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PubMed2005

Toronto: report calls for more harm reduction measures for drug users.

The City of Toronto should expand its harm reduction outreach strategies to reach marginalized drug users, in particular people who use crack cocaine. This is one of 66 recommendations contained in a report on a proposed Toronto Drug Strategy. The report also calls for increased emphasis on prevention, the decriminalization of cannabis possession, and consideration of a safe injection facility for hard drug users similar to the one already in operation in Vancouver.

Cocaine-Related Disorders↗
PubMed2004

Integrating harm reduction and abstinence-based substance abuse treatment in the public sector.

Harm reduction and abstinence-based substance abuse treatment can not only be integrated, but their integration is more powerful than either separately. This integration has more positive effects than either model separately on the large problem of patient retention in substance abuse treatment. This integration is particularly relevant for its utility and acceptance in the public sector. Examples from a clinic currently utilizing this model in a public hospital are presented.

Harm Reduction↗
PubMedDate not supplied

Health risks and opportunities for harm reduction among injection-drug-using clients of Saskatoon's needle exchange program.

Information about injection drug users' lifestyles is necessary to develop effective harm reduction strategies. One way to gather this information is through needle exchange programs. In 1998, a convenience sample of 100 clients of Saskatoon's needle exchange service was interviewed about their injection and sexual practices. Ritalin and morphine were the most commonly injected drugs. Over half the participants (53%) reported having shared needles, usually with friends, relatives, and partners. Slightly more (62%) had shared injection equipment. Most participants had multiple sexual partners, especially the women, half of whom were sex trade workers. Condom use was higher with casual partners than with regular partners. While awareness about HIV transmission was high, most participants considered their risk of infection to be below average. These findings are discussed in light of the insights they provide regarding both health risks and opportunities for harm reduction in the study population.

Adolescent↗
PubMed2006

The cost-effectiveness of expanding harm reduction activities for injecting drug users in Odessa, Ukraine.

OBJECTIVES: The objectives of this study were to estimate the cost-effectiveness of a harm reduction intervention among injecting drug users (IDUs) in Odessa, Ukraine; and to explore how the cost-effectiveness changes if the intervention were scaled up to 60% as recommended by WHO/UNAIDS. STUDY DESIGN: Economic providers' costs were estimated. A dynamic mathematical model, fitted to epidemiologic data, projected the intervention's impact. The cost per HIV infection averted for different intervention coverages was estimated. RESULTS: From September 1999 to August 2000, at the current coverage of between 20% to 38% and an injection drug user (IDU) HIV prevalence of 54%, projections suggest 792 HIV infections were averted, a 22% decrease in IDU HIV incidence, but a 1% increase in IDU HIV prevalence. Cost per HIV infection averted was $97. Scaling up the intervention to reach 60% of IDUs remains cost-effective and reduces HIV prevalence by 4% over 5 years. CONCLUSION: At the current coverage, the harm reduction intervention in Odessa is cost-effective but is unlikely to reduce IDU HIV prevalence in the short-term. To reduce HIV prevalence, more resources are needed to increase coverage.

Adult↗
PubMed2006

Legal harm reduction among intravenous drug users.

OBJECTIVE: HIV/AIDS infection in injecting drug users occurs with explosive rapidity and, having occurred, they can form a core group for further sexual and vertical transmission. As HIV transmission among injecting drug users can be extremely rapid, various approaches to intervention and obstructing the spread of HIV infection have been explored. Overall, these have been relatively ineffective so what has emerged, both in the developed and developing world, is harm reduction. MATERIAL AND METHOD: In the light of these general considerations, the authors reviewed the law of Thailand in relation to drug abuse and dependence according to the harm reduction for the prevention of HIV/AIDS infection in injecting drug users. RESULTS: With the review, the authors recommend some changes in the law: 1. Introducing a law that allows IDUs to possess sterile syringes and needles while under supervision of a physician. 2. Introducing a law that allows for testing for HIV in people in custody in whom there are grounds for suspecting drug abuses. 3. Establishing and financing a Multi-disciplinary Coordinating Committee on the Prevention of HIV/AIDS (MCCPH/A). CONCLUSION: It should be emphasized that, as in other countries, drug abuse and dependence should, where appropriate, be decriminalized. A large proportion of people with drug-related problems are ill and in need of treatment rather than criminals requiring harsh penalties handed down by the courts.

HIV Infections↗
PubMed2004

Bangkok 2004. Drug control, human rights, and harm reduction in the age of AIDS.

In many countries, HIV prevalence among people who use illicit drugs is high. Yet many governments resist implementing effective HIV prevention measures, and drug users often lack access to care, treatment, and support, including for HIV/AIDS. Growing evidence indicates the dominant prohibitionist approach to illicit drugs is ineffective--and even counterproductive, blocking or undermining measures shown to reduce harms to drug users and to communities affected by open drug scenes. The growing debate over global drug control policy could shift us collectively away from the current, failed prescriptions to a more rational, pragmatic, and health-promoting framework of harm reduction. This article by Richard Elliott is an abridged version of a paper prepared for "Human Rights at the Margins: HIV/AIDS, Prisoners, Drug Users and the Law," a satellite meeting held in Bangkok on 9 July 2004, and organized by the Canadian HIV/AIDS Legal Network and the Lawyers Collective HIV/AIDS Unit (India). The article briefly outlines the impact of these two different policy approaches, examines international law on drug control, discusses how harm reduction reflects a human rights-based approach to drugs, and assesses some strategies for reforming global policy on illicit drugs.

Drug and Narcotic Control↗
PubMedDate not supplied

[The course of the realization of the Harm Reduction program in the city of Nikolayev].

The growth of drug addiction has been noted in Nikolaev. This growth has not been stopped by methods based on the use of force. The results of work in accordance with the program "Harm Reduction" are presented. The program functions on the basis of the Charity Fund "Blahodiinist" and is intended for the prevention of the spread of HIV infection in groups of risk among injecting drug users and in other groups. The realization of the program includes provision of information material, reduction of harm in connection with the use of drugs by injection and the risk of getting HIV and sexually transmitted diseases. The analysis of the results has shown the effectiveness of the program (the frequency of using condoms has increased, the number of sex partners and the number of casual liaisons have dropped, the custom of using sterile syringes has been formed). Considering that during epidemics the coverage of not less than 70% of the representative of risk groups is necessary, the program should be realized on a greater scale to increase its effectiveness.

Charities↗
PubMedDate not supplied

[The realization of the concept of Harm Reduction in Russia].

By the present moment cases of HIV infection among injecting narcotic users (INU) have been registered in more than 100 countries. To prevent HIV infection, the program "Harm Reduction" has been developed in Britain; the program states that the prevention of HIV infection must be considered more important than the prevention of the use of narcotic drugs, as this infection is a growing danger for both drug users and public health in general. Breaking drug dependence must not be the only aim of services working with drug addicts, because this will exclude persons decisively disposed to the mode of life including the prolonged use of drugs from the sphere of their activity. Active INU having no contacts with organizations which must give them treatment and assistance find themselves in dangerous situations more often than INU maintaining contacts with such organizations. Penetration into such hidden group and its education must be the primary task. Propaganda plays a decisive role in this process, as the only way to penetrate into such group is to develop work in its territory, so that drug addicts, supplied with the necessary means could change their behavior in the desired direction. In the Russian Federation work on the project "Harm Reduction" has been carried out in 50 regions. This work has contributed to conducting teaching seminars, working out teaching programs, as well as to augmenting the interest among specialists of different professions to the problem of decreasing the spread of HIV infection. The importance of information distributed by the narcological service and the probability that very responsible persons take correct decisions on the basis of their understanding the situation have increased. The rating of public organization has risen.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Doing the possible: harm reduction, injecting drug use and blood borne viral infections in Australia.

Most surveys show that, other than among men who inject drugs and have a history of homosexual contact, the prevalence of HIV infection among injecting drug users (IDUs) in Australia is about 2%. Rates of needle sharing have also declined greatly in the last decade, although the high prevalence and incidence of hepatitis C infection suggest that existing strategies have not yet brought this epidemic under control. Harm reduction has been the major Australian approach to the reduction of blood borne viral infections (BBVIs) in IDUs. Harm reduction strategies include needle distribution schemes, drug substitution therapies and education about safe administration practices. Importantly, with IDUs as with gay men, the infected and affected communities have been brought into partnership with health educators, researchers and policy makers. This paper will review Australia's approach to the prevention of BBVI in IDUs and the effectiveness of current strategies. I will argue that while HIV/AIDS among heterosexual IDUs appears to have been successfully prevented, international experiences of rapidly emerging epidemics demonstrate there is little room for complacency. Moreover, reducing the incidence of hepatitis C and hepatitis B among IDUs remains a major challenge.

Journal Article↗
PubMed2003

Harm reduction.

Explore the source record for details and available documents.

Harm Reduction↗
PubMed1998

Support for harm-reduction among staff of specialized addiction treatment services in Ontario, Canada.

In a mail survey of staff of specialized addiction treatment services in Ontario, respondents from different types of services varied in their level of support for a variety of harm reduction initiatives. Across all types of services support was common for needle exchange services (82-95% in favour) and for short-term non-abstinence goals for clients with alcohol or drug problems (51-98% in favour). However, mean ratings for the effectiveness of methadone maintenance were negative or near zero, and only in assessment/referral and out-patient samples did the majority (61% in each case) have a positive view of methadone maintenance programmes. Only a minority of respondents (15% to 35%) indicated support for the prescription of heroin to heroin addicts. In multivariate analyses, support for harm-reduction strategies was found to be positively related to belief in the effectiveness of pharmacological and cognitive-behavioural interventions and working in an out-patient treatment service, and negatively related to belief in interventions based on the disease model.

Journal Article↗
PubMed1998

Syringe exchange as a social movement: a case study of harm reduction in Oakland, California.

The federal ban on funding for syringe exchange programs (SEPs) has greatly hampered attempts to prevent the spread of HIV among injection drug users in the United States. State laws prohibiting the possession and/or distribution of syringes have made SEPs illegal. These factors have lent a unique social movement quality to harm reduction efforts in the United States. Using a social movement perspective, this paper explores dynamics of the implementation and defense of the syringe exchange program in Oakland, California. The advantages and disadvantages of the social movement aspects of harm reduction are discussed.

California↗
PubMed1996

Harm reduction for alcohol-use-related problems among college students.

Traditionally, the college Spring Break in the U.S. is used by a significant number of university students as an opportunity for excessive alcohol use. Thus, this fairly discreet time period lends itself to the introduction of a harm reduction intervention for problems related to alcohol use. During the week prior to the Spring Break, university students completed a diary for the eight days of the break (Saturday to Saturday). Students were asked to predict their alcohol consumption and the frequency and type of alcohol problems they would experience during the Spring Break. These same students were then asked to complete the diary one week after the Spring Break reporting their actual consumption and alcohol problems. A control group also completed the diary after Spring Break. Although consumption rates for beer, wine and liquor did not differ between groups, students who completed the diary before Spring Break reported a significantly lower frequency of alcohol problems for the eight day period. Results are discussed in terms of harm reduction strategies for high risk periods and targeting alcohol problems.

Adult↗
PubMedDate not supplied

Cost-effectiveness of harm reduction in preventing hepatitis C among injection drug users.

OBJECTIVES: Hepatitis C (HCV) has emerged as a major epidemic among injection drug users (IDUs), with observed prevalence exceeding 70% in many American and European cities. This article explores the potential of syringe exchange programs (SEPs) to reduce HCV incidence and prevalence. DESIGN: A random-mixing epidemiological model is used to examine the potential impact of harm reduction interventions. METHODS: Steady-state analysis is used to scrutinize the impact of SEP on HCV incidence and prevalence and to examine the accuracy of short-term incidence analysis in predicting long-run program effects. RESULTS: SEP is predicted to have little impact on HCV incidence and prevalence within realistic populations of IDUs. CONCLUSIONS: Short-term incidence analysis substantially overstates SEP effectiveness and cost-effectiveness in preventing HCV. More comprehensive harm reduction models, coupled with referral of active IDUs to treatment, must complement syringe exchange to successfully contain highly infectious blood-borne diseases.

Blood-Borne Pathogens↗
PubMed1995

Harm reduction in Bern: from outreach to heroin maintenance.

In Switzerland, harm-reduction programs have the support of the national government and many localities, in congruence with much of the rest of Europe and in contrast with the United States, and take place in public settings. The threat of AIDS is recognized as the greater harm. This paper describes the overall national program and highlights the experience from one city; the program is noteworthy because it is aimed at gathering comparative data from controlled trials.

Drug Prescriptions↗
PubMed2005

Cultural approach to HIV/AIDS harm reduction in Muslim countries.

Muslim countries, previously considered protected from HIV/AIDS due to religious and cultural norms, are facing a rapidly rising threat. Despite the evidence of an advancing epidemic, the usual response from the policy makers in Muslim countries, for protection against HIV infection, is a major focus on propagating abstention from illicit drug and sexual practices. Sexuality, considered a private matter, is a taboo topic for discussion. Harm reduction, a pragmatic approach for HIV prevention, is underutilized. The social stigma attached to HIV/AIDS, that exists in all societies is much more pronounced in Muslim cultures. This stigma prevents those at risk from coming forward for appropriate counseling, testing, and treatment, as it involves disclosure of risky practices. The purpose of this paper is to define the extent of the HIV/AIDS problem in Muslim countries, outline the major challenges to HIV/AIDS prevention and treatment, and discuss the concept of harm reduction, with a cultural approach, as a strategy to prevent further spread of the disease. Recommendations include integrating HIV prevention and treatment strategies within existing social, cultural and religious frameworks, working with religious leaders as key collaborators, and provision of appropriate healthcare resources and infrastructure for successful HIV prevention and treatment programs in Muslim countries.

Journal Article↗
PubMed2005

Estimating the health impacts of tobacco harm reduction policies: a simulation modeling approach.

With adult smoking prevalence rates declining too slowly to reach national objectives, opinion leaders are considering policies to improve tobacco-related outcomes by regulating the composition of cigarettes to be (1) less harmful and/or (2) less addictive. Because harm reduction efforts may actually encourage higher cigarette consumption by promoting a safer image, and addictiveness reduction may increase the harmfulness of cigarettes by encouraging compensatory smoking behaviors, policymakers must consider the tradeoffs between these two approaches when proposing legislation to control cigarette content. To estimate health impacts, we developed a dynamic computer model simulating changes in the age- and gender-specific smoking behaviors of the U.S. population over time. Secondary data for model parameters were obtained from publicly available sources. Population health impacts were measured as change in smoking prevalence and the change in cumulative quality-adjusted life-years (QALYs) in the U.S. population over 75 years. According to the risk-use threshold matrix generated by the simulation, modifying cigarettes to reduce their harmfulness and/or addictiveness could result in important gains to the nation's health. Addictiveness reduction efforts producing a 60% improvement in smoking behavior change probabilities would produce a net gain in population health at every plausible level of increase of smoking-related harm that was modeled. A 40% reduction in smoking-related harm would produce a net QALY gain at every level of behavior change considered. This research should prove useful to policymakers as they contemplate giving the FDA the authority to regulate the composition of cigarettes.

Adult↗