Background
Harm reduction has primarily developed in response to the needs of people who use drugs, notably injected opioids, in the Global North. In Bogotá, Colombia the primary drug of concern is neither injected nor opioid, rather it is a form of smokeable cocaine, known as basuco. In this Global South, post-conflict setting, drugs and drug policy have played a major role in both violence and attempts at peace. This study contributes to the development of harm reduction policy in this context.
Objectives
To define ‘harm reduction’ in a context of smokeable cocaine use and identify potential harm reduction responses; to understand the production of drug-related harm using lenses of violence and zemiology; to understand how harm and harm reduction relate to the Colombian peace process.
Methods
Ten months of ethnographic fieldwork with street-based people who use basuco in central Bogotá from May 2022 to April 2023, including 41 semi-structured interviews with a purposive, stratified sample designed to include diversity of gender, age, race, displacement status, and drug use history.
Results and implications
There are causal links between the Colombian conflict and basuco-related harm across four zemiological categories (physical, economic, emotional and cultural harm). Framing drug-related harm in terms of violence (direct, structural and cultural) helps to identify generative mechanisms that produce harm. Drug policy must be included in peace processes, and this must extend to people who use drugs.