“About Nothing Without Us”: A Comparative Analysis of Autonomous Organizing Among People Who Use Drugs and Psychiatrized Groups in Canada

Abstract

Background: A growing body of literature demonstrates the value of autonomous organizations of people who use drugs (PUD) in education, mutual support, and policy debates. Simultaneously, over the past 10 years, Canada has witnessed increased emphasis on what is generally termed (service) user involvement in public health, particularly among PUD and/or psychiatrizatized groups. Paralleling the development of autonomous organizations of PUD in relation to independent groups by and for various psychiatrized constituencies, this article traces the history of Canadian drug/service user organizing with an overt focus on structural barriers, suggesting that the psychiatric survivor and mad movements have served as critical organizing models among PUD. Methods: Drawing from a comparative review of psychiatric survivor/mad initiatives and organizations of PUD, in tandem with observations from the author’s cumulative ethnographic field research, this paper conducts a critique of how PUD are positioned in Canadian drug policy. Results: Despite popular perceptions regarding Canada’s embrace of harm reduction, recent political shifts have indicated both a clear regression to moral-criminological approaches closely aligned with the U.S. “war on drugs,” and the persistence of structural barriers among Canadian PUD. Conclusion: Drawing from evidenced- based research concerning peer-based forms of harm reduction, this paper argues for the fundamental centrality of autonomous organizations by and for PUD in the harm reduction movement at local and global scales, suggesting that addiction research and policy development that neglects the direct involvement of PUD bears little, if any, relevance to the people in whose interests it is ostensibly conducted.