title: Harm reduction as a complex adaptive system: A dynamic framework for analyzing Tanzanian policies concerning heroin use.
abstract: Contrary to popular belief, policies on drug use are not always based on scientific evidence or composed in a rational manner. Rather, decisions concerning drug policies reflect the negotiation of actors' ambitions, values, and facts as they organize in different ways around the perceived problems associated with illicit drug use. Drug policy is thus best represented as a complex adaptive system (CAS) that is dynamic, self-organizing, and coevolving. In this analysis, we use a CAS framework to examine how harm reduction emerged around heroin trafficking and use in Tanzania over the past thirty years (1985-present). This account is an organizational ethnography based on of the observant participation of the authors as actors within this system. We review the dynamic history and self-organizing nature of harm reduction, noting how interactions among system actors and components have coevolved with patterns of heroin us, policing, and treatment activities over time. Using a CAS framework, we describe harm reduction as a complex process where ambitions, values, facts, and technologies interact in the Tanzanian sociopolitical environment. We review the dynamic history and self-organizing nature of heroin policies, noting how the interactions within and between competing prohibitionist and harm reduction policies have changed with patterns of heroin use, policing, and treatment activities over time. Actors learn from their experiences to organize with other actors, align their values and facts, and implement new policies. Using a CAS approach provides researchers and policy actors a better understanding of patterns and intricacies in drug policy. This knowledge of how the system works can help improve the policy process through adaptive action to introduce new actors, different ideas, and avenues for communication into the system.
authors.affiliation: Center for Health Promotion and Prevention Research (CHPPR), University of Texas Health Science Center at Houston (UTHealth), School of Public Health, 7000 Fannin St., 26th Floor, Houston, TX 77030, USA. Electronic address: eric.a.ratliff@uth.tmc.edu.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Ratliff
authors.affiliation: Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
authors.forename: Pamela
authors.initials: P
authors.lastname: Kaduri
authors.affiliation: Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
authors.forename: Frank
authors.initials: F
authors.lastname: Masao
authors.affiliation: Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
authors.forename: Jessie K K
authors.initials: JK
authors.lastname: Mbwambo
authors.affiliation: Center for Health Promotion and Prevention Research (CHPPR), University of Texas Health Science Center at Houston (UTHealth), School of Public Health, 7000 Fannin St., 26th Floor, Houston, TX 77030, USA.
authors.forename: Sheryl A
authors.initials: SA
authors.lastname: McCurdy
mesh_terms: D064423:Drug Trafficking / Q000517:prevention & control*; D040261:Harm Reduction; D006291:Health Policy; D003932:Heroin / Q000600:supply & distribution; D006556:Heroin Dependence / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D011050:Policy Making; D013636:Tanzania / Q000453:epidemiology
chemical_list: D003932:Heroin
keywords: Complex adaptive systems; Harm reduction; Heroin; Policy analysis; Prohibition; Tanzania