REVIEW ARTICLE
MENDONÇA, Natália Heringer [1], BENTO, Nárgila Mara da Silva [2], ALMEIDA, Dulce Maria Filgueira de [3]
MENDONÇA, Natália Heringer. BENTO, Nárgila Mara da Silva. ALMEIDA, Dulce Maria Filgueira de. The controversy of a public debate: the drug use rooms in France. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year. 06, Ed. 11, Vol. 01, pp. 61-79. November 2021. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/social-sciences/drug-use-rooms
ABSTRACT
The present study originated from the effort to understand the social context of the implementation of Reduced Risk Consumption Rooms for injecting drug users based on the case of France, which authorized the opening of these establishments in 2016. Given that the use of psychoactive drugs was long fought through a prohibitionist policy that took effect from 1970 in the country, the following guide question arises: what were the social aspects that led to the adoption of another model, hitherto morally challenged by its society, which accepts the moderate use and in appropriate environments of those substances? The article aims to analyze the discursive constitution interposed about the Consumption Rooms in the French public debate. We conducted a research of a theoretical nature using a qualitative methodology, which was a non-exhaustive bibliographic review, made in 2019, including scientific articles and theses. The main consultation base was the National and University Library of Strasbourg. The results indicate that, according to the material analyzed, genealogy about the use of psychoactive substances is related to the stigmatization of users. The social aspect that led to the transition from prohibitionism to the adoption of the model of moderation in the use of psychoactive drugs occurred through a field of controversies that gradually inserted the theme of harm reduction in the French public debate. Moreover, until the time of the research, there was a scarce scientific production on the subject, despite its importance for public debate. It is concluded that the overcoming of controversies on the subject can contribute to the destigmatization/stigmatization of users of psychoactive substances, redefining their social role and status in interaction processes in society.
Keywords: Public debate, Psychoactive Substances, Low Risk Consumption Rooms, France.
1. INTRODUCTION
In the constitution of human societies the use of psychoactive substances has always been a constant. Used in ritual processes, whether in religious ceremonies or in hedonistic festive circumstances, these substances have always been part of human cultures (ESCOHOTADO, 2008). Around the 1980s, the epidemic resulting from Acquired Immunodeficiency Syndrome (AIDS), as well as the increase in infections due to Hepatitis C (sexually transmitted) provoked discussions about the consumption of psychoactive substances, especially those of an injectable nature. During this period, a reformulation of public health was discussed by several actors from the international sphere, thus instituting a public debate. A reorganization of public health policies centered on the way of life of people directly affected by their measures was claimed, as well as the adequacy of these measures to the reality of populations (JAUFFRET-ROUSTIDE; CAILBAULT, 2018). From this perspective, the moderate use of substances in an appropriate establishment appeared as a plausible alternative considering the social context, in addition to the abstinence of users.
Garrau (2018), in the work Politiques de la vulnérabilité, explains that Plato’s conception of the rational human being consists of an ideal individual who totally controls his desires, which is based on the logic of abstinence. In opposition to the platonic notion, Aristotle (1992) in Éthique à Nicomaque contributes to elaborate the idea of temperance, which would underlie the logic of moderation. Finally, even without explicitly mentioning these logics, in the article Le contrecorps de la toxicomanie, Le Breton (2012a) dialogues with the notion that recourse to drugs is morally feasible and includes it in the set of ordalic conducts, explained in Sociologie du risque (LE BRETON, 2012b).
According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA, 2017), the first supervised injection room was opened in Switzerland in 1986. Today, the country offers 12 of these structures. Germany authorised its operation in 2000 and currently has 24 establishments. Spain has 13 and the Netherlands offers 31 spaces of the same type. There are still two in Norway, one in Luxembourg and four in Denmark. Others still exist in Canada and Australia. In France, even outside the legal framework, a first Consumer Room was opened in 1994 by the group Auto-support des usagers de drogue[4] (ASUD) in Montpellier. However, the establishment was closed after the overdose of a young woman in 1995. After this episode, the Consumption Rooms would only receive legal authorization to operate in 2016.
With regard to the French context, Jauffret-Roustide and Cailbault (2018) show the dramatic contours that the debate on the subject has gained in press coverage. The arguments most evoked by the media in favor of the Consumption Rooms argued that they favored the decrease in overdose rates and contamination by communicable diseases. However, the profusion of arguments was much lower in relation to those that emphasized the social tranquility resulting from the decrease in consumption in public spaces and the decrease in exposure to moral and social humiliation of users who suffer from the feeling of shame and fear.
In the 2000s, even though the majority of health personnel had adhered to the discourse of reducing health damage, arguments were still published in the press that the Consumption Rooms would be the perpetuation of the evil that a person can do to himself. In the micro context, the controversy is intense, especially in Paris, in the Quartier Gare, where the Parisian Consumer Room was installed. In this neighborhood, many oppose the rooms because they fear that the marginalization of residents is accentuated and they are put in danger. In turn, it is believed that the Strasbourg Consumption Room did not suffer from opposition from residents because its implementation was planned to be made on the premises of the university hospital.
Having said that, considering that the use of psychoactive drugs was fought by France through a prohibitionist model from 1970 on, the fundamental question arises: what were the social aspects that led to the adoption of another model, hitherto morally challenged by its society, which accepts the moderate use and in appropriate environments of those substances? Thus, this article[5] aims to analyze, based on a bibliographical research, the discursive constitution interposed between prohibitionism and the health paradigm about the institutionalization of establishments, called Consumption Rooms at Reduced Risk, intended for users of injectable psychoactive substances in France.
2. THE CONSUMPTION ROOMS, ABST IN AND MODERATION: ASPCETOS OF A MORAL PUBLIC DEBATE
The controversy over the implementation of the Consumption Rooms highlights the moral aspect of the process that led to its authorization, because it shows the reformulation of the discourse about what is understood as desirable and acceptable conduct in our society. It is part of the genealogy of the transition from prohibitionism to harm reduction. This passage shows how the contesting subject of the 1970s became the junky and marginal of the 1980s and the 1990s addict. Through this path that conceives and designates the user in different ways, different constructions of the subject also pass.
In Le sujet et le pouvoir, Foucault (1982) discerns about the forms of constitution of the subject, bringing a precise theoretical contribution to understand how the logic that was installed with the paradigm of reducing health risks institutes a new form of apprehension of the drug user. It is associated with this idea his book Surveiller et punir. Naissance de la prison (FOUCAULT, 1975), in which we see how the logics that subject the so-called docile bodies operate. In this regard, Foucault (1982) clarifies that the term “subject” has at least two meanings: in the first, the individual is subjected to someone or something; in the second, he is the author of a sense that is implicated in an action. However, in both cases, the author maintains that there is a power acting on the subject. This assertion is based on the theory of rational action, according to which every action is preceded by the attribution of intention that gives it meaning. This characteristic is conceived, from Greek philosophy, as the main quality that distinguishes humans from animals. By giving an intention to each action and acting in such a way as to achieve it, the individual consecrates himself as a subject of his actions and, consequently, as a subject of himself. This is because, when reflecting on a decision, it puts into practice its ability to self-determine.
To perform this attribution of meaning, the subject uses his references learned in the course of social interactions and the meanings he gives them. Therefore, Foucault (1982) emphasizes, even in the individually motivated action, the subject is submitted to an external force. In this sense, the author argues that specific knowledge influences the equally specific ways in which a person attributes meaning to both his or her own actions and to himself. For example, the logic of prohibition-abstinence propagated in the 1970s raised beliefs about drug use that persisted for a long time, and even today we see some people referring to drug users as drug addicts. Effects of psychiatry at the time, the ideal of abstinence and the theory of climbing classified, isolated, medicated, punished and institutionalized those who were outside the social adequacy. Therefore, it is a knowledge that makes possible the exercise of a specific power, in the words of Foucault (1982), of a can-knowledge.
In the field of drug use, the prohibition policy defined the person who makes such use as a problem; the psychiatric knowledge of the 1970s legitimized him by establishing what is drug addiction and its stages. In this context, a specific discipline (FOUCAULT, 1975) comes to regularize the uses that individuals make of different substances. According to this rite, individuals are accused of self-surveillance as to the amounts, types of drugs, frequency, forms of consumption and, moreover, judge whether they fit as supposedly normal people or whether they are mild, moderate or deeply addicted.
However, we highlight that, in rational action, the process of attribution of meanings is constant and is repeated with each action. Thus, if, on the one hand, the subjects are conditioned by the internalization of the norms, on the other, they have the ability to resignify their experiences (JOAS, 2001). In this way, they also constantly reinterpret the way they conceive themselves.
Bringing this reasoning to our theme, the way in which users appropriate their experiences with drugs expresses very particular forms of use, as unique as can be the resignifications of these substances and themselves. For example, many seek not to resort to institutional means, making substitution cycles with medicines such as codeine and methadone themselves (KOKOREFF et al., 2018). Others note that their addiction is linked to injection and start introducing other liquids such as water (DOS SANTOS, 2016). Therefore, if the discipline in the use of subjective drugs individuals, some if subjective as normal and others as drug addicts, there are also indications that this meaning will be reformulated by the subject.
In this context, we realized that, in the transition from prohibitionism to harm reduction, the predominance of the logic of abstinence gave way to that of moderation. In prohibitionism, the abstinence of some drugs produced a kind of docile body (FOUCAULT, 1975) and, until recently, it apart those who adesed this ideal from those who diverted it, incarcerated the latter in prisons or in a psychiatric institution. However, in reducing damage, the adoption of the idea of moderation will “docilize” the bodies in another way: by controlled access to pleasure and risk. As the subject continues to be an agent of his choice, incarceration takes place in the plane of ideas, because the subject is trapped in the very responsibility of controlling the use of the drug.
In order to clarify the logics of abstinence and moderation, we resorted to the discussion initiated by Plato and Aristotle about human action. Platonic morality is part of the separation between the sensitive world and the world of ideas, the first related to the body and the second to the mind. For him, the sensitive is the expression of the sensations, of the desires of the body, which deceive us easily. When motivated by them, the subject would be more exposed to uncertainty. Thus, to neutralize them, it is necessary that the individual exists for reason, because it allows to dominate desire. Therefore, according to this moral, life should be aseptic, self-sufficient and free of bodily passions (GARRAU, 2018). Such affirmation of extreme autonomy and denial of sensitivity are the basis of the ideal of abstinence.
Aristotle (1992) also thinks that the domain of uncertainty involves the restriction of desires. However, he does not propose the denial of the sensitive world, but access to it through temperance. This is, according to the philosopher, a moral virtue, that is, it is a disposition that the subjects build from learning and good practices. It consists of the middle ground between excess and lack of some desire, in this case, the desire for the pleasures of the body beyond or below natural needs (ARISTOTELES, 1992). The Aristotelian approach is of interest to our study, because it is not a question of the search for pleasure, but the search for its excess, which characterizes irrationality. Thus, using temperance, the action aimed at achieving pleasure can become rational.
Thus, we perceive a similarity of meaning between the concept of temperance and that of moderation present in the policy of harm reduction regarding drug use. In this case, good consumer practices create the willingness to act rationally. That is, the individual employs his rationality, since he uses the psychoactive substance, choosing to do it without excess, either from the product or from the risk to health. In this context, moderation would maintain the dignity of the person by the belief in controlled use as a way to coexist with the use of the drug. This control concerns the amount, frequency and modes that have fewer risks of use, representing the attempt to rationalize consumption by reducing the individual’s exposure to the uncertainty of possible damages.
More recently, Le Breton (2012a) addresses drug use from the perspective of the relationship between desire and pain. It adds to the approaches that were important for contesting the problematic view related to the user of narcotics and that take the focus away from abstinence. It is about conceiving users out of a suicide profile, but as people seeking to make their lives possible. The author states that dependence originates in the action undertaken by the subject in order to end an involuntary pain. This is temporarily replaced by a voluntary pain, that is, the use of the drug. The author inscribes this consumption among the ordalic conducts. In this type of behavior, the person seeks to value his own life through dangerous experiences to which he/she exposes himself (LE BRETON, 2012b).
Initially, the voluntary, controllable pain that replaces that involuntary pain allows us to give a meaning to one’s own, to be present and to contain its existential emptiness. It also tends to alleviate existence in a confused, suffocating individualistic world in which sufferings are covered up and relationships are uncertain. During dependence, however, the user becomes strongly linked to this relief, from which the temporary demand becomes permanent (LE BRETON, 2012a).
For this reason, the user lives in a constant back and forth between sensations, which makes it possible not to be fully immersed in suffering or in the idea of ending existence. It is a cyclical time, in which the person alternates the intensity of the sensations caused by the drug and the lack of it (LE BRETON, 2012a). It is a time of its own created by the person and by his management of involuntary pain. Consequently, for the author, the user seeks to reproduce that relief so that he can remain in belonging to the world in his own way and not because he aspires to death. This way of understanding the user as a subject who seeks to give meaning to life dialogues with the arguments that came to support the implementation of the Consumer Rooms in France.
In fact, the public debate developed on a local scale and it was thanks to the initiative of the advocates of harm reduction that this discussion gained greater visibility, especially from 2009. The activists held events to present the issue to public spaces and urged local politicians to seek to know similar rooms in other countries. After this mobilization, the Institut National de la Santé et de la Recherche Médicale[6] (INSERM) stated in 2010 that the Consumption Rooms should be installed on an experimental and scientifically evaluated basis (JAUFFRET-ROUSTIDE; CAILBAULT, 2018).
From the perspective of pragmatic sociology, the publicization of the demand for a space of drug use, accentuated by the activists of 2009, caused an “increase in general” (BOLTANSKI; THÉVENOT, 1991) of the problem of the pelevel condition of users. The prominent term indicates that a problem considered as singular tends to be understood as collective through a process in which the public debate between actors who make up the field of controversies brings a problem of a microsphere to the macrosphere.
Thus, the publicization of the debate encouraged others to become sensitized and aroused public empathy for users (JAUFFRET-ROUSTIDE; CAILBAULT, 2018). As this exhibition led citizens, users and local politicians to join the field of debate, the diversity of arguments attenuated the strength of the moral discourse of abstinence and those who supported it. That is, the plurality of thoughts engendered a critique of what was in place up to that moment about how to deal with how drug use and allowed a new commitment: to experience the reduced risk consumption rooms. Therefore, the action of small groups and the publicity of the debate, plus the manifestation of INSERM, would lead to the future authorization of the Consumption Rooms on an experimental basis.
It is interesting to note that the authorization of the implementation of the Consumption Rooms conditioned to experimentation made possible the combination of drug use with its concomitant control, data collection and analysis. It also reinforces the prominent position of some social actors in the health field, especially those who, when updating their discourses, maintain their importance in the field during the years of experimentation. This was the case of INSERM, which after having issued a favorable note and conditioned the implementation of the rooms to the examination by specialists, became the body responsible for its evaluation.
Currently, consumption rooms are analyzed by two research programs (MILDECA, 2016). The Cosinus, a socio-epidemiological evaluation conducted by INSERM that commins the improvement of socio-sanitary conditions and the harm reduction practices of users of a Consumption Room in contrast to users who do not attend them. A second evaluation studies the social acceptability of Consumption Rooms and their impact on social tranquility. It is held by the Centre de recherche médecine, sciences, santé, santé mentale, société[7] (CERMES3), a multidisciplinary laboratory that employs the ethnographic observation of public spaces and interviews of users, actors of harm reduction, associations and residents.
However, it should be noted that the use of narcotics remains an offence in France. Users of psychoactiveagents know that they can still be punished – when using these substances outside an environment such as the Consumption Rooms – with an incarceration of up to one year and a fine of 3,750 euros, or with alternative penalty to be defined by a judge. This can be translated into unpaid work, stage of sensitization to the dangers of drugs and therapeutic injunction. In other words, from a legal point of view, the ban has been relaxed, but not extinguished.
3. METHODOLOGY
As mentioned, with the objective of analyzing, based on a bibliographic research, the discursive constitution interposed about the Consumption Rooms at Reduced Risk in the French public debate, we carried out a research of a theoretical nature, using a qualitative methodology, using the study model the bibliographic research. This was a non-exhaustive bibliographic review, including the following types of documents: scientific articles and theses. The consultation base was formed by the National and University Library of Strasbourg and, in addition, we used Google, both academic and conventional. In the searches, the keywords were inserted as descriptors: “Consumption room at reduced risk”; “harm reduction”; “drug use control”; “anti-drug policies.” And as Boolean operators we use “AND” and “OR”. We don’t set a time frame.
Four articles and three theses were found for the period from 2000 to 2018, as seen in the following Table.
TABLE 1 – Documents Identified in the First Search
| Title | Kind | Year | |
| 1 | Entre politiques du vivant et politiques de la vie: pour une anthropologie de la santé. | Article | 2000 |
| 2 | Le contrecorps de la toxicomanie. | Article | 2012 |
| 3 | Usages de traitements de substitution aux opiacés: étude comparative: France, Suisse et Québec. | Thesis | 2016 |
| 4 | Les salles de consommation à moindre risque. | Article | 2016 |
| 5 | L’addiction comme pathologie de la volonté: repenser l’impuissance de la volonté à la lumière des sciences cognitives. | Thesis | 2017 |
| 6 | Ouverture d’une salle de consommation à moindre risque (SCMR): attentes des usagers de drogues. 2018. | Thesis | 2018 |
| 7 | Drug consumptionrooms: comparing times, spaces and actors in issues of social acceptability in French public debate. | Article | 2018 |
Source: own (2021).
Considering the total number of materials obtained, according to the reading, we realized the need to perform a new search with the themes, “drug prohibition”, “prohibitionism”, “moderation”, “temperance” and “controversy”, using the same Boolean operators. No scientific articles and theses were obtained with these descriptors, except for four books, which will be used as support in the analysis.
Consecutively to the first and second searches mentioned, we proceeded to reading, categorization, analysis and discussion. The analysis of the documents obtained took place according to the content analysis (BARDIN, 2009). From the initial reading of the documents, we have called the theme “genealogy” for analysis, since it was the recurring theme in the studies presented. This theme was, therefore, considered content exposed in the public debate about the discursive constitution between prohibitionism and the paradigm of reducing health damage about the institutionalization of establishments called Consumption Rooms at Reduced Risk in France.
4. FROM GENEALOGY TO STIGMATIZATION
As we perceive from the table above, the scientific production in France on the subject is still incipient. Only three theses and four scientific articles were identified. Analyzing them separately, we can see that theses and articles are concentrated in the period from 2000 to 2018, indicating that there is a relationship between the time frame of scientific production and the opening of the first Reduced Risk Consumption Room in France, which occurred unofficially in 1994 and officially in 2016, as previously seen. Another factor to be highlighted is the institutionalization of the international public debate on the subject, which in some European countries, such as Germany, gains even more breath in the early 2000s.
The analysis undertaken considered, based on the documents obtained (scientific articles and theses), the concept – content – “genealogy”. To this end, we have been in the mediation of this concept and in the appropriation of the notion of “stigma” (GOFFMAN, 2004) for the analysis.
We highlight the collective work directed by Michel Kokoreff, Anne Coppel and Michel Peraldi (2018) which was also taken as a reference for the discussion. The work addresses the question of the genealogy of our theme. In it, the authors refer to the period originating in France from the use of psychoactive substances as a period of invisible catastrophe. A chronological picture of an invisible and nonlinear history is proposed in the introduction by separating a period of discovery (1964-1973), one of oscillation (1973-1987) and another of reflux (1988-1996). In this context, the 1960s mark the time when heroin was essentially used by artists, some writers and especially graduates, while the financial elite preferably used cocaine. During this period, a large amount of heroin, known as marseillaise, was exported from Marseille to the United States by the so-called French Connexion (KOKOREFF et al., 2018).
We then move on to approaches about genealogy present in scientific articles and theses. Fassin (2000), in his article, brings the perspective of social sanitization to understand how the process of constructing a public health problem takes place. The first article by Jauffret-Roustide (2016) examines the Consumption Rooms as a means of reducing the socially constructed degradation of users. Dos Santos’s thesis (2016) analyzes how the ideal of abstinence present in prohibitionism was relativized and led to a process of normalization of additive conducts. Trouessin’s thesis (2017) discusses the transition in the way of apprehending the person – from drug addict to user – and the respective use of drugs – from drug addiction to addition to psychoactive. In the third thesis obtained, Valentin (2018) observes the beginning of the operation of the Strasbourg room and explains that it offers users aseptic material for the use of injectable drugs, such as disposable syringes and needles and scarves to avoid septicemias. The article by Jauffret-Roustide and Cailbault (2018) employs the sociology of controversies to analyze, through the observation of public debate in the local and national written press in the French media, how the Consumption Rooms at Reduced Risk took place.
Jauffret-Roustide and Cailbault (2018) point out that the strong polarization between the intellectual openness of public health and attachment to the idea of abstinence gave a very emotional air to discussions about the drug problem. This caused complementary positions to be considered as opposites. The fact that the press treated the controversies as polarization marked the discussion about the Consumption Rooms in a much more dramatic way than the researchers observed in the field.
Taking into account injecting drug users, if at the social plane they were marginalized and excluded from access to their rights, at the health plan they eventually distanced themselves from the health care system (JAUFFRET-ROUSTIDE, 2016). Kokoreff et al. (2018) address the social and historical context in which the use of psychoactive substances has become a social problem in France, unfolding in a prohibitionist policy. The consequences of this go beyond overdoses or contamination by HIV and Hepatitis C, also encompassing septicemia or other health problems that were not treated. From pregnant to cardiac, several users did not seek health services due to fear of control and stigmatization. Given the scale of these problems, it is difficult to calculate the number of actual deaths caused by the use of injecting drugs.
According to Goffman (2004, p. 22), “in the sociological study of stigmatized people, interest is generally focused on the type of collective life, when it exists, that lead those who belong to a particular category”. Within the meaning of the author, the corporificated signs, that is, materialized in people’s bodies, can engender mechanisms of prestige or stigmatization, however, both are markers of the social identity of people, in our case, of the regulars of the Consumption Rooms at Reduced Risk.
Heroin began to be part of the cycles of social relations linked to the influx of hippies and freaks[8] that crossed French territory in France. In the 1970s, this product had an unprecedented spread with the multiplication of suppliers from various countries such as Turkey, Lebanon, Pakistan, Thailand and Iran (KOKOREFF et al., 2018). The intensification of trafficking led to scenes of outdoor selling in the 1980s and the significant number of arrests of young people in the cités[9], who were the most persecuted by the police. This set in motion a penal machine that would extend into the next decade. The 1990s were then marked by: a fight against street traffickers, a spurlet of users who aged and found themselves in great penury, and finally by Islam presenting itself as a point of support to get out of drug addiction. This was also the moment when the harm reduction discourse emerged.
Specifically as far as the 1960s were mentioned, common sense did not associate drugs with youth, because consumption was not a known theme, even among educators and teachers (KOKOREFF et al., 2018). From 1964, young people became more politically engaged social actors and, in 1968, they joined the workers in a social movement that became known as May of ’68. In Paris of this period, youth discovered other forms of life besides those linked to bourgeois-operated binarism. It was a context of experimentation, among them, that of drugs: cannabis, LSD, amphetamines, diverted drugs, heroin, methamphetamine and cocaine.
Kokoreff et al. (2018) also point out that, in 1969, a series of overdoses reported by the press provoked a discussion of dramatic contours involving the use of these substances. On the one hand, newspaper articles would have contributed to a very emotional view about the relationship between young people and drugs. On the other hand, there was implicitly a great interest of the State in legifering on the repression of drugs in order to increase the control and maintenance of the social order, in view of the political challenges it faced. In fact, the overdose cases were punctual, but their exposure served as a justification for the legislative measures taken, under the argument of protection of threatened youth.
It follows from this time that the person who used psychoactive drugs was categorized by psychiatry as a drug addict and its consumption has come to be understood through an escalation of drug addiction. This would start with the consumption of drugs considered to be lighter and end up with the consumption of heavier drugs. The heroin phase would be, according to this theory, the most degrading. In it, the usual user was designated as junky and associated with the idea that this drug leads to a deadly impasse from which one cannot leave (KOKOREFF et al., 2018).
However, we cannot fail to emphasize that the relationship between the stigmatized (user of psychoactive substances) and the other (those who consider themselves “normal”) are socially complementary, that is, they are part of the processes of social interaction (GOFFMAN, 2008). Thus, between toxicomen and normal there is a necessary social relationship. Additionally, Machado Pais (2003, p. 205), in a study on youth cultures in Lisbon, emphasizes that: “drug use takes different meanings according to the cultural specificities and symbolic experiences of the different groups that drug use ends up reinforcing”.
Machado Pais’s (2003) understanding is corroborated by Kokoreff et al. (2018) when stated that drug uses are as diverse as their users. Among the latter, there are those who control the use or those who alternate substances and periods of consumption. Thus, the use of drugs can have a particular meaning for each person and, in addition, there are many users who manage their own consumption, managing to maintain professional activity, pause the use seasonally or alternate it with other treatments.
Dos Santos’s thesis (2016), which proposes a kind of comparative study, also presents part of a genealogy about the consumption of psychoactive substances in the different localities analyzed by it (France, Switzerland and Quebec). The author highlights the existence of a “relativization of the norm of abstinence” (DOS SANTOS, 2016, p. 133) throughout the 1980s. He stresses that there are efforts to rethink drug addiction. According to the aforementioned work, several studies sought to show that denying consumption was ineffective and then a tendency to accept eventual consumption was built. In addition, another mode of admission of drug use consisted of stabilization through methadone, in the case of opiate use. This new way of looking at drug use heralded the future flexibilization regarding the model of seclusion of users.
Thus, harm reduction was introduced as part of the normalization of drug use even before its official adoption by the State. In this new context, the user has been transformed into an active agent of harm reduction. This changes two important sociological understandings, their social role in the processes of social interaction, as well as their status, because it assumes responsibility in relation to health and the damage that can be caused to it (GOFFMAN, 2004).
5. FINAL CONSIDERATIONS
From the study that aimed to analyze the discursive constitution interposed about the Consumption Rooms at Reduced Risk in the French public debate, it was observed that the implementation of these establishments in France was historically preceded by the construction of drug use itself as a social problem and stigmatization of psychoactive users. The apprehension of this problem occurred, initially, by the political and medical environment in an austere and prohibitive way, with harmful results in terms of marginalization and illness of those users.
Since our initial question sought to understand the social aspects that led to the transition from prohibitionism to the adoption of the model of moderation and harm reduction, we can conclude that this transition resulted from the constitution of a field of controversies which inserted the theme into the French public debate. In view of the health challenges launched, the agenda of harm reduction in the consumption of psychoactive drugs has become the domain of public health, with new actors configuring this field. Driven by actions in smaller spheres, the issue reached great amplitude and led to the negotiation of the conditions for the implementation, in 2016, of those establishments that aim to mitigate the vulnerability of people who consume injectable substances.
According to the documents analyzed (scientific articles and theses), we observed that the previously prevailing prohibitionist model is associated with an ideal based on abstinence, while that of harm reduction, which replaced it, is linked to the logic of moderation. It is infers that there is a consensus among the authors about the understanding that a Consumption Room is a structure that, because it is inscribed in a disciplinary model of harm reduction, allows consumption through moderation, as opposed to the prohibition model.
The authors Le Breton (2012a, 2012b), Dos Santos (2016), Kokoreff et al. (2018), Jauffret-Roustide and Cailbault (2018) align themselves with the idea that, based on the understanding that regular drug use and the search for life do not necessarily oppose, Consumption Rooms seem to emerge as a means of ensuring a dignified existence for users, because their work goes beyond the provision of a place of hygienic and protected care. This notion is important because it allows the redefinition of social roles and the status of users of psychoactive substances. These spaces would thus give drug users the recovery of subject status. The use of drugs with controlled risk in this location may indicate that the person seeks lucid consumption, ritualized management that takes into account cleanliness, quantity, frequency and harm reduction. Through this process, the person would reach the world of the sensitive through drugs, but by moderate use, he would claim his rationality, his ability to make decisions that society considers reasonable.
However, as seen by the scarce scientific production identified up to the moment of this work, more studies are needed in order to identify whether, in fact, the Consumption Rooms allow to bring a feeling of adequacy to those who do not feel consistent with the social standards of conduct, in this case, users of psychoactive substances who attend them. Moreover, we believe it is important to investigate whether the resumption of the status of subject conveyed by the use of substances in Consumption Rooms allows autonomy and the addition to drugs to coexist, one counterweighting to the other. In summary, in the case of a relatively recent structure unknown by many countries, the subject deserves to be better investigated, mainly, privilegionting the point of view of its regulars.
It is concluded that overcoming the controversies about the debate can contribute to the destigmatization/stigmatization of users of psychoactive substances, redefining their social role and status in interaction processes in society. Therefore, we share this discussion with the Brazilian public, believing we can contribute to the debate on the adoption of harm reduction measures for populations affected by drugs in the country. Historically marginalized and distanced from health services, these people are the target audience of the Reduced Risk Drug Consumption Rooms, which aim to alleviate their vulnerability.
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APPENDIX – REFERENCE FOOTNOTE
4. Self-help for drug users.
5. This is a section of the Master’s Thesis in Ethics and Society, from the Faculty of Social Sciences of the University of Strasbourg, France, held in 2019.
6. National Institute of Health and Medical Research
7. Center for research medicine, science, health, mental health, and society.
8. So popularly called users who led drug experimentation to the last consequences.
9. French term that refers to peripheries.
[1] Master’s degree and graduation. ORCID: https://orcid.org/0000-0001-6280-6980
[2] PhD student, master’s, undergraduate. ORCID: https://orcid.org/0000-0002-5941-190X
[3] Advisor. Post-doctorate, doctorate, master’s degree, graduation. ORCID: https://orcid.org/0000-0003-2352-5478
Submitted: October, 2021.
Approved: November, 2021.
