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PubMed2005

Alcohol policy and harm reduction in Australia.

With consultations having been held across Australia this year as part of the process of developing a new National Alcohol Strategy, it seemed timely to invite my colleagues from the National Drug Research Institute who are experts in the alcohol field to write this Harm Reduction Digest. The authors have canvassed a range of alcohol policy options and discussed their effectiveness in reducing harm for what is arguably Australia's number one drug problem. Australia's response to alcohol and other drug problems has, historically, been based on 'harm minimization--incorporating supply reduction, demand reduction and harm reduction'. At this time where the policy options for alcohol are being set for the next 5 years in a climate of 'small government', removing restrictions of 'fair competition' in business and a belief in the free market, what does the research have to say about recommended policies and strategies to reduce alcohol-related harm?

Alcohol-Related Disorders↗

PubMed2006

Getting clean and harm reduction: adversarial or complementary issues for injection drug users.

Many contemporary HIV prevention interventions targeting injection drug users (IDUs) have been implemented using Harm Reduction as a theoretical framework. Among drug-using individuals, however, the abstinence-based "getting clean" models espoused by Narcotics Anonymous and other widely adopted approaches to drug treatment are often more readily accepted. This paper describes an ethnographic examination of the ideological dichotomy between Harm Reduction and abstinence-based "getting clean" treatment model which emerged during the piloting phase of an HIV prevention intervention in Baltimore City, Maryland, USA. This paper describes how the conflict was identified and what changes were made to the intervention to help resolve the participants' dichotomous thinking concerning their substance abuse issues.

Anthropology, Cultural↗

PubMed2000

Early results from a school alcohol harm minimization study: the School Health and Alcohol Harm Reduction Project.

AIMS: The School Health and Alcohol Harm Reduction Project aims to reduce alcohol-related harm by enhancing students' abilities to identify and deal with high-risk drinking situations particularly likely to be encountered by young people. DESIGN: The SHAHRP study has adopted a quasi-experimental research design, incorporating intervention and control groups and measuring change over a 3-year period. SETTING: The study is set in metropolitan, government secondary schools (13-17-year-olds) in Perth, Western Australia. The 14 schools involved in the SHAHRP study represent approximately 23% of government secondary schools in the Perth metropolitan area. PARTICIPANTS: The sample was selected using cluster sampling, with stratification by socio-economic area, and involves over 2300 intervention and control students from junior secondary schools. Seventy-three per cent (73.7%) of students completed surveys at both baseline and first follow-up. INTERVENTION: The intervention incorporated evidence-based approaches to enhance potential for behaviour change in the target population. The intervention is a curriculum-based programmeme with an explicit harm minimization goal and will be conducted in two phases over a 2-year period. MEASURES AND FINDINGS: The early results of the study demonstrate initial knowledge and attitude change, predicted by the students' involvement in the intervention. A surprising impact of the first phase of SHAHRP was the significant difference in alcohol consumption and harms between control and intervention groups, with the SHAHRP group demonstrating a significantly lower increase in alcohol consumption than the control group. Students who were supervised drinkers at baseline and who received the SHAHRP intervention were overwhelmingly represented in the change results. CONCLUSIONS: Results from phase one of the SHAHRP study suggest that classroom-based alcohol education programmemes can reduce harm, particularly in students who are supervised drinkers prior to the intervention.

Adolescent↗

PubMed1999

A framework for the evaluation of activities and programs with harm-reduction objectives.

This paper presents a framework for the evaluation of activities and programs with harm-reduction objectives that draws attention to the logic, implementation, outcomes, costs, and cost-effectiveness of these initiatives and encompasses stakeholder concerns and theoretical models. Evaluations of harm-reduction initiatives are essential if their proponents wish to establish them as viable alternatives to abstinence-oriented approaches. [Translations are provided in the International Abstracts Section of this issue.]

Canada↗

PubMed2002

Barcelona 2002: law, ethics, and human rights. The need for harm-reduction approaches in Eastern Europe and the former Soviet Union.

In a region where HIV is spread primarily by injection drug use, harm-reduction strategies must be the mainstay of prevention efforts. In her plenary presentation to the XIV International Conference on AIDS on 9 July 2002, Kasia Malinowska-Sempruch asserts that if the world does not turn its attention to the emerging and exploding epidemic in Eastern Europe and the former Soviet Union, the region will suffer the same fate as Africa. The presentation explains that while their economies continue to struggle, the countries in the region have seen their public health systems crumble in the face of the twin health crises of injection drug use and HIV infection. The presentation demonstrates how current repressive laws and practices with respect to drug use serve only to fuel the epidemic. It describes harm-reduction approaches (such as needle exchanges and drug-treatment programs) and provides examples of how NGOs in the region have been attempting to implement such approaches, often with little or no support from governments. Finally, the presentation outlines other measures required to respond to the epidemic in the region, including ensuring that people infected with HIV can access care, treatment, and support services.

Europe, Eastern↗

PubMed2003

Drug use, harm reduction, and health policies in Argentina: obstacles and new perspectives.

High human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) incidence among injection drug users (IDUs) shows the failure of traditional health policies. The preference of IDUs for injected cocaine exposes them to high risks for contracting HIV because of the frequency of drug use. The correlation of poverty with the selling of drugs, especially the so-called "drugs of poverty"--freebase cocaine and crack--is a consequence of prohibitions against drug use and of urban unemployment. In Argentina, "zero-tolerance" approaches and punishment for personal drug use tend to exclude IDUs from the country's health care system. A historical perspective is presented regarding approaches to the prevention of HIV/AIDS and harm reduction in Latin America and Argentina, where, despite isolated efforts, IDUs had no free access to sterile needles until the end of the 1990s. We present the impact of programs and campaigns of the Argentinean Harm Reduction Association, showing how and why, even with obstacles, harm reduction is possible and necessary.

Anti-HIV Agents↗

PubMed2005

The impact of a police drug crackdown on drug injectors' ability to practice harm reduction: a qualitative study.

This paper employs qualitative methods to explore the ramifications of a police drug crackdown on drug injectors' ability to practice harm reduction. Between August and December 2000, we conducted open-ended interviews with 40 illicit-drug-injecting residents of a New York City police precinct undergoing a crackdown. Interview topics included participants' experiences with police in the precinct and their drug use practices. Grounded theory methods were used to analyze resulting transcripts. Because place emerged as a salient analytic category, we also drew on elements of social geography to interpret results. The analysis suggests that particular crackdown tactics, notably frequent police searches of participants' bodies and elevated surveillance of the precinct's public spaces, reconfigured participants' experiences of their bodies and the public spaces comprising the precinct in ways that adversely affected their capacity to engage in harm reduction. Frequent police searches, for example, discouraged participants from carrying the injection equipment they needed to ensure that they could inject with a sterile syringe. Constant monitoring of local public spaces made it difficult for homeless women and men to inject safely. Simultaneously, participants expressed support for police actions that reduced public drug activity. Given these findings, we recommend the implementation of strategies, designed by partnerships of community groups and governmental and non-governmental organizations, which reduce public drug activity without imperiling injectors' health. Possible strategies include improving access to treatment and establishing safe injection spaces.

Adolescent↗

PubMed2004

Tobacco harm reduction: what do the experts think?

OBJECTIVE: To assess experts' opinions about the future of, and potential to improve individual and public health through "tobacco harm reduction" (THR), the use of novel nicotine containing products purporting to reduce the health risks from cigarette smoking. DESIGN: Semi-structured telephone interviews on nine topic areas, with qualitative content analysis of coded transcripts. PARTICIPANTS: 29 professionals with expertise related to tobacco and interest in THR, including prominent tobacco control advocates (7), pharmaceutical (3) and tobacco industry scientists/officials (5), non-industry scientists (12), and Congressional staff (2). RESULTS: Respondents agreed that harm reduction is at minimum theoretically plausible, that characteristics of "good" and "bad" THR products can be identified, that government regulation is essential but not likely in the foreseeable future, and that additional scientific data are very much needed. However, there was no consensus on specifics, such as preferred regulatory strategies or examples of ideal THR products. Disagreement was seen not only across but also within respondent categories. Mistrust of key stakeholders-for example, tobacco control advocates distrust of tobacco industry scientists and vice versa-was pervasive, and cited frequently as a barrier to regulation and collaboration. CONCLUSIONS: Continued dialogue and debate are essential as we enter a new and uncertain era of products purporting to reduce tobacco produced harm. Experts have concluded that effective government regulation is crucial to minimising the risks associated with THR and maximising potential benefits.

Attitude of Health Personnel↗

PubMedDate not supplied

Differences in African American and White college students' drinking behaviors: consequences, harm reduction strategies, and health information sources.

The authors explored the differences between African American and White college students' drinking behaviors and their attitudes toward consequences, harm-reduction strategies, and health information sources. They collected data from a randomly selected sample of 1,110 students in a large public university to examine the effects of a high-risk drinking prevention intervention. In the current analysis, they compared African American and White students on indicators of high-risk drinking, drinking consequences, harm-reduction strategies, the sources that students typically used for health information, and the believability of those sources. The African American students scored lower on drinking measures than the White students did, reported fewer negative consequences, and more regularly employed drinking-reduction strategies, with one exception--choosing a designated driver. Both African and White respondents reported that their parents were their most frequent and usual sources of health-related information and said that parents and health professionals were the most credible sources.

Adolescent↗

PubMed2005

Effectiveness of harm reduction programmes for injecting drug users in Dhaka city.

This paper provides a brief overview of the harm reduction programme for injecting drug users (IDU) of CARE, Bangladesh in Dhaka city and uses data from surveillance and a focussed research study on a cohort of IDU, to evaluate the programme. The harm reduction programme in Dhaka is run by CARE, Bangladesh and includes needle/syringe exchange, awareness raising on HIV/STI, abscess management, condom distribution and advocacy with different groups of people. The needle/syringe exchange programme (NEP) has been in place since 1998, the 2nd Generation Surveillance in Bangladesh is being conducted since 1998, and an in-depth cohort study, started in 2002, is being conducted in two areas of Dhaka city with approximately 500 IDU under CARE's NEP who are being followed bi-annually to assess risk behaviour, incidence of HIV, hepatitis C and syphilis. As the surveillance and the cohort study are both closely associated with the NEP of CARE, Bangladesh, these data can be used to monitor the NEP.

Journal Article↗

PubMed1998

Toward a psychology of harm reduction.

This article discusses 3 different strategies for dealing with the harmful consequences of drug use and other risky behaviors: We can discourage people from engaging in the behavior (prevalence reduction), we can encourage people to reduce the frequency or extent of the behavior (quantity reduction), or we can try to reduce the harmful consequences of the behavior when it occurs (harm reduction). These strategies are not mutually exclusive; this article offers a framework for integrating them. The framework is useful for examining frequent claims that harm reduction "sends the wrong message." Opposition to harm reduction is based in part on a recognition of potential trade-offs among the strategies, but it is also fueled by several more symbolic psychological factors. Strategies for successfully integrating prevalence reduction, quantity reduction, and harm reduction are explored.

Humans↗

PubMed2002

Infant birth weight as a measure of harm reduction during smoking cessation trials in pregnancy.

During pregnancy, a reduction of 50% or more of a biochemical measure of smoking, among continuing smokers, has been proposed by Windsor and colleagues as a new behavioral indicator of harm reduction because it was accompanied by greater infant birth weight compared with that of infants of smokers with lesser reductions. The purpose of the authors' study was to replicate these observations. During a trial of smoking cessation during pregnancy, data on cigarettes per day, urinary cotinine. and infant birth weight were obtained from 240 women. There were no significant differences in average birth weight between infants of women whocontinued to smoke but reduced their cigarette consumption by 50% or more and infants of women with lesser reductions. These results indicate that this birth weight comparison does not provide a valid estimate of the harm reduction associated with a reduction of 50% or more in cigarette consumption during pregnancy.

Adult↗

PubMed2001

Shortcomings of harm reduction: toward a morally invested drug reform strategy.

After a decade of steady diffusion in the drugs field, the harm reduction movement, posing pragmatic public health solutions based on empirical analysis, is still hindered by dissension and general confusion as to its underlying ideals. Despite having short-term political advantages, its 'value-neutral' style of discourse undercuts deeper moral foundations by attempts to forge the common ground in drug debates. Drawing on key statements in the literature and insights from interviews with leading Canadian drug policy observers, this commentary looks at rhetorical shortcomings that may act to encumber longer term harm reduction adoption and promotion.

Journal Article↗

PubMed2003

The Australian tar derby: the origins and fate of a low tar harm reduction programme.

OBJECTIVE: To document the development of the low tar harm reduction programme in Australia, including tobacco industry responses. DATA SOURCES: Tobacco industry documents, retail tobacco journals, newspapers, medical journals, and Anti-Cancer Council of Victoria (ACCV) newsletters and archival records. STUDY SELECTION: Documents on the strategies and knowledge bases of the ACCV, other Australian health authorities, and the tobacco industry. RESULTS: The ACCV built a durable system for measuring and publicising the tar and nicotine yields of Australian cigarettes and influencing their development. The tobacco industry initially sought to block the development of this system but later appeared to cooperate with it, as is evidenced by the current market dominance of low tar brands. However, behind the scenes, the industry used its substantial knowledge advantage regarding compensatory smoking and its ability to re-engineer cigarettes to gain effective control of the system and subvert the ACCV's objectives. CONCLUSIONS: Replacement of the low tar programme with new means of minimising the harms from cigarette smoking should be a policy priority for the Australian government. This will require regulation, rather than further voluntary agreements, and stringent monitoring of successor programmes will be necessary.

Australia↗

PubMed1999

Harm reduction: concepts and practice. A policy discussion paper.

This paper provides an overview of the context, definition, and key features of the harm reduction approach, and provides several examples of current programs in various countries. Both licit and illicit drugs are included in these illustrations. Some of the critical issues, and the strategies needed to advance harm reduction, are discussed. [Translations are provided in the International Abstracts Section of this issue.]

Canada↗

PubMed1995

Harm reduction in the developing world.

This paper examines harm reduction from the perspective of poor countries. In considering which elements of the broad approach are suitable for adaptation and adoption by poor countries, there is a need to examine critically the arguments put forth in support of it and which, if any, of these are supported by evidence. There are also significant indirect influences that the approach is likely to have on how drug use is understood and interpreted by wider society. The likely impact of these on areas other than simply services directed to drug users needs to be assessed. There are some features regarding harm caused by alcohol and other drug use that are specific to poor countries. Most important among these is that levels of use which are not deemed to be harmful in rich societies cause grave harm through diverting meagre resources away from survival needs in the poor world. Alcohol, as well as other drugs, tends in deprived settings to cause dependence and other problems much earlier in people's drinking careers and at much lower levels of consumption than in rich countries.

Journal Article↗

PubMed2001

The impact of harm-reduction-based methadone treatment on mortality among heroin users.

OBJECTIVES: The purpose of this study was to investigate the impact of harm-reduction-based methadone programs on mortality among heroin users. METHODS: A prospective cohort investigation was conducted among 827 participants in the Amsterdam Cohort Study. Poisson regression was used to identify methadone maintenance treatment characteristics (dosage, frequency of program attendance, and type of program) that are significantly and independently associated with mortality due to natural causes and overdose. RESULTS: From 1985 to 1996, 89 participants died of natural causes, and 31 died as a result of an overdose. After adjustment for HIV and underweight status, there was an increase in natural-cause mortality among subjects who left methadone treatment (relative risk [RR] = 2.38, 95% confidence interval [CI] = 1.28, 4.55). Leaving treatment was also related to higher overdose mortality, but only among injection drug users (RR = 4.55, 95% CI = 1.89, 10.00). CONCLUSIONS: Harm-reduction-based methadone treatment, in which the use of illicit drugs is tolerated, is strongly related to decreased mortality from natural causes and from overdoses. Provision of methadone in itself, together with social-medical care, appears more important than the actual methadone dosage.

Adult↗

PubMed2003

Harm reduction: a social work practice model and social justice agenda.

Efforts in the United States to eradicate drug use through supply reduction (that is, the War on Drugs) have increasingly violated the principles of social justice and human rights, both locally and globally. This has created ethical conflicts for social workers in policy making, practice, and research. Harm reduction has been conceptualized as a peace movement and is aligned with the humanistic values around which social work is organized. The authors examine how social workers may reduce the ethical conflicts associated with efforts to address substance abuse by adopting a harm reduction approach to policy, practice, and research. They examine current drug policies, the consequences of the policies, and, in particular, how the policies affect social workers as practitioners, agents of social control, and guardians of social justice.

Drug and Narcotic Control↗