When in a drug epidemic should the policy objective switch from use reduction to harm reduction?

A heated debate in drug policy concerns the relative merits of "harm reduction: (e. g., reducing drug-related HIV/AIDS transmission) vs. "use reduction" (controlling drug use per se). This paper models whether shifting emphasis between these goals over the course of a drug epidemic might reduce social costs relative to pursuing one or the other exclusively. Results suggest different answers for different drugs and/or countries. In particular, harmreduction may have always been effective for Australia's injection drug use problem, but for US cocaine it may not have been in the past even if it could be so today. In certain circumstances harm reduction may "tip" an epidemic toward a high-rather than low-use equilibrium. The location in state space of regions where this occurs can be sensitive to parameter changes, suggesting caution may be in order when advocating harm reduction, unless there is confidence the epidemic has been modeled and parameterized accurately. (C) 2009 Elsevier B. V. All rights reserved.