Pleasure, drugs, materiality and tensions in harm reduction in practice: The case of safer injection programmes

Abstract

Drawing on ethnographies of a public health programme called ‘safer injection education’ (where people inject drugs under the supervision of harm reduction providers), this article explores how the materialities of drug use (such as paraphernalia and space) intersect with habitual behaviours and expectations. The article compares the diverse accounts of people who inject drugs with the biomedical knowledge of professionals to argue that people experience different forms of pleasure which challenge clinical understandings of addiction as driven by a desire to alleviate the pain of withdrawal symptoms. The analysis also critiques the assumption that people who use drugs are enslaved or unaware of their behaviours, showing instead that they are well aware of their patterns of psychoactive substance use and actively manage them in order to increase pleasure, and produce expertise and agency. During safer injection education sessions, people who inject drugs challenge normative assumptions and prescriptions on drug-related risks, and deploy practices and accounts that resonate with narcofeminist approaches, which produces solidarity between peers, social transformation and new forms of resistance to prohibitionist drug policy regimes and the pathologisation of drug use.