Drugs, communities, and "harm reduction" in Germany: the new relevance of "public health" principles in local responses.

Drug policy in Germany currently is subject to dramatic changes away from the dominance of repression and hard-line prohibition. However, a crucial share of the recent initiatives (decriminalization, "low threshold" social services, needle exchanges, opiate substitution programs etc.) that define the new interaction between the public system and the drug user have not occurred through any decisive changes in the main state-policy instruments. A possible legal shift was, for example, explicitly denied in the recent decision of the German Constitutional Court on the constitutionality of the German narcotics control law. Rather, these moves are the result of pragmatic, cooperative action at the front-line of communities directly confronted with drug use and the resulting problems. This paper looks in embracing progressive, "harm reduction"-based approaches for their communities' drug problem despite predominant indifference or resistance from other political levels. An overview is given of how the different actors involved in implementing front-line drug policy--police, social services, health agencies--have changed their approach in order to pragmatically "reduce harm" to drug users and their communities. As assessment of the effects of this substantial shift in public action towards drugs is suggested through changes in indicators of drug-related harm, e.g., the prevalence of drug-related deaths, health problems, provision of social services, effects of substitution programs, and drug-related crime rates.