Harm and risk reduction: History, theories, issues, and implications

Harm reduction is explored, historically, in terms of ideologies, concepts, processes, types, stakeholders, legal, policy, service delivery, and ethical considerations and their micro and macro consequences. Necessary critical conditions underpinning ideologies and programs throughout their life cycle are examined, as are selected unresolved issues and paradoxes. Importantly, harm reduction can inadvertently result in distancing drug users (DUs) from mainstream ("normed") care by institutionalizing specialized care for DUs who remain "marginalized" from the community at large. Also, harm reduction can become harm production when program staff, who should be foster autonomy and self-care in partnership with DUs, are co-opted into becoming social control agents acting on compliant, passive, pathologized, and dehumanized stereotypes-Them.