From pleasure and connection to harm reduction and policy failure, a look at what decades of drug enforcement got wrong about human behavior.
The conversation around drugs has long been framed by cost. Policymakers calculate the billions lost every year to productivity gaps, hospitalizations, law enforcement and incarceration. The U.S. alone spends an estimated $193 billion annually dealing with the fallout of illicit drug use, according to the National Institute on Drug Abuse.
Yet there is a blind spot. People do not only use drugs because of the usual suspects: trauma, poverty or pathology. They also use them because they feel good. Pleasure. Connection. Belonging. A stronger sense of self.
There is an old joke that goes: “Do you know what’s the problem with drugs? That they feel too good.” And it is spot on. Ignoring this basic human driver has a cost of its own.
Researchers and frontline harm-reduction workers are now introducing a radical, almost counterintuitive idea: what if drug policy and education started not from fear, but from pleasure? What if acknowledging the real reasons people use could reduce overdoses, improve mental health and save governments millions?
As Valentine and Fraser noted in their 2008 study of methadone patients: “Although pleasurable and problematic drug use are often thought to be mutually exclusive, pleasure is reported from both the effects of drugs such as heroin and methadone and from the social worlds of methadone maintenance treatment.”
This is the frontier of “pleasure management” or “pleasure maximization,” a new way of thinking about consumption that blends economics, public health and lived experience. Daniel Bear and colleagues argue that harm reduction too often “foregrounds risks at the expense of benefits.” Their framework of Mindful Consumption and Benefit Maximization (MCBM) begins by asking users why they consume, what benefits they seek and how to reduce risks while preserving those benefits.
Zara Snapp, director of Instituto RIA in Mexico, reminds us that this is not a new invention. She points to ancestral traditions across Latin America where psychoactive plants were used to foster vision, knowledge and connection to the sacred. In this sense, today’s debates about pleasure management are part of a much longer human story about using substances for meaning and wellbeing, not only risk.
Silvia Inchaurraga, a psychoanalyst and president of ARDA (the Harm Reduction Association of Argentina), frames it in terms of rights: “The concept of harm reduction cannot stand without legitimizing the right of people to consume drugs… interventions must always start from recognition of this right and the user as a citizen.” She argues that pleasure management challenges abstentionist logics that seek to eliminate risk altogether, instead of acknowledging that people use for multiple reasons, including wellbeing.
Why People Really Use
A 2017 systematic review by Guise and colleagues looked at 41 studies on why people initiate injection. They found that choices were rarely about desperation alone. People began injecting to seek pleasure, respond to rising tolerance, secure belonging and cope with trauma.
Sexual pleasure is another driver. In a study of African American MDMA users, Khary Rigg found four main motives: altering the effects of marijuana and alcohol, enhancing sexual pleasure, prolonging performance and encouraging partners to experiment. As one participant put it, ecstasy was a tool for “freaky” sexual experiences.
These findings break with stereotypes. While White ravers often describe MDMA use in terms of empathy or connection with music, Rigg’s participants focused on sex. The difference is more than cultural nuance. It is a reminder that pleasure is not monolithic. Harm-reduction messages need to be specific to the communities they aim to serve.
Even in contexts we label “problematic,” pleasure is part of the story. Valentine and Fraser’s methadone patients said they enjoyed not only the effects of heroin or methadone but also the social life that treatment programs created. Methadone clinics were not just about survival. They were also spaces of joy and belonging.
Harm Reduction From Below
If pleasure motivates use, it also motivates care: people are not reckless, and often develop their own strategies to balance enjoyment with safety.
In Brooklyn, queer nightlife workers told researcher Tait Mandler how they carefully balanced chemicals to sustain performance and avoid harm. Far from reckless, this was intentional “curation” of highs and safety.
Snapp sees the same thing across Latin America. “Managing pleasure means understanding that people seek connection, empathy and a sense of being interconnected. Substances can help foster that, to generate greater awareness,” she told me. She also points to drug-checking services like Checa Tu Sustancia in Mexico and Échele Cabeza in Colombia, where users are asked why they consume, how often, and why they test their substances. “The answers were simple: to enjoy it, to feel good. And the outcome is fewer ambulance calls, fewer overdoses, and less strain on public resources.”
In Argentina, Inchaurraga and ARDA have carried this into public campaigns for decades, with slogans like “Si te picas, léeme” [If you inject yourself, read me] (2000), “Si consumís igual tenés derechos” [If you consume, you still have rights] (2005), and most recently, “Chequeaste tus pastis?” [Did you check your pills?] (2024). These messages, shared in clubs, festivals and universities, normalize dialogue about both risks and pleasures, making harm reduction visible in everyday life.
For Snapp, these services embody collective care. They are not only technical interventions but spaces where people can talk openly about their practices, share strategies and make better decisions together. She also contrasts this with how alcohol and tobacco are normalized despite the enormous harm they can cause, arguing that pleasure management offers “another side of the coin,” a chance to build healthier cultures of enjoyment and self-regulation.
Sheila Vakharia, managing director of research at the Drug Policy Alliance, reminds us that harm reduction itself was born as a peer-led practice: people who used drugs organized to keep each other safe, insisting that their motives, from coping to connection to joy, were valid. “Harm reduction was started by people who use drugs to keep one another safe… many harm reductionists acknowledge that maximizing pleasure while reducing risk should be a key part of the work,” she says.
Even formal services reflect this shift. In Frankfurt, Duncan and colleagues documented how supervised drug-consumption rooms created not only safer conditions but also new kinds of pleasure: safety, dignity and belonging (Duncan et al., 2017).
Taken together, these stories show that pleasure management is not an abstract concept. It is visible in clubs, in clinics and in communities. What is missing is recognition and support from policymakers.
The Real Costs And Potential Savings
If people and communities are already managing their consumption, the question becomes: why is policy not keeping up, and what is that lag costing us?
Most public spending on drugs is reactive and punitive. Police budgets, courtrooms, prison beds and emergency room visits absorb the majority. Very little goes to preventing those costs by addressing why people use in the first place.
These are not inevitable costs. As a Drug Policy Alliance report shows, they are the direct result of the global war on drugs, a policy that not only maximizes harm but also disproportionately impacts low-income communities, women, Black people and Latinos. In other words, governments are not just overspending; they are overspending on policies that worsen the very problems they claim to solve.
The research is clear. In a study of sexual minority adults using the 2017 National Survey on Drug Use and Health, Yockey and colleagues found that 21.9% reported tranquilizer use in the past year. Risk factors included being female, over 35, polydrug use and loss of pleasure in once pleasurable activities. In other words, depression and stress were fueling consumption. Addressing these realities before they spiral into crises is far less expensive than waiting for overdoses or hospitalizations.
Inchaurraga emphasizes the economic dimension: “Policies that criminalize end up multiplying costs. What we need are policies that reduce harm and recognize the motivations of use. That is where the savings are.” Her association’s programs back this up with numbers. In one early study of injection-kit distribution in Rosario, 5 to 6 of every 10 people reached entered health services for HIV testing, counseling or treatment. More recently, ARDA deployed more than 100 harm-reduction devices at parties across five provinces, reached over 21,000 people with information, and tested 1,600 drug samples, finding that 18% contained something different than expected. These interventions reduce overdoses, cut hospitalizations and connect users to care, lowering long-term costs.
Vakharia adds a policy perspective: “The policies we have drafted and passed to allow for adult use of marijuana are probably the clearest illustration of our acknowledging pleasure as a motivator.”
And Snapp connects the dots to human rights: “According to the United Nations, more than 83% of people who use illegal drugs do so without developing problematic patterns. This framework responds to them and the need for information, services that don’t demand abstinence and ultimately a safe supply through legal regulation.” She also notes that while resistance persists (critics often claim that talking about pleasure “promotes use”), some governments are beginning to adopt the language. In Uruguay and even in Iztapalapa and Mexico City, local officials have started to frame public programs around the idea of managing pleasure, signaling that the concept is entering mainstream policy debates.
Inchaurraga observes the same dynamic in Argentina: public health discourse often accepts harm reduction only as HIV prevention, but resists legitimizing pleasure as a health goal. This, she warns, leaves rights unaddressed and perpetuates stigma.
Compare this with what governments currently spend on police, prisons and courts. These investments not only fail to reduce use but also compound costs through stigma and exclusion. International models back up the alternative. Studies of supervised consumption spaces in Europe and Canada show that these services prevent HIV infections, reduce emergency calls and lower overdose deaths. Each avoided overdose can save tens of thousands of dollars in hospital care. Every avoided arrest frees up courtrooms and prison cells.
The real cost of drug use is not that people seek pleasure. It is that policy continues to ignore it.
Toward Pleasure Management
The evidence points in one direction. Harm reduction alone is not enough. To cut costs and improve lives, policy must embrace pleasure management.
Pleasure management is not a break from harm reduction but an extension of it. For decades, grassroots harm-reduction programs have recognized the dimensions of pleasure and the right to sovereignty over one’s body. What is new is the visibility and urgency of these approaches in a global landscape where criminalization has failed, and people are politicizing to demand pragmatic, rights-based responses.
Bear and colleagues’ Mindful Consumption and Benefit Maximization framework is one proposal. It critiques harm reduction for focusing on risks while sidelining benefits, and urges educators to help people reflect on motives, desired effects and strategies to maximize benefits while minimizing harms.
Other researchers, like David Nutt in the UK, have reinforced this point with comparative harm rankings. His landmark Lancet study found that alcohol, a legal drug, causes more overall harm than heroin or crack cocaine—largely because of its massive impact on others through violence, accidents, and social costs. The implication is clear: prohibitionist classifications do not match real-world evidence of harm.
Snapp and Instituto RIA stress the cultural and political importance: “We see this as deeply linked to self-care and collective care… understanding that people who use substances, even controversial ones, do so, often, to feel good or to alleviate some pain, which also connects to wellbeing.” She frames it not just as a pragmatic tool but as part of a rights-based drug policy, arguing that recognizing pleasure is also about protecting dignity and ensuring that people who use drugs are treated as people with agency, not pathologized or excluded. These programs also serve as important spaces to politicize and organize the drug policy reform movement.
Inchaurraga and her colleagues at ARDA take a governance view: interventions should begin from recognition of the right to consume as citizens, not criminalize it.
Even in supervised consumption rooms, Duncan et al. found that pleasure and safety can coexist. People reported new forms of satisfaction in being treated with dignity and care. Mandler’s work in Brooklyn nightlife shows the same: users already regulate dosage, timing and substance choice to balance fun with function. These grassroots strategies are proof that pleasure management is real and scalable.
Three pillars stand out:
- Mindful use. Integrate MCBM concepts into education so people think intentionally about consumption.
- Community spaces. Support safer-use environments that reduce emergencies and create belonging.
- Tailored messaging. Recognize that motivations differ by culture, gender and context. Harm reduction must reflect those realities to work.
As Vakharia concludes: “Pleasure and recreation are among the biggest motivators for substance use of all kinds, so it needs to be incorporated into conversations about safety and policy.”
From Fear To Pragmatism
Drug policy has long been guided by fear. Billions are poured into punishment and cleanup while one of the biggest drivers of use, pleasure, is ignored. The result is a system that is both costly and ineffective.
The evidence from researchers and practitioners points to a different path. Mindful consumption, community spaces and culturally tailored messaging all show that pleasure management is not only possible, it is already underway. People are planning, moderating, sharing and experimenting responsibly. Services that acknowledge this reality reduce emergencies, save lives and cut costs.
These shifts are not only local. At the international level, the consensus that has long underpinned global drug control is starting to crack. In 2025, Colombia led a historic resolution at the UN Commission on Narcotic Drugs, securing the first-ever independent review of the drug control treaties. For the first time, prohibition itself will be under external scrutiny. Pleasure management and harm reduction are part of this broader paradigm shift away from punishment and toward evidence, rights, and pragmatism.
For governments, the choice is stark. Keep spending on prison beds and ER visits, or redirect a fraction of that money toward interventions that reflect why people actually use drugs. The return on investment is obvious.
Pleasure management is not a luxury. It is rights-based, pragmatic economics and smarter public health. And above all, more just and more humane.
Disclaimer: This article discusses emerging research and policy debates around drug use and harm reduction. It is not intended to promote or encourage substance use. Readers should comply with applicable laws and consult health professionals for medical advice.
This story was originally published on Forbes in August 2025 and has been updated and adapted for High Times with permission.
Photo: Shutterstock
