'Total Peace' and the War on Drugs: Basuco, violence and harm reduction in Bogotá, Colombia

Harm reduction has primarily developed as a bio-behavioural response to the health harms faced by people who use drugs, notably injected opioids, in the Global North. In Bogotá, Colombia the primary drug of concern is neither injected nor opioid, rather it is a form of smokeable cocaine, known as basuco. In this Global South, conflict-affected setting, drugs and drug policy have played a major role in both violence and attempts at peace. The status of basuco as a non-injected, non-opioid illegal drug with a close association with these larger socio-political phenomena makes it - and the lives of people who use it - a valuable case to test the limits of the dominant harm reduction paradigm. Combining Galtung's theory of violence and zemiological categories of harm, this critical realist, ethnographic study contributes to the development of harm reduction policy, practice and theory in this context. It does so based on data collected through 41 semi-structured interviews, and eleven months of participant observation, sketching, photography and creative workshops among street-based people who use basuco. It finds that people who use basuco in Bogotá are subject to compounded violence at the intersection of the Colombian internal conflict and the global War on Drugs. A cycle of direct, structural and cultural violence produces harms far broader than those addressed by bio-behavioural harm reduction interventions, occurring across four interdependent zemiological categories of physical, economic, emotional and cultural harm. Common components of the generative mechanisms of harm across these categories include stigma and marginalisation, criminalisation and criminal violence, abstinence-dominated norms around drug use, a constraining global political economy, and the legacy and continued impact of the internal conflict. Reducing harm requires reducing the violence that produces it - or building peace. This study argues for more comprehensive and context-aware form of harm reduction, which could amount to an inclusive peace process in the War on Drugs. Developments in the Colombian peace process since 2022, under the Petro administration's banner of 'Total Peace', have begun to address the violence and harms faced by people who use basuco. Greater focus on the specific generative mechanisms of harm faced by people who use basuco could support greater reductions in these harms. This requires structural change towards more peaceful social conditions. Using Archer's concept of morphogenesis, this thesis argues that such change is possible by influencing the options agents have to respond to social conditions, thereby reshaping those conditions.