Between Care and Order: Street-Level Workers’ Discretion and Drug Policies in Amsterdam (the Netherlands) and Porto Alegre (Brazil)

__Abstract__ This comparative study analyses the implementation of policies on so-called ‘problem drugs’ (crack cocaine and heroin) for the cities of Amsterdam (in the Netherlands) and Porto Alegre (in Brazil). Using a variant on the street level bureaucracy approach, the study assumes that workers’ discretion has a central role in understanding the processes through which official public policies come into grounded existence. Workers’ discretionary choices involve the creation of strategies to cope with the gaps between the goals and expectations from official policies and the actual conditions of work at the street level. In the case of drug policies, this also includes negotiating between different approaches towards people who use drugs, which range from human rights and health care for users to law enforcement to ensure public order. Workers engage with organizational rules, goals and regulations plus other workers and users in making discretionary decisions on both problem definitions and possible solutions for drug use. All these factors are found to shape the ways in which workers’ discretion is exercised. The research focuses on State supported workers in the social, health and law enforcement fields to analyse the dilemmas workers encounter in their daily interactions with drug users, and how they develop strategies to cope with them. More specifically, it looks at how dilemmas and strategies vary across workers’ different working territories, differing interpretive beliefs around drug use, levels of support and constraints coming from their organizations, differing patterns of collaboration within and between sectors, and experiences of relationship with drug users

Benefits and Challenges of Qualitative Methodologies in Cross-cultural Psychology Studies

Qualitative research has been considered increasingly valuable for cross-cultural psychology studies, but its contributions and challenges to the field remain under discussed. This chapter does that by analysing a qualitative study which compares interpretive beliefs and behaviour of street-level workers from health, social, and law enforcement sectors working with policies for crack cocaine and heroin in the cities of Amsterdam, Netherlands, and Porto Alegre, Brazil. Challenges and contributions for the use of qualitative methodologies in cross-cultural studies were found in different research stages. Challenges were centred on how to balance empirical closure and analytical distance. Benefits relate to a wider variation in responses and a more contextual level of experiences, allowing for more grounded theorization

Double Expectations: Law Enforcement Workers and Dilemmas on Handling Drug Use at the Street Level

This paper analyses law enforcement workers' experiences when transforming policies for crack cocaine and heroin into practice. It focuses on dilemmas workers have and choices they make when approaching drug users. Grounded theory principles and ethnographic techniques were used to gather and analyse in depth interviews and extensive participant observations of 20 workers across the cities of Amsterdam (Netherlands) and Porto Alegre (Brazil). The comparative analysis enables to explore the impact of different socio-economic and political environments on workers' practices around drug use. Three areas in which law enforcement workers reported to have dilemmas concern workers' choices on how to deal with violence; choices between being tough or friendly towards users; and on defining their role on curbing public nuisance. If a first sight shows differences between the cities, in a closer look interesting similarities appear. When deciding upon approaching drug users, law enforcement workers drift between order and care approaches. At the street level, different contexts produce ambiguities and workers' experiences question the etic reductionism in simple dichotomies of care vs. order approaches. From this closer perspective, similarities appear more clearly, as well as counterpoising perspectives to the stereotypical views of Dutch and Brazilian workers

From opiates to methamphetamine:building new harm reduction responses in Jakarta, Indonesia

Background: Despite the rise of stimulant use, most harm reduction programs still focus on people who inject opioids, leaving many people who use methamphetamine (PWUM) underserviced. In Asia, especially, where methamphetamine prevalence has overtaken opioids prevalence, harm reduction programs assisting PWUM are rare. The few existing innovative practices focusing on methamphetamine use lie underreported. Understanding how these programs moved their focus from opiates to methamphetamine could help inspire new harm reduction responses. Hence, this paper analyzes a newly implemented outreach program assisting methamphetamine users in Jakarta, Indonesia. It addresses the program's critical learning points when making the transition to respond to stimulant use. Methods: This case study is part of a more extensive research on good practices of harm reduction for stimulant use. For this case study, data was collected through Indonesian contextual documents and documents from the program, structured questionnaire, in-depth interviews with service staff and service users, a focus group discussion with service users, and in-loco observations of activities. For this paper, data was reinterpreted to focus on the key topics that needed to be addressed when the program transitioned from working with people who use opioids to PWUM. Results: Four key topics were found: (1) getting in touch with different types of PWUM and building trust relationships; (2) adapting safer smoking kits to local circumstances; (3) reframing partnerships while finding ways to address mental health issues; and (4) responding to local law enforcement practices. Conclusions: The meaningful involvement of PWUM was essential in the development and evaluation of outreach work, the planning, and the adaptation of safer smoking kits to local circumstances. Also, it helped to gain understanding of the broader needs of PWUM, including mental health care and their difficulties related to law enforcement activities. Operating under a broad harm reduction definition and addressing a broad spectrum of individual and social needs are preferable to focusing solely on specific interventions and supplies for safer drug use. Since many PWUM smoke rather than inject, securing funding for harm reduction focused on people who do not inject drugs and/or who do not use opioids is fundamental in keeping programs sustainable

Marginalidade ou Cidadania? A rede discursiva que configura o trabalho dos redutores de danos

ABSTRACT. Scientific literature review shows that Harm Reduction (HR) articles focus mainly the discussion about the implications of different drug users treatment models and the efficiency of HR with injection drug users. However, there are few studies about HR workers. In this context, the present article aims to discuss the work of outreachworkers, proposing an analysis of how the discursive formations about drugs and Aids, in contemporary society, influence the work and the subjectivity of the outreachworkers, as well as the possibilities of having “sustainable projects” as a way to include harm reduction practices in public health services. // RESUMO. A revisão bibliográfica mostra que os estudos relativos à redução de danos (RD) se centram, predominantemente, na discussão das implicações de diferentes modelos de tratamento para o usuário de drogas e na redução de danos aplicada a usuários de drogas injetáveis. Porém, poucos estudos são encontrados acerca do trabalhador em RD. Neste contexto, o presente artigo propõe uma reflexão a respeito do trabalho dos redutores de danos, questionando como as formações discursivas sobre aids e drogas, na sociedade contemporânea, atravessam a subjetividade e o trabalho dos redutores, bem como sobre as possibilidades de inserção e sustentabilidade das ações em redução de danos

GRUPO COMO DISPOSITIVO DE TRANSFORMAÇÃO NAS RELAÇÕES SOCIAIS DOS SUJEITOS / GROUP AS A TRANSFORMATIVE TOOL IN SUBJECTIVE SOCIAL RELATIONSHIPS

Pensar o grupo como um dispositivo de transformação nas relações dos sujeitos parece uma tarefa intensa; neste trabalho nos propomosa pensar questões grupais e as transformações subjetivas que ocorreram no desenrolar desse território que foi criado, dando ênfase ao processo de clínica ampliada com o objetivo de produzir saúde e aumentar a autonomia dos sujeitos

"EU SOU A SOBREVIVENTE DO QUE VOCÊ JOGA FORA"1 OU, OS PROCESSOS DE SUBJETIVAÇÃO NO TRABALHO DE CATAÇÃO / “I AM A SURVIVOR OF THAT YOU THROUGH WAY" OR, THE SUBJECTIVATION PROCESS IN SEEKING WORK

Este artigo foi produzido a partir das experiências e problematizações propiciadas nos Estágios Profissionalizantes em Psicologia Social Comunitária I e II, realizado na ACE - Associação de Catadores Ecológica2, localizada em um município do interior do estado do Rio Grande do Sul. Através desta produção, procura-se refletir sobre os processos de subjetivação no trabalho de um grupo de catadores, buscando discutir e analisar o contexto local e social em que estes estão inseridos. Procura-se embasar as experiências apresentadas neste trabalho, seguindo o pensamento de autores como Bauman, Nardi, Castel, Costa, Goffman e Singer. Trata-se de não procurar respostas ou conclusões, e sim, propor uma espécie de parada para a reflexão sobre umapaisagem que nem sempre é enxergada em nosso cotidiano, mas que persisteem seu chamado por visibilidade, através de outra forma de economia que busque amenizar a cegueira da sociedade e do Estado, no que tange as suas políticas públicas

The XTC Store: An ‘Experiential’ Public Survey

In 2022, Poppi Drug Museum and researchers from Utrecht University evaluated the societal responses to three scenarios of regulated sales of MDMA through a unique public survey: an ‘XTC store’ in the heart of Utrecht. This report describes the results of this research. The public debate about regulating MDMA – the active substance in ecstasy1 – regularly flares up. The Netherlands is the world’s largest producer and exporter of ecstasy, and more than a million Dutch people have ever used ecstasy. The huge illegal market creates numerous social problems, from unsafe use to criminal subversion of society. However, the conversation about regulation is highly polarised, which limits thinking about alternative scenarios. In this context, drug researchers from the Poppi Museum, in collaboration with researchers from Utrecht University, have further developed three scenarios for alternative, legalised sale of MDMA: a pharmacy, a smart shop and a club/party. With the help of creatives from the Utrecht- based ‘Uitvindersgilde’ and in collaboration with Corné van der Stelt, these three points of sale were set up next to each other in a shop in the centre of Utrecht. The store was open to the public between mid-July and late September 2022. The research linked to the XTC store had the following central question: under what conditions do visitors to the XTC store and drug experts find the regulated sale of ecstasy acceptable? The 1529 visitors to the store gave their views on the various sales conditions. In addition, the team organised two focus group discussions with politicians and policymakers, and drug policy expert academics, which were invited to the location. The first important conclusion is that neither the visitors of the XTC store nor the participants in the focus groups understand the ‘legalisation’ or ‘regulation’ of MDMA would mean allowing the sale of MDMA unlimitedly. Both groups are in favour of (strict) sale restrictions. The experts are more conservative; most opted for a fourth scenario: a specialised but unattractive retail outlet. Most visitors to the XTC store - largely people with experience of XTC use themselves - favoured sales by the pharmacy or a smart shop. In conversation, they too often came up with a scenario between these two options, albeit with a slightly lower threshold than the experts chose. Sales at parties and clubs could still count on acceptance by around 60% of the visitors. But for all scenarios, visitors to the XTC store welcomed restrictions on sales. For example, they favoured a minimum age limit, safety guarantees and limiting the maximum doses in pills. Almost everyone was against allowing marketing and advertising. The research had several limitations as a crossover between an ‘ experiential’ public survey and an art installation. Nevertheless, the report provides interesting indications for follow-up research and further policy explorations. The XTC store also proved very effective in creating awareness and nuanced exchange among visitors and facilitating political dialogue: on location and in the media. The conversation in the store moved beyond the polarised debate about whether or not to regulate and went into depth into possible alternative scenarios for dealing with MDMA. Doing so contributes to a deepening of the Dutch drug debate