(Re)politicizing harm reduction: Poststructuralist thinking to challenge the medicalization of harms among people who use drugs

Abstract

Poststructuralism, with its critical interpretations of knowledge, discourse, truth, and power, offers a set of compelling analytic tools for disentangling and deconstructing the ways in which health-related phenomena exist and are understood. This paper adopts a poststructuralist stance to outline the impacts of medical hegemony on the lives of people who use drugs, as well as responses to the harms experienced by this population. This analysis reveals how structuralist projects have narrowed the scope and impact of harm reduction through processes of medicalization, neoliberal responsibilitization, and medical co-opting and depoliticization. Nomadic thinking is then introduced as a means for health policy makers and practitioners to transform the boundaries of dominant approaches to harm reduction – particularly, in ways that (re)politicize harm reduction through forms of equity-promoting and social justice-oriented action. Implications for (re)politicized, community-engaged, and structurally responsive approaches to harm reduction in health policy and practice are then discussed.