Caulkins J P, Reuter P
Carnegie Mellon University, Heinz School, Pittsburgh, PA 15213-3890, USA.
Addiction. 1997 Sep;92(9):1143-50.
Historically, United States drug policy has focused on use reduction; harm reduction is a prominent alternative. This paper aims to provoke and inform more debate about the relative merits of these two. Since harm is not necessarily proportional to use, use reduction and harm reduction differ. Both terms are somewhat ambiguous; precisely defining them clarifies thinking and policy implications. Measures associated with use reduction goals are poor; those associated with harm reduction are even worse. National goals influence the many decentralized individuals who collectively make drug policy; clearly enunciating goals makes some policy choices transparent and goals serve a variety of purposes besides guiding programmatic decisions. We recommend that the overall objective be to minimize the total harm associated with drug production, distribution, consumption and control. Reducing use should be seen as a principal means of attaining that end.
从历史上看，美国的毒品政策一直侧重于减少使用；减少危害是一个突出的替代方案。本文旨在引发并为关于这两者相对优点的更多辩论提供信息。由于危害不一定与使用成正比，减少使用和减少危害是不同的。这两个术语都有些模糊；精确界定它们有助于理清思路和政策含义。与减少使用目标相关的措施效果不佳；与减少危害相关的措施更差。国家目标会影响众多集体制定毒品政策的分散个体；明确阐述目标会使一些政策选择变得透明，而且目标除了指导项目决策外还有多种用途。我们建议总体目标应是将与毒品生产、分销、消费和管制相关的总体危害降至最低。减少使用应被视为实现该目标的主要手段。
