The history and Principles of Harm Reduction

JPL: Practising general medicine position at a given time. Next, it is a matter of helping proposals gradually emerge quickly taught me the importance of out of ‘supported dependence’: changing the role given to the individual in disrisk behaviours related to the method pensing care. And so, while the qualof drug use (clean shooting, shooting in ity of response needs to be worked on conditions and in places where it can in the relationship with the person and be clean, or adopting alternatives to in the preventative solutions and care shooting). Then, it is a question of using offered, this quality is also dependent these to formulate ‘negotiated depend- on determinants arising from the more ence’ proposals: changing from ‘prod- general context: the framework for care uct’ to what becomes prescribed medi- constrained by drug-related legislation, cation. And lastly, the possibility has to which restricts how care is oriented in be envisaged of staying at this ‘negotiated the field of dependency.

All this forces the carer to manoeudependence’ stage for a given and chosen period, depending on the various meth- vre in order to shift these determining ods, or of ‘getting out’ and into ‘supported factors. For me, this meant I had to get involved in demonstrating such practice independence’.

To sum up, this is equivalent to mak- elsewhere than in the one-to-one context: ing care meaningful by knowing how to needle-exchange programme, methadapt proposals, gradually increase them and put them into practice in keeping with where the person is at, throughout the It is the patient who teaches the doctor how whole course of his or her dependency. to care for him. Everyone is, to a certain extent, Such care is constructed ‘with’ and not ‘for’ the person, and differs from the care that an expert on themselves and on the course is sometimes put together based solely on their life has taken. the caring desires of the carer. This could be summed up in a phrase which most closely reflects what HR has contributed: ‘Working with and not for the individual’. adone-substitution centres, etc. Once this was achieved, it helped re-establish Lastly, is HR closely linked to medical a certain ease, calmness and comfortableness in the relationship with drug practice?

JPL: The hierarchical model for clas- users, but above all it brought about a sifying risk is in general fundamental to much better quality of medical provision our work in general medicine. Risk reduc- for these people. All this work has protion relating to the use of psychoactive duced a host of results demonstrating products has naturally become part of our the value and effectiveness of the new practice, for those amongst us who want paradigm represented by HR, and in turn to really listen to these ‘specific’ patients, led to the legitimacy of these innovations going beyond any particular labelling, in being recognised and their inclusion in the same way as we listen to our other the public health law of 2004. Without this, our practice as general practition‘populace’ patients.

The involvement of general practition- ers would not have been altered to the ers, who are a significant majority, par- extent it has.

This is how HR has enriched my practicularly in conducting opiate-substitution treatments, perhaps points to the tice as a general practitioner, as well as, existence of a certain symbiosis between perhaps, the lives of ‘my patients’.

It’s a practice which takes account of general medical practice and the practice the person, but one that does not forget and natural development of HR. either to take account of the health of What would you say in conclusion the community: it’s a way of conceiving about HR’s contribution to your prac- health by trying to reconcile individual and collective health. tice as a doctor?

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