Harm reduction as a complex adaptive system: A dynamic framework for analyzing Tanzanian policies concerning heroin use

• Published in: The International journal of drug policy Vol. 30; pp. 7 - 16
• Main Authors: Ratliff, Eric A, Kaduri, Pamela, Masao, Frank, Mbwambo, Jessie K.K, McCurdy, Sheryl A
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2016; Elsevier Science Ltd
• Subjects: Actors; Complex adaptive systems; Drug abuse; Drug policy; Drug trafficking; Drug Trafficking - prevention & control; Drug use; Ethnography; Harm Reduction; Health Policy; Heroin; Heroin - supply & distribution; Heroin Dependence - epidemiology; Heroin Dependence - prevention & control; Humans; Internal Medicine; Medical Education; Natural environment; Negotiation; Participation; Policing; Policy analysis; Policy Making; Prohibition; Scientific evidence; Substance abuse treatment; Tanzania; Tanzania - epidemiology; Time use; Trafficking; Treatment programs; Values; Tanzania; Prohibition; Harm reduction; Complex adaptive systems; Policy analysis; Heroin; Tanzania
• ISSN: 0955-3959; 1873-4758
• DOI: 10.1016/j.drugpo.2015.12.008

Abstract Contrary to popular belief, policies on drug use are not always based on scientific evidence or composed in a rational manner. Rather, decisions concerning drug policies reflect the negotiation of actors’ ambitions, values, and facts as they organize in different ways around the perceived problems associated with illicit drug use. Drug policy is thus best represented as a complex adaptive system (CAS) that is dynamic, self-organizing, and coevolving. In this analysis, we use a CAS framework to examine how harm reduction emerged around heroin trafficking and use in Tanzania over the past thirty years (1985-present). This account is an organizational ethnography based on of the observant participation of the authors as actors within this system. We review the dynamic history and self-organizing nature of harm reduction, noting how interactions among system actors and components have coevolved with patterns of heroin us, policing, and treatment activities over time. Using a CAS framework, we describe harm reduction as a complex process where ambitions, values, facts, and technologies interact in the Tanzanian sociopolitical environment. We review the dynamic history and self-organizing nature of heroin policies, noting how the interactions within and between competing prohibitionist and harm reduction policies have changed with patterns of heroin use, policing, and treatment activities over time. Actors learn from their experiences to organize with other actors, align their values and facts, and implement new policies. Using a CAS approach provides researchers and policy actors a better understanding of patterns and intricacies in drug policy. This knowledge of how the system works can help improve the policy process through adaptive action to introduce new actors, different ideas, and avenues for communication into the system.