. This means moving beyond an acknowledgement that drug policy is always political, and engaging more directly with what this politicization means for racialized and classed communities. It is not acceptable to continue to deny the safety of racialized and minoritized groups in order to secure or sure up the safety of people for whom harm is already less likely to occur.
This paper intervenes in prevailing debates across both criminology and the alcohol and other drugs fields to challenge those advocating for “harm reduction” to consider more deeply who will benefit and/or be potentially harmed by the initiatives being advanced. In an academic landscape increasingly predicated on publishing at speed and demonstrating impact, this is also a call to slow our thinking. We have argued that abolitionist and Liberatory Harm Reduction scholarship and activism gives us tools to think more critically about the movement away from community-led harm reduction and how we might start to advocate for its return. We have offered a theory in this paper that attempts to break down often held misconceptions that abolition and abolitionist thinking is binary and therefore incompatible with the temporal/immediate needs and demands of people who use and experience harms from drug use. Again, the intention of this work is not to shut down lines of thinking, but hopefully to open up conversations about the role of the state, its harms and intentions, and what its involvement means for different communities and people who use drugs.
Footnotes
Acknowledgments
This research was conducted on the lands of the Bidjigal people, the lands on which UNSW is build and the authors work. We acknowledge that sovereignty was never ceded and that we have benefited immeasurably from the stolen lands and wealth of the First Peoples of this place.
Ethical approval statement
This research did not involve direct contact with people who were the subject of research and therefore does not meet the definition of the conduct of human research that requires ethical approval.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.