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What is harm reduction?

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What is harm reduction?


“The task of the State is not to make the poeple happy but to minimise the avoidable suffering” Karl Popper

Harm reduction is a combination of strategies and programmes to minimise the harmful effects of drug and alcohol abuse. The term itself has been used since the 1980s, when new programmes emerged to try to stop the spread of HIV. One such programme involves the provision of free hypodermic needles for drug users who inject. The objective was to stop the spread of infections and diseases like HIV that came as a result of intravenous drug use. This strategy seemed to be effective: the spread of HIV and other infections slowed among drug users.

The main aims of harm reduction in a narcotics sense are to stop the spread of HIV and hepatitis, as well as reduce the rate of drug overdoses and improve the living standards of intravenous drug users. A secondary goal of harm reduction is to put drug users back on the right track towards kicking their addiction. The first step is not to get addicts to quit their dependence overnight, but to encourage them to gradually turn to ever softer, less harmful drugs.

In the past 20 years the harm reduction project has helped change attitudes about drugs and drug users. Experts do not see the drug users as the root of the problem, rather see them as partners in reducing the problem. The methods have also changed, evolving from a quick-fix to a softly-softly approach.

It does not mean that harm reduction goes hand in hand with decriminalising or legalising soft drugs. There is no moral theory or belief, rather a desire to act practically to deal with the physical effects.

Harm reduction procedures

Practical measures in harm reduction programmes include:

  • provision of free hypodermic needles
  • drug substitution, or having medical alternatives to narcotics prescribed by doctors
  • a party service, where trained staff offer their services at parties where drugs are likely to be in circulation
  • a monitoring service to follow up on ex-addicts
  • provision of social workers to help homeless drug users

Some addictions are easier to treat medically than others: heroin addiction can be cured with methadone therapy, whereas there is not yet a satisfactory substitute for cocaine. Researchers see possibilities in substituting cocaine, for example dexametamphetamine and modalphinil, while other possible solutions include chewing coca-leaf or drinking coca-tea.

Harm reduction extends to legal drugs such as alcohol, where an example tactic is the introduction of unbreakable glasses in pubs to limit the consequences of fights. This reduces the potential for harm. For smokers there are nicotine patches and gums as well as electronic cigarettes, the safety of which is still a subject of some debate.

What are the results of these projects?

These projects can only be successful if they become part of national health and social care programmes, according to Mitchel Kazatchkine, director of The Global Fund to Fight AIDS, Tuberculosis and Malaria. Harm reduction projects should work in parallel with government projects and the law. In most eastern European countries, harm reduction programmes are unlikely to be successful partly because they do not have political support. In some countries these programmes are even banned.

Free and clean needle initiatives and methadone therapy have proved their effectiveness in the fight against HIV: 40 percent of all European intravenous drug-users receive some medical care and can live a more or less normal life. Methadone reduces the number of fatal overdoses and is also effective therapy for drug-users in prisons.

The so called ‘public-rooms’, where drug-users can inject themselves in a safer environment, began to appear in Western Europe in 1986, and since then more than 90 such facilities have been opened. Studies show that the open use of drugs, did not grow as a result of the public-rooms. Studies in Vancouver even suggest that drug-related crime decreased with the opening of such public-rooms.

Prevention vs Harm reduction

The effectiveness of high school lectures that aim to prevent young people getting into drugs are not yet proven. Some studies even show that forceful anti-cigarette or anti-drug campaigns can be counter-effective.

The most effective projects have proven to be those in which young people tell their own stories and recount their own bad experiences. Their words are more credible than those of teachers or experienced drug counsellors. One such project on a European level is Unplugged.

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