Pleasure is more or less absent from serious talk within medicine, though it is a common enough motive for, and element of, human activity. When it comes to drugs, pleasure is often positioned as the grounds upon which legal and moral distinctions (between licit and illicit instances) are made. Taking drugs for pleasure would appear to transgress the moral logic of ‘restoring health’ that guarantees medical legitimacy. But the undeniable importance and common appeal of pleasure might lead us to wonder whether this routine exclusion and disavowal of pleasure doesn’t serve to prop up the self-evidence of medical rationality. After all, enabling pleasure is also one of medicine’s most basic concerns. In this paper I consider how a more open acknowledgement of pleasure might help to reframe public health practice and policy concerning the use of illicit drugs. I use Foucault’s History of Sexuality to conceptualize practices of ‘harm reduction’ (the loose mix of policies and procedures that take distance from prohibitionist initiatives). Making reference to concepts such as ‘care of the self’ and the ‘use of pleasure’, I argue that Foucault’s work suggests a distinction between ‘therapeutic’ and ‘social pragmatic’ approaches to pleasure, and that this distinction may be useful for framing relatively de-pathologizing modes of care. While Foucault is often used to critique the regulatory effects of public health, my reading aims to develop a more flexible approach to the practices of bodies and pleasures – one that is critically attuned to the operation of disciplinary norms, capable of preventing specific dangers, but also open to embodied experimentation and the different possibilities of pleasure.

Dr Kane Race is a Senior Lecturer of Gender and Cultural Studies at the University of Sydney. He has published widely on questions of risk, government and ethics in the context of HIV prevention, sexual practice and drug use, and participates extensively in the social response to HIV/AIDS in Australia. His forthcoming book, Pleasure Consuming Medicine (Duke University Press) takes up questions of sex, drugs, citizenship and health, and provides a critical analysis of neoliberal discourses of drug use.

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