Between Care and Control: Examining Surveillance Practices in Harm Reduction.

Area of Science:

• Public Health
• Sociology of Health
• Health Policy

Background:

• Harm reduction services are expanding, leading to increased surveillance of people who use drugs (PWUD).
• Data collected is repurposed for clinical, evaluative, epidemiological, and administrative uses, justified by improved care and efficiency.
• Surveillance expansion raises concerns about potential negative impacts on service access and equity.

Purpose of the Study:

• To critically analyze the impacts and implications of expanding surveillance within harm reduction settings.
• To examine how surveillance practices affect service uptake, health disparities, and the intersection of health and criminal-legal systems.
• To advocate for a critical dialogue on surveillance in harm reduction and the protection of PWUD anonymity.

Main Methods:

• Reflective essay based on empirical analysis of work within harm reduction services and movements.
• Critical examination of surveillance rationales and practices.
• Analysis of the relationship between care, control, and data sharing.

Main Results:

• While not all surveillance is inherently harmful, unchecked expansion can decrease service uptake and worsen health disparities.
• Surveillance practices can create conditionalities for service access and blur the lines between therapeutic care and social control.
• Data sharing with law enforcement and criminal legal actors poses significant risks.

Conclusions:

• A critical dialogue on surveillance in harm reduction is essential.
• Data sharing of health information with law enforcement must end.
• The need for meaningful anonymity for PWUD accessing services must be respected.