1 Expanding Understanding of Enforcements Role in Harm Reduction Jonathan Caulkins Carnegie Mellon University Qatar Campus and Heinz College RAND, Drug Policy Research Center Peter Reuter University of Maryland RAND, Drug Policy Research Center

What Do You Associate With the Phrase Harm Reduction? Public health Protect users Syringe exchange Controlling HIV/AIDS Supervised injection 2

What Will You Associate With the Phrase Harm Reduction? Public health Protect users Syringe exchange dddd Controlling HIV/AIDS Supervised injection Police Protect non-users Driving flagrant markets underground Controlling crime & violence Specific deterrence 3

4 What Is Harm Reduction? Classic Definition Total Harm = Total Use * Harm/Unit Use Use reduction tries to reduce Total Harm by reducing 1 st term HR tries to reduce Total Harm by reducing 2 nd term

5 What Is Total Harm? Extension Total Harm = Total Use * Harm/Unit Use + Production * Harm/Unit Produced + Distribution * Harm/Unit Distributed + Drug Control * Harm/Unit of Control

6 What Is Harmfulness? Elaborate Extension Harmfulness = Harmfulness to users + Harmfulness to users intimates + Harmfulness to users neighbors + Harmfulness to general public

7 Law Enforcement Can Reduce Total Harm by Reducing: Total use Traditional focus of drug enforcement (in US) Harm to users Traditional goal of public health harm reduction Harm users impose on others Harm caused by markets & distribution

8 Ways Users Harm Others Total use Traditional focus of drug enforcement (in US) Harm to users Traditional goal of public health harm reduction Harm users impose on others Crime (Economic-compulsive) Intoxication (& Psychopharmacological crime) Families Harm caused by markets & distribution

9 Ways Markets & Distribution Harm Total use Traditional focus of drug enforcement (in US) Harm to users Traditional goal of public health harm reduction Harm users impose on others Harm caused by markets & distribution Violence by dealers Disorder of public/flagrant markets Other: corruption, terror, environmental damage, having political power, etc.

10 Major Sources of Harm in the US Total use Traditional focus of drug enforcement (in US) Harm to users Traditional goal of public health harm reduction Harm users impose on others Harm caused by markets & distribution Violence by dealers Disorder of public/flagrant markets Other: corruption, terror, environmental damage, having political power, etc.

11 Targeting Violent Dealers & Flagrant Markets Closing public markets Traditional crackdowns Deterrence: Reuben Greenberg, Link Valley, etc. Specific deterrence Boston gun project, Highpoint Police targeting individuals Community-generated Most Wanted list Targeting behaviors Usually via enhanced sentences Could be via policing prioritization

12 Enhanced Sanctions: Classic Examples That Fail Quantity possessed Long sentences for couriers & mules Crack vs. powder cocaine Crack is made out of powder cocaine, Drug free school zones Not specific enough; cover most of city (Could augment with time of day)

13 Enhanced Sanctions: More Promising Ideas Currently exist Firearm enhancements Arguably this works; many dealers do not carry their guns Worth considering (?) Corrupting an official Adult selling to a minor Being part of a drug selling organization Employing someone who carries a gun Key: Lower baseline sanction severity

14 Issue of Measures: Two Ironclad Rules You cant manage what you cant measure. Peter Drucker (?) Anything can be measured in a way that is superior to not measuring it at all. Gilbs Law

15 Tentative Suggestions of Measures to Prompt Discussion # of homicides or aggravated assaults in area Flagrant drug markets There exists a research protocol for this directly, and indirectly via search time measures Surveys of residents # of people arrested from Most Wanted list # of ED trauma cases for people on heroin registry

16 Conclusions Harm reduction isnt just for public health Law enforcement has a key role too Harm reduction isnt just about drug users Family and markets matter too Law enforcement for harm reduction is a vision, not a specific program Same true of classic harm reduction Translating vision into reality will be done by practitioners Same true of classic harm reduction