By Tessie Castillo

For six weeks this summer I had the extraordinary opportunity to visit harm reduction programs all over Western Europe. In Belgium I toured a safe consumption site where people smoke and inject drugs under medical supervision. In Switzerland I explored Geneva, where physicians prescribe heroin to mitigate the dangers of unregulated street drugs. In Amsterdam I stopped by the drug user union credited with launching the world’s first official syringe exchange program.

Coming from North Carolina, where harm reduction programs have barely begun to take root, I considered the European tour akin to visiting the motherland. Finally I would see “real” harm reduction programs, evolved after decades of fine-tuning. But Europe also showed me something I hadn’t expected.

Every program I visited was clean and medical, government-funded and seamlessly integrated into public health policy. But to my surprise, I saw little evidence of drug user-led activism. The edgy, scrappy side of harm reduction⁠—that agitation for change so visible in the United States⁠—seemed absent.

In Western Europe “everything has been professionalized, so the basic idea of harm reduction has faded away,” said Katrin Schiffer of Correlation European Harm Reduction Network, whom I interviewed at her office in Amsterdam. “Even the people who work in harm reduction have trouble explaining what it is.”

At first I wondered if these programs had always lacked an active drug user component. But after interviewing experts in several countries and researching the history of European harm reduction, I found that drug user-led activism was critical to launching the programs that exist today.