The global drug policy landscape is becoming increasingly polarised: some countries are moving towards legalising and decriminalising drug use and supply, while others remain firmly entrenched within prohibition. Contributing to this, politicians from Eastern states have dismissed harm reduction as an imported Western concept, while their punitive measures towards drug users are portrayed as reflecting anti-drug “Asian values”.
Hong Kong’s drug policy is an uneasy balance between both of these positions. As a former outpost of the British empire, the region retained many institutions and legal frameworks under the “one country two systems” arrangement following its handover to China in 1997. This includes drug policy, which is strongly rooted in the colonial era response to widespread heroin use.
The region has consistently focused on drug abstinence through a combination of voluntary and involuntary residential drug treatment, street-level and border enforcement, and low quantity thresholds for drug trafficking offences. While harm reduction has been embedded within a pioneering methadone maintenance therapy scheme since the 1970s, this is the extent of formalised harm reduction services. Hong Kong’s public information campaigns exemplify this “just say no” approach, encouraging its citizens to “stand firm” against drug use, enhancing the social stigmatisation of drug use.
Given regional changes in patterns of drug consumption, supply markets, and demographics of the people who use drugs (PWUD), frontline drug workers in Hong Kong have repeatedly called for the adoption of harm reduction strategies which would allow them to work closer with the physical and mental health needs of the communities they work with.
Official statements from the Hong Kong government are cautious and reserved towards harm reduction (beyond methadone). However, in 2015 and 2021, the government called upon academics, frontline workers and NGOs to explore the feasibility and applicability of harm reduction measures within the local context, recognising they may be a tool for initially engaging PWUD with services within a longer-term strategy to achieve abstinence. But a central question is: how do you do harm reduction within this context of long standing anti-drug policies?
To address this question, we wanted to understand frontline drug workers’ (FDWs) experiences as they are the key point of contact between the state and PWUD in Hong Kong. We conducted five focus groups with 17 FDWs to see how they navigate the gap between the big-picture policy goals of Hong Kong pushing for drug abstinence, and the diverse needs and values of PWUD.
Bridging the gap through “moral improvisation”
Our focus groups revealed that, in spite of bureaucratic and organisational pressures that prioritise abstinence, mostly due to funding requirements, FDWs try to implement harm reduction ideas by focusing on reducing drug-related harms and approaching treatment holistically. They see the government’s emphasis on abstinence as at odds with the varied beliefs and needs of their clients.
We saw what we called “moral improvisation”, which describes how FDWs rely on their moral instincts to come up with strategies that focus on harm reduction and the complex needs of their clients, while abiding by the wider abstinence framework. They take a practical approach, understanding that completely quitting drugs right away isn’t always possible or what clients want. Instead, they promote moderation, relationship-building, and encouraging clients’ independence and self-control. As one participant shared:
“Harm reduction… as a social worker, I don’t expect them to quit drugs right away. It’s not about the difference between 0 and 1. I hope throughout the process, we can apply some measures like reducing the amount and frequency to minimise the bad impacts…to reduce their addiction through decreasing the amount and frequency of using drugs…”
Setting realistic goals toward moderation, rather than abstinence, helps clients avoid feeling like failures, and keeps them engaged in treatment.
Accordingly, FDWs see drug use as one aspect of bigger issues affecting clients’ mental and physical health. By addressing the indirect effects of drug use, FDWs try to connect with clients in a way that supports their overall well-being and autonomy. They focus on building trust, working together to create personalised plans, and offering support that goes beyond just drug issues. As one participant shared:
“The-just-say-no approach doesn’t work because it feels like lecturing and moralizing whereas… the kind of healing that comes from being in a group of people who get it and who are not judging you for the worst thing that you think or the way you feel, like I’ve been there too”.
FDWs also highlight the important role of peer counsellors, people with lived experience of drug addiction, in building trust and rapport with clients, acting as role models and sources of support. FDWs also involve clients’ families in treatment, recognising how important family support can be in tackling drug problems. One frontline worker describes her approach:
“They think that we’re going to guide them to quit drugs, but they aren’t ready yet. That’s why we allocate peer supporters as frontline workers to break the ice… We don’t convey the message of quitting drugs through outreach, although it’s our ultimate goal. When we do the intake, we aim at building relationships… The most important part of the project is our peer supporters. They share the same experience. They encourage the clients through sharing their stories and provide assistance as ex-drug users.”
Looking Ahead
Overall, our research suggested that “moral improvisation” is key for FDWs as they navigate the tricky terrain of Hong Kong’s abstinence-based drug policies while trying to meet the diverse needs of PWUD. By blending harm reduction ideas, supporting client autonomy, and building strong relationships, FDWs help bridge the gap between strict policy requirements and more personalised, client-focused care in Hong Kong’s challenging drug treatment scene. Follow up surveys with FDW exploring PWUD’s openness to receive harm reduction resources and messages illustrated mixed results. People using heroin found harm reduction helpful in navigating the risks of use; other PWUDs still felt the only way to reduce harm was to simply stop using. Such findings illustrate that, despite the significant progress made, there is still work to be done. Harm reduction strategies need to be flexible, accommodate different types of drug use as well as people’s personal characteristics, situations and contexts of drug use.
The form of harm reduction adopted in Hong Kong by FDWs may seemingly promote neoliberal values – like encouraging self-control and autonomy – but it is not necessarily ‘Western’ or incompatible with existing Eastern drug policies. Our findings emphasise that, concurrent with the harm reduction philosophy, harm reduction is both pragmatic and necessary for treatment, even with an overall abstinence objective. Outside of these focus groups, FDWs have suggested that we need new language to describe these practices – an Eastern equivalent of ‘harm reduction’ – to make them more culturally and socially acceptable.
You can read our paper here.
