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SOC309Y1 (31)

Update on Harm-Reduction Policy and Intervention Research.pdf

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Robb Travers

INTRODUCTION WHAT IS HARM REDUCTION? Key Concepts Harm reduction is a pragmatic approach to reduce the harmful consequences of drug use and other high-risk activities by incorporating several strategies that cut across the spectrum from safer use to managed use to abstinence. The primary goal of most harm reduction approaches is to meet individuals where they are at and not to ignore or condemn the harmful behaviors, but rather to work with the individual or community to minimize the harmful effects of a given behavior. Harm-reduction interventions and policies are most often individualized to the specific needs and wants of the individual or community; thus, a universal harm-reduction program is not possible and would not be useful. Harm-reduction efforts, in general, are rarely one size fits all. The principles of harm-reduction efforts are often firmly rooted in the ideals f pragmatism, humanism, immediate and attainable goals, and the recognition that harmful drugs and risky behaviors have always been and always will be a party of society. According to Weatherburn, any intervention program r policy that is intended to reduce harm associated with drug use and problem behavior can be considered harm reducing, whereas harm reduction is defined as a measure that is “designed to reduce the harms associated with drug use by means other than reducing drug use” (e.g. needle and syringe exchange programs). The term harm minimization is intended to reflect an overall goal of policies to minimize harm. Ideally, harm reduction will be construed as a strategy within a larger public health framework. From Prevention to Treatment Programs consistent with a definition of harm reduction as a goal or strategy, any program that does not require abstinence and seeks to reduce harm could be considered and seeks to reduce harm could be considered a harm-reduction intervention. “the essence of harm reduction is the recognition that treatment must start from the client's needs and personal goals and that all change that reduces the harms associated with substance use can be regarded as valuable”. It is important to maximize the efforts of individuals by recognizing that people do have the ability to change their own behavior and that even with continued drug use, many associated harms can be reduced or avoid (infectious disease transmission). Policy Issues accepting harm reduction as a goal or strategy to be implemented across society requires acceptance of a more humanistic perspective rather than a medical or legal solution to a grievous social problem. The use of policy to control drug use has a controversial past and is still heavily debated by policy makers. Policies have been developed to reduce supply of drugs, restrict their use, and indict tens of thousands of individuals each year for illicit drug use. Over past 100 years, policies have been imposed that address both the demand and supply of drugs as well as policies to mitigate the harms of drug abuse. The ultimate goal of both supply-reduction and demand-reduction policies is to minimize or eliminate the use and abuse of illicit drugs, which is not the primary goal of those policies that are specifically designed to reduce the harms related to illicit drug use. Supply-reduction strategies the goal of supply-side reduction is to reduce the availability of illicit drugs. To maximize the efficiency of supply-reduction programs, most of the supply-side efforts have focused on drug sources, including illicit crops, drug laboratories, drug-trafficking organizations, and street dealers. Given that the international drug trade system is a global problem, the United Nation create a global agreement that was designed to target drug trafficking. In 1998, the U.N. GeneralAssembly adopted the Political Declaration to counter the world drug problem. Unfortunately, their efforts failed, and in many areas of the world drug production, drug use, drug trafficking, and drug-use-related HIV injections increased markedly. Support control efforts can also be harmful. Law enforcement practices associated with supply reduction result in the loss of civil liberties, increased risk of overdoes and disease, and higher rates of imprisonment. In addition, when the price of one drug increases due to supply reduction, the use of other drugs that are less expensive tends to increase. Demand reduction Demand-reduction measures include prohibition, treatment, awareness campaigns, preventive interventions, community social services, and support for families. Demand-reduction strategies include preventing eperimental use from becoming regular use, providing early intervention for risky consumption patterns, providing treatment and rehabilitation programs, and reducing drug-related health consequences. In general, demand-reduction practices have been viewed as successful. Statistics have shown that providing drug treatment not only s more humane but also is more efficient and cost effective. Harm-reduction policies HARM-REUDCTION PROGRAMS In general, a harm-reduction policy seeks to meet individuals where they are and provide assistance with helping individuals and communities reduce the harms associated with drug use and other risky behaviors. Needle Syringe Programs Syringe and needle programs have been implemented to reduce the spread of blood-borne diseases (including HIV and hepatitis) among injection drug users. The first government approved program occurred in Amsterdam in 1984. In addition, many syringe and needle exchange programs provide drug treatment referrals, peer education, and HIV prevention programs to the recipients of the clean needles. Arecent comprehensive review concluded that needle exchange programs are effective, safe, and cost- effective. Furthermore, extensive research has found no evidence that needle exchange programs cause any deleterious effects. Safe Injection Facilities many countries operate safe injection facilities where injection drug users can inject their own drugs using clean equipment with the supervision of medically trained personnel. Safe injection facilities are associated with significant reductions in needle sharing and reuse, overdoses, and injecting/discarding needles in public places. Supervised safe injection facilities also result in fewer fatalities due to overdose. Furthermore, it has been associated with a increase in detoxification service use and increased enrollment in other addiction treatment. Thus safe injection facilities appear to save lives by reducing overdose, reducing morbidity and morality associated with overdose, and increasing a perso
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