What Is Harm Reduction?
One of the central tenets of harm reduction is the acceptance that the world will never be completely free of drugs, according to the Drug Policy Alliance. The idea behind harm prevention then is to decrease the risk and suffering related to drug use instead of hopelessly trying to eliminate drugs completely. The genesis of this concept can be traced back to the era when HIV was spreading at a rapid rate among intravenous drug users, but harm reduction has since expanded to cover a wide range of substances and practices.
Harm reduction accepts that there are people who are reluctant or unwilling to cease their use of drugs, and reducing harm is viewed as better than trying to force an individual to do something that they’re not willing or ready to do, according to Harm Reduction International (HRI). HRI asserts that some drug users don’t need treatment, but there is still a need to help them minimize risks related to their drug use. Harm reduction often employs a more informal approach to drug use, which can be appealing to people who want to avoid a clinical setting.
Principles of Harm Reduction
The Harm Reduction Coalition (HRC) lays out the following principles of harm reduction:
- Acceptance that illicit drug use is part of the world
- The choice to mitigate consequences of drug use instead of ignoring them
- Understanding that the concept of drug use and reasons for it are complex
- Acceptance that some forms of drug use are safer than others
- The establishment of a quality of life that doesn’t necessarily require cessation of drug use
- Provision of services to those in need without judgement
- The ability of drug users to have a say in programs and policies related to drug use
- The utilization of drug users themselves as a central part of harm reduction
- The sharing of information between drug users
- Recognition that a variety of factors can impact an individual’s ability to cope with drug-related harm
- The ability to avoid diminishing the harm associated with drug use
Harm Reduction Services
There are a multitude of services commonly associated with harm reduction. One of the better known is the distribution of sterile needles to intravenous drug users. The concept of harm reduction at least partially grew out of the epidemic of disease being spread through intravenous drug use, and the idea of providing such individuals with clean needles is not a new one. The rationale behind this concept is that, in many cases, a drug user is going to use no matter what, so it’s better that they do so with a sterile needle rather than be at risk for contracting a disease via a dirty one.
Opioid replacement therapy is another service that falls under the umbrella of harm reduction. In such cases, an individual who is addicted to a dangerous opioid, such as heroin, is given access to licit opioid medications that put them at a much lower risk for negative health consequences. The opioids they are given prevent them from going into withdrawal, thus decreasing the likelihood of resorting to illicit substances to quell symptoms.
Historically, the most common medication used in opioid replacement therapy is methadone. Methadone has been used for many years to treat those addicted to heroin or prescription opioid pain killers, and it is considered to be safe when taken properly. Buprenorphine is another substance that has become more popular in the world of opioid replacement therapy more recently, as it has seen substantial success in reducing opioid abuse.
Facilities for supervised consumption of drugs have been opened in an effort to provide individuals with a safe and controlled environment for drug use. Peer support programs, outreach efforts, and education services are examples of some other harm reduction strategies that have been implemented.
Controversy Surrounding Harm Reduction
Despite harm reduction being a well-established movement, it remains steeped in controversy. There is evidence to suggest that harm reduction can help to reduce the spread of diseases transmitted through sharing needles, such as HIV and hepatitis. It has also been found to reduce overdose deaths, according to the BC Centre for Disease Control. Other benefits include a reduction in public drug use, reduced crime among drug users, increased employment among drug users, increased education about safer drug practices, and increased safe sex practices among drug users.
However, some individuals disagree with some harm reduction practices. For example, some people see supervised injection sites as taxpayers paying for drug users to continue to harm themselves. Others see such practices as giving up in the fight against illicit drugs. Many of the individuals who are against harm reduction see many of the programs as enabling and even encouraging drug use.
Effectiveness of Harm Reduction
Harm reduction may see its fair share of controversy, but there is evidence to back up its effectiveness. HRI conducted a review of the matter, and it found varying levels of effectiveness across the spectrum of harm reduction programs. Methadone and other replacement therapies were found to definitively work when it came to opioid-addicted individuals. Needle and syringe programs also saw concrete evidence of their effectiveness.
Some harm reduction programs show promise, but they are not definitively effective at the time the review was conducted. Included in this category are depenalization, the prescription of heroin, pill testing, and supervised use facilities.
Many of the education programs used in harm reduction were considered to be under-researched, according to the review. This does not necessarily mean that information and communication initiatives are ineffective, but further research should be done to determine just how effective they are.
Despite the controversy surrounding harm reduction, there is evidence to back up the effectiveness of specific programs while the effectiveness of others remains unclear. As a result, harm reduction is likely an issue that will remain polarizing for quite some time.
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