Introducing and Interpreting of Concepts of Harm
Sookja SUH*, Mitsuho IKEDA**
*Niigata College of Nursing, Japan ; **Center for the Study of CO*Design, Osaka University;
Interinstitutional academic meeting in Toyonaka Campus 2018, 18
December 2018, Toyonaka, Osaka, Japan
[Acknowlegement] This work was supported by JSPS KAKENHI Grant Number 15K13084 (FY2015-2017)，and Grant Number 18K02068 (FY2018-2020).
reduction is a set of practical strategies and ideas aimed at reducing
negative consequences associated with drug use. Harm Reduction is also
a movement for social justice built on a belief in, and respect for,
the rights of people who use drugs." - from the Harm
Japan is one of the few countries that have not officially introduced the harm reduction policy. This study aims at examining the perception about harm reduction among addiction community - those affected by or involved as health care specialists, in drug problems - in Japan.
Summary: How was the idea of harm reduction brought to Japan? Study 1 aimed to clarify this process by literature review. Study 2 tried to identify the variation of discourse by interviewing method. The idea of harm reduction reached Japan about 30 years ago. Since then, the discussion on this topic has changed from a “foreign practice” that is only applicable to the countries with severe heroin use problems, to detailed arguments about whether it can be applied to Japan’s situation.
STUDY 1, Depicting a brief history of “harm reduction” in Japan
Harm Reduction in the History of Dependence Treatment
The harm reduction
approach began as an alternative to the zero
tolerance/abstinence-oriented countermeasure for drug use in 1970s
Europe. Later, its effectiveness was widely recognized with the spread
of HIV/AIDS, and currently, it is being introduced and developed in
many countries struggling with drug problems. Descriptions such as
these are very commonly seen in academic materials and other resources
describing the harm reduction approach.
based on the idea of harm reduction are being experimented with
throughout the world as the use of addictive luxury goods such as
alcohol, tobacco, and opium spread and generates medical and social
problems. Since the nineteenth century, in Europe and North America,
maintenance and substitute therapeutic addiction treatments have been
used. For example, there were attempts to treat opium addiction with
In Japan’s case, in prewar Taiwan, it is known that the opium restriction policy was carried out, with its main content being the control of the opium monopoly system, the registration license system of opium uses, and the supply and taxable amounts of opium. This wiped out the number of opium users by 1945, which had made up as much as 10% of the Taiwanese population.
The Arrival of the Term Harm Reduction to Japan
In 1983 the Ministry of
Health’s AIDS Research Group was established and in 1984, the AIDS
Survey Committee was established. In 1987, the first AIDS
Countermeasure Ministerial Conference was held. At that time, several
HIV-related papers had been translated from English into Japanese. The
term “harm reduction” was yet to appear among this literature;
however, descriptions of trial practices such as needle exchange
programs were also appearing. At that time, needle exchange programs
had already achieved successful results as an HIV countermeasure in
some cities in Europe and North America; however, it was closer to 1990
when the term “harm reduction” appeared in the methodology sections and
the term was defined. In English literature from that time
period, the term “harm minimization” was also often used. At this
time, when initial information was being collected about HIV through
overseas surveys and literature, the term “harm reduction” came to be
known among some Japanese experts as an example of various HIV
prevention programs for drug users. In 1994, Japan held the 10th
National AIDS Conference. To participate in the conference, parties
involved in harm reduction program implementation, advocay, and
research came to Japan and brought a lot of information.
The Spread in Japan’s Addiction Community
Information on harm
reduction was brought from overseas surveys and trends carried out by
ministries and agencies involved in drug policy; however, in Japan,
where the scale of drug problems is relatively small compared to other
countries, there were few researchers or practitioners interested in
harm reduction. Until around 2010, there were few people spreading
information on harm reduction and these included medical and social
scientists involved in international aid.
However, in the field
of alcohol treatment, discussions began to take place about the effect
of starting therapy goals with temperance (controlling the amount of
alcohol) rather than abstinence, and the term “harm reduction” began to
be used. Harm reduction became recognized in literature around 2010 as
a movement to examine in conjunction with the status of Japan’s drug
policy. In 2016, HR was made the theme of a specialized academic
conference on addiction and discussions were held on HR practices in
Japan’s alcohol and drug treatments.
STUDY 2 , Variation of discourse on “harm reduction” in Japan
we conducted a
qualitative research (semi-structured interview) targeted to two
groups. Group One is the service users of drug addiction health
care and social services including drug users and ex-drug users.
Group Two is the service providers of these services (health care
workers, nurses, psychiatrists etc.). For each group, 10 to 12
respondents were recruited by snow balling method. The data
was anonymatized and transcribed. The method of content analysis
was applied to the text data in order to describe the variation of
discourse regarding drug use, health care and harm
reduction. This is ongoing research and this presentation
is an interim report on 29 October 2018. This research is
approved by Research Ethics Committee of the CSCD, Osaka
University (No. 2017-2) .
Discourse found in the
Harm reduction is
effective; however, in the background lie the “reality that the use and
abuse of drugs are still extensively spreading to national and local
Confusing natural order of things
Even if it is effective, the goal of drug policy should be to ban drugs and harm reduction is a wag-the-dog policy.
Definition of one’s own
It is adaptive for a substance abuse patients to make the period in which they do not use substances in life as long as possible and this can be the harm reduction.
Since drug therapy for
stimulants has not been established, harm reduction cannot be
Doing It in Japan
At the individual
level, things similar to harm reduction are being done.
Acceptance of Those Who
It is important to be able to talk about relapse. There is not much meaning in blaming relapse
Harm reduction leads to
the idea that “there should be an individual recovery view.”
There are Things More
Important than Drug Withdrawal
If it is needed to live, then it is okay to use. Safety is necessary prior to drug withdrawal.
Avoidance of Isolation and Connection
Harm reduction connects one to peers and others.
Harm reduction is connected to one’s natural rights as a human being.
There should be a style of harm reduction that can be used in Japan’s situation.
to Medical Care
With the harm reduction idea, you can increase the number of people newly entered to medical care. Introducing people to medical care is important.
History of Introducing Harm Reduciton
|Japanese translation(2007) of
Slaying the Dragon (1998) by William L White
A variety of “addiction treatment trials” has been examined from the abstinence movement, self-help groups, therapy communities, early methadone treatments, to the current harm reduction trials.
|Confronting AIDS (1986) by
National Academy of Sciences, USA. Published in Japanese in 1988.
There is a description of the needle exchange program; however, the
term harm reduction is not used.
|AIDS in the World (1992) by
Jonathan Mann et al.
Although not translated into Japanese, this was read by many specialists in Japan. Terms “harm reduction” and “harm minimization” are listed in the index of the book.
|Drug and Discourse:
Methamphetamine in Japan (2006) by Akihiko Sato.
Author is a sociologist. There is a chapter discussing harm reduction as a measure to support European drug policy and social control mechanisms
|Challenge for a New Drug Policy
(2007) ed. By Shinichi Ishizuka.
Collection of papers by lawyers and recovery support practitioners in Japan. Also references harm reduction.
|What is Harm Reduction ? (2017)
By Toshihiko Matsumoto et al.
Collection of papers by psychiatrists, researchers and health care providers. The first book in Japan with the term “harm reduction” in the title.
|From left, a book for those who
seek for dark tourism in Europe (2009), non-fiction on the Dutch
society by a journalist (1996), an area study report on the Netherlands
by academics (2006), does not use the term harm reduction, but
describes methadone buses and drug use zones.
|The 51th Annual Academic Meeting
of JMSAAS : Addiction Science at the Viewpoint of Harm Reduction.
Held in Tokyo, October 2016. 668 people attended. 33 lectures were presented with the keyword “harm reduction” on the problem of drug, alcohol, and tobacco. Among these, 22 lectures reported on the situation and practices in Japan. In the public symposium “Considering Harm Reduction Development: Debates from the Viewpoints of Medical Care, Recovery Support, and Legal Treatments,” held a debate onstage. Others included the Symposium “Current State of Addiction Management Measures: Considering the Introduction of Harm Reduction” and an education lecture “General Remarks on the Treatment of Alcoholism: From the Kurihama Method to Harm Reduction.”
(C) SUH Skooja and IKEDA M., 2018-2019