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A powerful call to decolonise harm reduction

Croakey is closed for summer holidays and will resume publishing in the week of 15 January 2024. In the meantime, we are re-publishing some of our top articles from 2023.

This article was first published on Tuesday, April 18, 2023


Introduction by Croakey: People and organisations working for harm reduction have been urged to decolonise their work and unpack “the biases, structures, systems that operationalise racism, in our own practices and organisations”.

In a powerful address to the Harm Reduction International conference taking place in Naarm/Melbourne this week, Professor James Ward, Director of the University of Queensland Poche Centre for Indigenous Health, outlined wide-ranging benefits that would flow from decolonising harm reduction.

His presentation is published in full below. See more news from the conference on Twitter at #HR23.


James Ward writes:

May I begin by acknowledging Traditional Owners of this country here, the Bunurong Boon Wurrung and Wurundjeri Woi Wurrung peoples of the Eastern Kulin Nation. Thank you for your generous welcome, to all of us here, on your country, and for the duration of this conference. I want to acknowledge your ancestors many thousands of years of custodianship, care and protection of these lands, and acknowledge that these lands were always places of scholarship and learning.

May I also acknowledge Aboriginal and Torres Strait Islander people here today, other First Nations and Indigenous peoples here today.

Today I want to address the topic of decolonising harm reduction, what is it? and how do we achieve this?

But first and as is with traditions, I want to position myself.

I want to acknowledge my own ancestors who always held and included our people in the circle, who always maintained country, and held in balance through culture, custom, dance, song and stories, our people and our land.

These have been used to guide survivorship of my peoples that have lived and survived on this country here for at least 60,000 years.

First, some history

In framing this talk, let’s revisit the history of drug use. Human beings have used psychoactive substances for millennia. In Europe, the ancient Greeks used psychoactive substances prescribed by ancient physicians such as Hippocrates, Galen, and Ctesias to achieve a euphoric state of mind.

In the UK in the 19th century, the Victorians consumed alcohol, opium, cannabis, coca, mescaline and, after the invention of the hypodermic needle in the 1840s, morphine and heroin. In pre-colonial Africa and much of Asia, cannabis was cultivated, traded and used as medicine.

Cannabis also has a sacred role in the Rastafarian, Sufi and Hindu religions, and the Indigenous peoples of the Andean Amazon region revere the coca leaf. The opium poppy has a centuries-old history as traditional medicine and ceremonial use in Asia and the Middle East.

And here in Australia, among my own Aboriginal peoples in central Australia who are known as the longest surviving peoples with continuous culture on the face of the planet, here the use of psychotropic flora, that have played an important function in the survival and cohesiveness of communities since the beginnings of human history.

One such example is the plant Duboisia or Pituri, that has been used to create states of consciousness, particularly hyper suggestible ones, to enculturate adolescents, that subsequently contributes to the survival, cohesiveness, and success of community clans and groups.

Pituri has been used also for extreme pain relief, for long walks, or for ordeals. Pituri is accepted as of sacred origin and is treated with awe and reverence. These plants are in limited supply and protected from abuse, insofar as they remained under elders’ control and administration. This in essence meant that Aboriginal peoples were some of the earliest adopters of harm reduction.

Colonialism harms

Beyond Australia, contemporary substance use among Indigenous peoples today is inextricably linked to colonialism, both in the ways land was acquired and in relation to the disruption and trauma that came with colonisation, including the ongoing intergenerational trauma experienced by the younger generations of Indigenous peoples today.

It is apt, at a harm reduction conference, to point out that psychoactive substances such as opium, tobacco alcohol and cocaine were used by colonial powers to achieve their goals of dispossession of lands and peoples. These same commodities ensured the colonial experiment could expand to more lands, and to continue to ignore, displace, disrupt, and massacre Indigenous peoples.

At the same time, the introduction of drugs and substances, to Indigenous peoples has had devastating impacts on our peoples globally.

The most common feature of the modern day response to the weaponising of alcohol and other drugs against Indigenous peoples has been to double down on law enforcement and control.

This has occurred globally through the war on drugs. Individual countries, including Australia, have attempted to legislate and arrest their way out of substance abuse harms.

The result?

Indigenous, Black and Brown peoples who use drugs are over-policed, have higher rates of arrest, fatal overdoses, prosecution and incarceration for drug use than other identifiable population. And at the same time they lay bare their bodies to the triple whammy of discrimination, racism and stigma.

This has also resulted in higher HIV and hepatitis rates attributable to drug use among Indigenous peoples. Despite the fact that Indigenous, Black and Brown having similar rates of drug use.

So it begs the question: “What is it about current harm reduction policies that is not working for Indigenous peoples?”

A key principle of harm reduction in drug policy is to move away from the abstinence-based program model to one of minimising harms for people who use substances. Harm reduction has been in operation as a policy now for around 40 years. I am pretty sure most of you in this room applaud harm reduction as a strategy, as I do.

It has no doubt worked in saving many millions of lives globally, needle syringe programs, opioid replacement programs and supervised injecting facilities.

Decolonising is everyone’s business

So to decolonising harm reduction – what is it? and how do we achieve that?

Decolonising harm reduction, broadly as a concept, means deconstructing colonial ideologies of superiority and privilege of Western thought and approaches.

It means moulding harm reduction to the cultural values, paradigms and meanings that Indigenous peoples hold.

It also means in essence, to disrupt the colonial experiment and intent.

It may seem radical, but it seems plausible, ethically and morally the right thing to do.

Firstly I want to say that decolonisation of harm reduction is everyone’s business.

Decolonising harm reduction, as everyone’s business, means dismantling structures that perpetuate the status quo and addressing unbalanced power dynamics in our societies.

A first step in decolonising harm reduction is to recognise that we are living on lands that have never been surrendered, that have never been ceded, and for the great part have never been recognised by colonisers.

If you take a moment to ask yourself a question – where were your great great great or great great grandmothers/grandfathers born? Then on whose land territory or treaty they were they born on.

Confronting as it is, in some ways, most of us have a family history of colonisation and surprisingly most of us don’t know or recognise that.

This means that our own ancestors were complicit in the concept of colonising lands, they were either active in the takeover and exploitation and disruption of Indigenous ways of knowing and doing or they were silent bystanders. They were citizens in a time, where eugenics and white supremacy were actively pursued as legitimate paradigms, and when conquest, and rendering others as inferior was normal. It is this disruption that continues to impact First Nations peoples globally.

Like it or not, colonisation and its ongoing legacy is a major contributor to the over-representation of Indigenous peoples globally in drug use statistics.

We are all innocent inheritors and custodians of that history. It is not your fault, but it is important to learn this history and any privilege that has come with that, and then decolonise the way you do business. It is your responsibility, and all of us, need to pick up this damage, come together and collectively clean it up.

Voice matters

Decolonising harm reduction also means celebrating and understanding who we are, and connecting with the unique knowledges that we all bring to the table. Giving Indigenous populations a voice is decolonising practice.

For those of you who are visiting Australia, later this year we will hold a referendum to enshrine an Indigenous Voice to Parliament. This technically will mean Australians vote to change the founding constitution, and if successful, policy making will be amplified with the voices of Indigenous peoples who bring to the table, context, expertise and lived experiences.

An Indigenous collective voice in decision making and policy development will allow Indigenous people to be involved in the promotion of their own wellbeing and in the social, economic and cultural determinants of health, it’s only then that we can begin to solve the challenges we are currently facing.

A key point that the Voice seeks to redress is that it is a mechanism for us to be seen by governments and corporations, and for us to see ourselves as an integral part of the responses that involve our own peoples.

Decolonised harm reduction also means recognising context, it has to honour our history, our identity, our culture, our politics and the impact these collectively have on us today. Simple recognition of First Nations lands, culture and leadership every time we gather in groups is not enough, but it is a critical starting point.

Having an understanding of the social structures in our communities, the non-hierarchical structures, the concept of storying, of time, of place, synchronicity, balance, relationality is decolonising practice.

It is about empowering the elders in our communities to make decisions regarding drug use, drug control, drug treatment and enforcement.

Decolonised harm reduction also rekindles the ways in which we considered drug use prior to colonisation, for cultural rituals, for ceremony, and in a roundabout way as a public health issue even before public health was termed.

It recognises that our people have always cared for our peoples, they always had our people in the circle. And always operated with principles of inclusivity, reciprocity and fulfilling obligations to our clans and kins.

Decolonised harm reduction is also about embracing the concept that health and wellbeing is about relationality and that health and wellbeing is not only about the absence of disease, but health and wellbeing is about the physical, the spiritual, and about connection to land and kin systems. But importantly it’s about all of these being in balance and in sync.

Decolonising harm reduction is also about addressing racism, especially in the healthcare system. Too often our peoples face racism when they attend care, it ends up sometimes in death. Over and over, many coronial inquiries in this country have pointed to racism as an underlying cause of death for Indigenous peoples in the healthcare system, either being refused, inadequately treated or turned away.

It’s about all of us unpacking the biases, structures systems that operationalise racism, in our own practices and organisations.

Decolonising harm reduction has to be about decentralising resource allocation and programs and allowing sovereignty of communities to develop locally led solutions.

Fundamental to all of this is an appropriate level of funding commensurate with need. Without this, it undermines the ability to make tangible and lasting improvements in Indigenous health.

Healing

Finally, decolonising harm reduction recognises that not one size fits all.

Can I suggest decolonised harm reduction has to be more about the right strategy, at the right level of potency, with the right population, at the right point in time and the right length of time, if we are to disrupt the status quo. And most importantly, the strategy has to be led by us.

Before closing it would be remiss of me not to state that over and all above harm reduction, what we collectively need to disrupt, is the criminalisation of drug use and recognise the impact this has on Indigenous Black and Brown peoples. The criminalisation of substance use is disproportionately harming our peoples.

The “war on drugs” has never been a war on the root causes of drug use, it has always been a war on the people using drugs through increased policing, prosecution and incarceration.

Until it is a war on the conditions which create the issue, it will continue to be a façade of action for political gain at the cost of the people who need health interventions not criminalisation.

Further, the war on drugs steals livelihoods, disrupts communities and continues the legacy of colonial powers where criminalising and stigmatising drugs and making their use seem ‘deviant’ has served to demonise, dehumanise and marginalise the communities who use them.

This strategy has been employed the world over to harm and repress ethnic minority groups, political dissidents, the poor and the dispossessed. It is the polar opposite of decolonising harm reduction.

So, in closing, if we can decolonise harm reduction, we can allow our spirits to connect and this will enable our people to heal people. To do this will mean we have to dismantle systems, our thinking, our policies, and most importantly engage, connect and be with Indigenous peoples.

And as a sovereign person of this nation who is in his sixth decade in this life, as an epidemiologist, as a professor in Indigenous health, I can say this. The western society approach to harm reduction has failed to alleviate effectively enough, nor quickly enough, the disease, death and suffering among my people and many other Indigenous populations globally. Enough is Enough.

Decolonise, decolonise and decolonise harm reduction.

• This presentation was delivered at the Harm Reduction International Conference in Naarm/Melbourne on 18 April, 2023


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