By Greg Denham

I have worked in the law enforcement field for over twenty five years, and a
significant part of my work has been in the drug policy area. I have come to
the conclusion that harm reduction services, particularly needle and syringe
programs, are an essential component of a comprehensive strategy designed to
reduce drug related harm in communities.

This view, however, is not always shared openly by other police. Privately, while many
police officers accept that harm reduction services are important, their attitude
is more likely to condemn than condone.

Why does harm reduction get such a bad name, particularly amongst law enforcement
officials? Police attitudes often reflect the views of the broader community. Many
people find drug use to be abhorrent, and feel that when clean drug equipment
is provided, ‘abstinence’-based approaches (such as ‘say no to drugs’ or the
‘war on drugs’) are being undermined.

Police are particularly condemning of injecting drug use because they constantly deal
with its negative outcomes. Police frequently deal with people they see as
having ‘lost their lives’ to drug abuse. They also respond to the consequences
of drug use when they assist affected families, victims of crime, and communities
impacted by drug use.

It is not surprising therefore that there are barriers between police and harm
reduction services. Service providers see police as inflexible, and see the coercive
approaches police use in their treatment of users. Police may see health
workers as ‘soft’ and narrowly-focused. At the same time, many police believe
that they are ‘caught in the middle’ and cannot ‘get it right’ 100% of the time
in 100% of the cases they handle.

Police often say that service providers should see the world more often through the
eyes of police — and I am sure the same words can be heard from those working
in the harm reduction field.

So how do we address this impasse?

First, it might surprise both police and harm reduction service providers to discover
that there are some things they agree about. From my experience, both groups
actually have a lot in common, particularly at the grass roots level — where
the attitude is often that ‘a problem shared is a problem halved’.  There is usually a real need for a forum
where both sides can discuss collaboration, shared outcomes, resource-sharing
and problem solving – but fora like this rarely exist.

Research overwhelmingly supports the notion that collaboration between both sides can
effectively reduce the negative consequences of drug use and help create an ‘enabling
environment’ for harm reduction services. In particular, it is vital to engage
local police in the decision-making process, to ensure that health services are
delivered without hindrance.

But unfortunately, there are many examples worldwide of situations where
relationships between harm reduction service providers and police have been
problematic. In Cambodia there has recently been publicity about
issues with injecting drug use and policing. The Cambodian capital, Phnom
Penh, has a high number of injecting drug users, many of whom live impoverished
lives with little access to health care.

There, the provision of clean needles and syringes has been authorized by the Cambodian
Government through the National Authority for
Combating Drugs. The NACD is the same government department responsible for
coordinating anti-drug efforts in Cambodia, and is made up of many police.

The NACD grants licenses to NGOs to allow them to deliver harm reduction services, in
particular needle and syringe exchange, to injecting drug users. This service
helps reduce some of the risks from drug use and in particular helps prevent
the spread of HIV both among and from injecting drug users.

Korsang is one of these NGOs, and it meets
the needs of injecting drug users by providing services that are ‘user
friendly’. There’s space for users to come in off the streets, seek medical
attention and get much-needed help. Korsang’s client numbers are growing
steadily as more and more people seek health care services from resident
doctors and health professionals.

Korsang’s work also involves street-based activities, in which outreach workers walk through
areas of high drug use to give out. I have visited Korsang on several occasions
and admire the dedication and genuine concern they have for their clients,
people on whom many other agencies have turned their backs.

In this way, Korsang meets the health needs of injecting drug users in an
environment of trust and acceptance. This often leads to misunderstandings in
the local community who may feel that these services are bringing ‘unwanted’
people into the neighborhood. This in turn can lead to confrontations with
police, who are called in to respond to community concerns.There have been
several incidents involving Korsang and local police, and the relationship appears
to have broken down.  Work is required to
determine the nature of this impasse and the underlying causes.

As a researcher and program developer in harm reduction and law enforcement with
the Nossal Institute for Global Health,
I have a vested interest in this situation. We are undertaking a research
project to analyze harm reduction programs and their impact on law enforcement
policy and practice in Cambodia
(and in two other SE Asian countries, Vietnam
and Laos).
The project aims to help bridge the gap between agencies.

This research project, known as Law Enforcement and Harm Reduction at Nossal (LEHRN)
– which is partnered with the National Institute for Public Health in Phnom
Penh – will seek to identify how and why harm reduction services influence
police policy-making and how this in turn affects police operational practice
— or in other words, ‘what happens on the streets’.

In order to highlight this research project, a seminar will be conducted on
February 24th 2010 in Phnom
Penh. This seminar, chaired by the Nossal Institute
for Global Health’s Professor Nick Crofts, will bring together regional
expertise from the law enforcement and health
sectors to explore issues of HIV and injecting drug use in Vietnam,
Cambodia, Laos and beyond.

Speakers will also include representatives of the Institute for Social Development Studies (Vietnam), the National Institute of Public Health (Cambodia), the University of Health Sciences
(Laos), and Victoria Police (Australia).

I would encourage anyone who is interested in understanding more about the complex
relationship between law enforcement agencies and harm reduction services to
attend the seminar. Please email me directly to
get more information.

Greg Denham is Law Enforcement and Harm Reduction
Adviser at the Nossal Institute for Global Health.