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PubMed2005

Drug use and harm reduction in Afghanistan.

Opium has been cultivated in Afghanistan since 1100 A.D., although production has steadily increased since 1979. Currently, Afghanistan produces three-quarters of the global opium supply, with injection drug use and HIV currently following the opium trade route through Central Asia. Although systematic studies are lacking, heroin use appears to be on the rise in Afghanistan. The purpose of this paper is to briefly provide historical background and current statistics for drug production and use in Afghanistan, to discuss the new government's policies towards problem drug use and available rehabilitation programs, and to assess Afghan harm reduction needs with consideration of regional trends.

Journal Article↗
PubMed1994

Is the prescription of amphetamine justified as a harm reduction measure?

Although amphetamine is the most widely illicitly used drug in the United Kingdom after cannabis, relatively few problematic users present to treatment agencies. Injecting amphetamine users are a high risk group as far as HIV transmission is concerned. This paper reviews the first 3 years' operation of an oral amphetamine prescribing programme for injecting users. Over half the subjects ceased injecting, and there was a considerable reduction in injecting by the remainder. 85% had not used or shared injecting equipment during the programme. However, subjects reported still using street amphetamine and offending, although at a lower rate than previously. There was little change in sexual practices. There was an increase in primary amphetamine users presenting for treatment. There is a case to be made that closely controlled and monitored programmes such as this can be justified on harm reduction grounds. A number of issues concerned with amphetamine prescribing are discussed.

Administration, Oral↗
PubMed2006

Condomless sex: gay men, barebacking, and harm reduction.

Social science research as well as a rise in sexually transmitted diseases and new HIV infections among men who have sex with men point to increasing numbers of gay men engaging in unprotected anal intercourse without condoms, a practice called "barebacking". There is some evidence that barebacking is linked to the rise of crystal methamphetamine use (by men of all races and socioeconomic groups) and surfing the Internet to locate sex partners, although these are not the only factors contributing to this phenomenon. This article summarizes current research findings on sexual risk taking among gay men, discusses psychosocial issues that contribute to barebacking, and suggests a harm-reduction approach to clinical work with gay men who bareback as an effective method of addressing the behavior.

Condoms↗
PubMedDate not supplied

Therapeutic communities: AIDS/HIV risk and harm reduction.

The limited survey data available suggest that therapeutic communities have increasingly organized themselves to develop HIV prevention programs and to integrate HIV-infected and AIDS clients into the treatment community while providing specialized program as necessary. Nonetheless, there remains a need for a comprehensive survey of the response of therapeutic communities to AIDS and the risk of HIV infection. There is need as well for studies that can build on findings linking retention in the therapeutic community to strategies that focus on clients' motivation or readiness for treatment. In addition, therapeutic community programs can ally with outreach programs both to provide priority admission to seropositive clients, women with children, adolescents, and criminal justice clients, and to provide harm reduction services to those unwilling to enter treatment while also taking incremental steps to engage those clients in ever increasing behavior change initiatives.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department.

This study evaluated the use of a brief motivational interview (MI) to reduce alcohol-related consequences and use among adolescents treated in an emergency room (ER) following an alcohol-related event. Patients aged 18 to 19 years (N = 94) were randomly assigned to receive either MI or standard care (SC). Assessment and intervention were conducted in the ER during or after the patient's treatment. Follow-up assessments showed that patients who received the MI had a significantly lower incidence of drinking and driving, traffic violations, alcohol-related injuries, and alcohol-related problems than patients who received SC. Both conditions showed reduced alcohol consumption. The harm-reduction focus of the MI was evident in that MI reduced negative outcomes related to drinking, beyond what was produced by the precipitating event plus SC alone.

Adolescent↗
PubMed1999

Prevention and harm reduction for chemical dependency: a process perspective.

Clinical psychology is often on the periphery of treatment and prevention efforts to stop substance abuse and dependence. This article describes the current status of prevention research and practice, outlines a process perspective on the initiation and cessation of drug use and abuse, and offers some new ideas about how psychology can and should become involved in the prevention of chemical dependency. Psychologists are faced with the precursors and consequences of chemical dependency on a daily basis. With improved training and increased awareness, and aided by a process perspective, psychology and psychologists can play an important role in preventing the onset of chemical dependency, creating early interventions to stop the process of initiation, and becoming more involved in treatment and harm-reduction efforts. Psychologists have the basic training and the biopsychosocial orientation that could make them effective agents for primary, secondary, and tertiary prevention of chemical dependency.

Attitude to Health↗
PubMed2006

Engagement, reciprocity and advocacy: ethical harm reduction practice in research with injecting drug users.

In this paper, we contribute to the ethical challenges of harm reduction-based research by describing and reflecting on our experiences of initiating and maintaining relationships with research participants during an innovative neighbourhood-based study of the social and molecular epidemiology of the hepatitis C virus among injecting drug users over a 2-year period. We show through examples of our work how recruitment to our study had practical value for both researchers and study participants including advocacy and reciprocity. We argue that the recruitment process needed to be flexible, able to cope with the demands of the street drug market, and that we as researchers need to engage participants in their own environments as much as possible. We conclude with a series of recommendations for other researchers such as the need to employ appropriately skilled researchers who are flexible, innovative and comfortable in street settings, and for the setting of realistic time-frames for preliminary research, data collection and feedback and analysis.

Biomedical Research↗
PubMed2001

Prevalence of hepatitis C among injection drug users in England and Wales: is harm reduction working?

OBJECTIVES: This study sought to establish the prevalence of hepatitis C antibodies (anti-HCV) and hepatitis B antibodies (anti-HBc) among injection drug users in England and Wales. METHODS: A voluntary cross-sectional survey collected oral fluid samples and behavioral information; 2203 injectors were recruited through drug agencies, and 758 were recruited in the community. RESULTS: Prevalence was 30% for anti-HCV, 21% for anti-HBc, and 0.9% for HIV antibodies. Anti-HCV prevalence rates were significantly greater among those with longer injecting careers, those in older age groups, those residing in London, those recruited in drug agencies, those positive for anti-HBc, and those with a previous voluntary HIV test. CONCLUSIONS: Anti-HCV prevalence rates among injectors in England and Wales, where comprehensive harm reduction programs exist, are lower than rates in other industrialized countries.

Adult↗
PubMed2001

Quality control by cocaine users: underdeveloped harm reduction strategies.

The use of any drug involves both values and rules of conduct (social sanctions) and patterns of behavior (social rituals). Based on an ethnographic study (1996-1999) among 111 cocaine users from the metropolitan area of Antwerp (Belgium), the self-regulatory mechanisms surrounding the methods of controlling the quality of a drug are described. Users' perceptions of reliable and unreliable sources of cocaine, quality and adulteration of cocaine and quality control techniques are confronted with objective information. It is argued that these informal control mechanisms may be crucial factors in the controlled use of any intoxicant, but myths are an important ingredient of the observed rituals, which indicates that knowledge about certain drugs and the best ways to use them in a safe way is still underdeveloped. Users are left to their own folk-experimental devices for testing tools or techniques, and many aspects of the natural processes of social learning are generally not based on objective information. Future harm reduction interventions should therefore also stimulate the development and dissemination of effective informal control mechanisms among illicit drug users.

Amphetamines↗
PubMed1993

Social change and the control of psychotropic drugs-risk management, harm reduction and 'postmodernity'.

This paper argues that in order to understand the broad tide of change in drug control in recent times, we need to link these changes to a general understanding of social change. The paper sketches out how modern society arose and how it is giving way to the postmodern. Two themes are then developed. The first concerns the way that the state shrinks in postmodernity and links this to drug control, mentioning the example of random drug testing in the workplace as a good example of the change. It then moves to looking at the related shift in social control regimes from the 'corporal' regime of the premodern through the 'carceral' regime of the modern to population and risk management in the postmodern. It argues that in society in general there is a tension between carceral discipline and the amoral management of risk and that this is exhibited in drug control as a struggle between individual treatment and law enforcement on the one hand and 'harm reduction' on the other. This is illustrated by reference to a persistent tension within the NCADA enterprise.

Journal Article↗
PubMed2004

Hepatitis C and its risk management among drug injectors in London: renewing harm reduction in the context of uncertainty.

AIM: Recognizing the dearth of qualitative research on hepatitis C virus (HCV) infection associated with injecting drug use in the UK, this paper summarizes qualitative insights from a study exploring the social relations of HCV risk management among drug injectors in London. METHOD: Adopting an inductive approach to data collection and analysis, 59 depth tape-recorded qualitative interviews were undertaken in 2001 with drug injectors recruited via drug user networks. RESULTS: While access to injecting equipment was reportedly good, needle and syringe sharing continued in exceptional circumstances and in the context of 'trust relationships'. Analyses of drug injectors' accounts of variations of 'I never share' showed that this construction denoted less a descriptor of actual risk behaviour than presentation of perceived risk status. Paraphernalia sharing, including spoons and filters, was common. There was much confusion and uncertainty concerning HCV knowledge, including its medical and transmission risks. Injectors were aware of the provisionality and partiality of their HCV knowledge. Confusion also surrounded the meaning of HCV antibody test results, with some feeling that their positive diagnosis had been 'trivialized' by their experiences of HCV testing. Injectors tended to make sense of HCV risk in relation to HIV. With most viewing HCV prevalence as high and HCV transmission as an inevitable consequence of injecting, HCV risk was perceived as ubiquitous and unavoidable. CONCLUSIONS: There is an urgent need to renew UK policies of harm reduction in order to support perceptions that HCV is avoidable and preventable.

Adolescent↗
PubMed2006

Aiming at Tobacco Harm Reduction: a survey comparing smokers differing in readiness to quit.

BACKGROUND: Greece has the highest smoking rates (in the 15-nation bloc) in Europe. The purpose of this study was to investigate Greek smokers' intention and appraisal of capability to quit employing the theoretical frameworks of Decisional Balance (DB) and Cognitive Dissonance (CD). METHODS: A cross-sectional study including 401 Greek habitual smokers (205 men and 195 women), falling into four groups according to their intention and self-appraised capability to quit smoking was carried out. Participants completed a questionnaire recording their attitude towards smoking, intention and self appraised capability to quit smoking, socio-demographic information, as well as a DB and a CD scale. RESULTS: The most numerous group of smokers (38%) consisted of those who neither intended nor felt capable to quit and these smokers perceived more benefits of smoking than negatives. DB changed gradually according to smokers' "readiness" to quit: the more ready they felt to quit the less the pros of smoking outnumbered the cons. Regarding relief of CD, smokers who intended but did not feel capable to quit employed more "excuses" compared to those who felt capable. Additionally smokers with a past history of unsuccessful quit attempts employed fewer "excuses" even though they were more frequently found among those who intended but did not feel capable to quit. CONCLUSION: Findings provide support for the DB theory. On the other hand, "excuses" do not appear to be extensively employed to reduce the conflict between smoking and concern for health. There is much heterogeneity regarding smokers' intention and appraised capability to quit, reflecting theoretical and methodological problems with the distinction among stages of change. Harm reduction programs and interventions designed to increase the implementation of smoking cessation should take into account the detrimental effect of past unsuccessful quit attempts.

Journal Article↗
PubMed1997

Harm reduction measures and injecting inside prison versus mandatory drugs testing: results of a cross sectional anonymous questionnaire survey. The European Commission Network on HIV Infection and Hepatitis in Prison.

OBJECTIVES: (a) To determine both the frequency of injecting inside prison and use of sterilising tablets to clean needles in the previous four weeks; (b) to assess the efficiency of random mandatory drugs testing at detecting prisoners who inject heroin inside prison; (c) to determine the percentage of prisoners who had been offered vaccination against hepatitis B. DESIGN: Cross sectional willing anonymous salivary HIV surveillance linked to a self completion risk factor questionnaire. SETTING: Lowmoss prison, Glasgow, and Aberdeen prison on 11 and 30 October 1996. SUBJECTS: 293 (94%) of all 312 inmates at Lowmoss and 146 (93%) of all 157 at Aberdeen, resulting in 286 and 143 valid questionnaires. MAIN OUTCOME MEASURES: Frequency of injecting inside prison in the previous four weeks by injector inmates who had been in prison for at least four weeks. RESULTS: 116 (41%) Lowmoss and 53 (37%) Aberdeen prisoners had a history of injecting drug use but only 4% of inmates (17/395; 95% confidence interval 2% to 6%) had ever been offered vaccination against hepatitis B. 42 Lowmoss prisoners (estimated 207 injections and 258 uses of sterilising tablets) and 31 Aberdeen prisoners (229 injections, 221 uses) had injected inside prison in the previous four weeks. The prisons together held 112 injector inmates who had been in prison for more than four weeks, of whom 57 (51%; 42% to 60%) had injected in prison in the past four weeks; their estimated mean number of injections was 6.0 (SD 5.7). Prisoners injecting heroin six times in four weeks will test positive in random mandatory drugs testing on at most 18 days out of 28. CONCLUSIONS: Sterilising tablets and hepatitis B vaccination should be offered to all prisoners. Random mandatory drugs testing seriously underestimates injector inmates' harm reduction needs.

Cross-Sectional Studies↗