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PubMed2005

Incarceration, addiction and harm reduction: inmates experience injecting drugs in prison.

Within Canadian prisons HIV/AIDS is becoming more common among inmates. While injection drug use in correctional facilities is documented to be a problem, qualitative research into the HIV risks faced by inmates is lacking. The goal of this research was to qualitatively examine HIV risk associated with injecting inside British Columbia prisons. A sample of 26 former male inmates who had recently used drugs within correctional facilities were recruited from a ongoing cohort study of injection drug users in Vancouver, Canada. Data for this study were collected through in-depth interviews conducted in 2001/2002. Analysis of these data involved identifying emergent themes and then exploring these central concepts in further interviews to confirm the accuracy of interpretation. The harms normally associated with drug addiction, and injection drug use are exacerbated in prison. Interpersonal relationships and the possession of exchangeable resources determine access to scarce syringes. The scarcity of syringes has resulted in patterns of sharing amongst large numbers of persons. Continual reuse of scarce syringes poses serious health hazards and bleach distribution is an inadequate solution. The findings of this study emphasize the need for effective harm reduction programs that provide an appropriate response to the problem of injection drug use among inmates.

Anecdotes as Topic↗
PubMed2002

Using a harm reduction approach with clients who have alcohol/drug dependencies in a spinal cord rehabilitation program.

BACKGROUND: Dissatisfied with the frequently adversarial nature of relationships with clients who use alcohol or drugs while rehabilitation inpatients, and the often less than optimal outcomes for these individuals, the Spinal Cord Program at the G.F. Strong Rehabilitation Center in Vancouver, BC, decided to pilot a new approach. OBJECTIVE: The goal of the pilot project is to promote successful rehabilitation, including less conflict in rehabilitation, a completed rehabilitation program, and continued connection after discharge if needed. METHOD: A dedicated team was formed and trained to work with these clients using harm reduction principles. PARTICIPANTS: From its inception in December 2000, through May 2001, the team worked with 6 inpatients, 12% of admissions to the Spinal Cord Program during that period. RESULTS: Outcomes based on the above goals have been positive. There have been no discharges against a client's will or instances of significant conflict with the team. Several clients have returned to the center for assistance or to visit post-discharge. Only 1 client left rehabilitation prematurely.

Alcoholism↗
PubMed2005

Spontaneous harm reduction: a barrier for substance-dependent individuals seeking treatment?

OBJECTIVE: Greater information regarding motivations and treatment barriers faced by substance-dependent individuals has clinical and public health implications. This study aimed to formulate hypotheses regarding psychological, social and family variables that can be constructed as motivations or subjective barriers for the early seeking of formal treatment. METHODS: A qualitative study was conducted in an intentional sample (selected through saturation and variety of types) of 13 substance-dependent individuals who sought treatment. In-depth, semi-structured interviews were conducted using open questions, and the transcribed data were subjected to qualitative analysis. RESULTS: Four types of spontaneous harm reduction measures were identified, according to the subjective logic of each participant: having some periods at rest (not using and recovering from adverse effects); caretaking by close acquaintances (relatives, partners, drug dealers and alcoholic beverage sellers); selectivity regarding substance source, type and means of administration; establishing "healthy" limits of ingestion. CONCLUSIONS: The measures identified might represent barriers to the early seeking of treatment but might also represent spontaneous learning of abilities beneficial to future treatment. Health care professionals should take into consideration their existence and should address them in clinical settings. Issues representative of the formulated categories should be presented in structured questionnaires used in future quantitative studies of barriers to treatment in this population.

Adolescent↗
PubMed2000

Substance abuse and developments in harm reduction.

A drug is a substance that produces a psychoactive, chemical or medicinal effect on the user. The psychoactive effect of mood-altering drugs is modulated by the user's perception of the risks of drug use, his or her ability to control drug use and the demographic, socioeconomic and cultural context. The ability to control drug use may vary along a continuum from compulsive use at one end to controlled use at the other. The "drug problem" has been socially constructed, and the presence of a moral panic has led to public support for the prohibitionist approach. The legalization approach has severely attacked the dominant prohibitionist approach but has failed to gain much support in society because of its extreme libertarian views. The harm reduction approach, which is based on public health principles, avoids the extremes of value-loaded judgements on drug use and focuses on the reduction of drug-related harm through pragmatic and low-threshold programs. This approach is likely to be important in tackling the drug problem in the 21st century.

Drug and Narcotic Control↗
PubMed2004

[Harm reduction policy related to drug use: the needles exchange programs].

In several developed countries, needles exchange programs (NEPs) are a key preventive tool in harm reduction policy related to drug use. Many studies about NEP show it reduces HIV infections related to syringes sharing when part of others preventive actions. NEPs seem to have no impact on HCV transmission. Furthermore, young drug users, who are at high risk for HIV and HCV infections, are not attending NEPs very often. Trying to maintain high accessibility to sterile syringes, efforts must be stressed on hard-to-reach populations such as young injection drug users (IDU), focusing on their social network. Emphasis must also be put on prevention of unsafe sexual intercourse, often related to syringe sharing, which must be more prevented. Finally, design of assessment studies should be improved.

Communicable Disease Control↗
PubMed1995

Declining risk for HIV among injecting drug users in Kathmandu, Nepal: the impact of a harm-reduction programme.

OBJECTIVE: To measure changes in self-reported risk behaviour for HIV infections and HIV seroprevalence among injecting drug user (IDU) clients of an outreach harm-reduction programme in Kathmandu, Nepal. METHODS: The Lifesaving and Lifegiving Society (LALS) of Kathmandu began providing sterile injecting equipment and education to Nepalese IDU in 1991. A sample of these IDU were interviewed and tested for HIV each year from 1991 through 1994. RESULTS: Indicators of unsafe injecting fell, as knowledge of HIV rose more in 1994 for those who had been in touch with LALS for longer. Indicators of unsafe sex did not change. HIV seroprevalence remained low, 1.6% in 1991 and 0% in 1994. CONCLUSION: We conclude that programmes for the prevention of HIV spread among IDU are possible and effective in Asia, and are urgently needed.

Adult↗
PubMed1998

Harm reduction in the hills of northern Thailand.

The human immunodeficiency virus (HIV) pandemic has swept through injecting drug user (IDU) communities around the world. Once HIV is present in an IDU community, seroprevalence rates escalate rapidly unless immediate and comprehensive prevention methods are put in place. Such measures often include providing IDUs with sterile injecting equipment and dispensing methadone or other opiate substitution formulas. These measures fall under the rubric of harm reduction-an attempt to reduce the harm to drug users, their families, and communities, including preventing or limiting the transmission of HIV and other blood-borne viruses. In Thailand, HIV-1 spread rapidly among IDUs with seroprevalence rates jumping from 1 to 40% in the space of a year. Current incidence rates are estimated at 11 per 100 person years. This paper describes the establishment and implementation of needle and syringe exchanges among injecting drug users in nine Hilltribe communities in Northern Thailand. The exchanges have been operating for between 1 and 3 years and have been effective in limiting the transmission of HIV within these small communities. The needle and syringe exchanges are run by indigenous staff with the cooperation of the community and provide a good example of the feasibility of establishing locally-run, community-based harm reduction programs.

Feasibility Studies↗
PubMed1998

Harm reduction and street-based program: looking into Nepal.

In August 1991 the Lifesaving and Lifegiving Society (LALS) became the first nongovernmental organization in Nepal to work with injecting drug users (IDUs) to reduce the harm caused by drugs in order to prevent HIV/AIDS. Its mission is to provide education, counseling, and primary health care, as well as bleach, sterile water, condoms, and new needles and syringes to IDUs to lower their risk of acquiring blood-borne diseases. An evaluation of the program found that the prevalence of HIV infection among IDUs who were in regular contact with the program from 1991 to 1994 was 1.6%. No new cases of HIV infection were detected among participants in either 1993 or 1994. Though a harm reduction program is expensive to implement and sustain in Nepal, through its nonjudgmental, noncoercive, and confidential philosophy, LALS has engaged drug users into recovery and given them a platform by which they are able to address their concerns in a public forum.

Community-Institutional Relations↗
PubMed2000

Dual diagnosis - does harm reduction have a role?

A pragmatic approach to those with a dual diagnosis of mental illness and problem drug use accepts that drug and alcohol use is firmly established in this population, and aims to minimise and reduce any harms associated with using. However, it is evident that we know little about drug using practices and knowledge among this group in order to effect such an approach. This paper aims to investigate the potential of utilising a harm reduction based approach as an alternative to current service responses for those with a dual diagnosis.

Journal Article↗
PubMed1996

Patient education for behavior change: help from the Transtheoretical and Harm Reduction models.

Promoting healthy behaviors at all levels of prevention is an important component of nursing care in the HIV epidemic. This paper explores two models that can be used to support behavior change efforts: the Transtheoretical Model, which describes stages in the change process, and the Harm Reduction Model, which offers an incremental approach to helping clients move toward safer and healthier habits. A review of the literature shows that these holistic and caring models can be combined effectively to assist clients who are dealing with HIV-related issues. The resulting theory-based approach can help nurses maintain consistency and direction in educational interventions for behavior change.

Empathy↗
PubMed2006

Addicted to the good life: harm reduction in chronic disease management.

Individual values sometimes lead patients to make lifestyle choices that have negative effects on their health. Doctors tend to feel responsible for delivering best-practice health outcomes to such patients, but also feel inclined to respect their patients' values. The adoption of a harm reduction model may provide a strategy for delivering the best care that is compatible with each patient's chosen lifestyle.

Alcohol Drinking↗
PubMedDate not supplied

Involving street youth in peer harm reduction education. The challenges of evaluation.

OBJECTIVES: To describe and discuss the challenges in evaluation of a participatory action research with street-involved youth. METHODS: A combination of quantitative and qualitative methods were utilized for both process and outcome evaluations. Process evaluation methods included in-depth individual interviews, focus groups, participant observation, and session debriefing forms. Summative evaluation research included focus testing of the harm reduction video and a survey of video users. FINDINGS: Members of the youth team reported favourably on the experience, citing friendship, skills development, fun, and pride of accomplishment among the key benefits of participation. Political tensions arose because of the focus on reducing harm from drug use rather than encouraging abstension. The heavy demands of participatory research and development, resource constraints and the priority given to product development in these kinds of projects necessarily precludes extensive youth participation in the design, implementation and analysis of additional evaluation research. Even when resources are directed towards evaluation, there is a tendency to focus on data collection, which may limit time and resources for data analysis. Finally, there is an inclination to focus on the product development rather than dissemination and impact of the product. INTERPRETATION: Despite the challenges inherent in participatory action research and its evaluation, this project was regarded as an empowering experience by the street youth who participated in it. It is worthwhile to direct resources to evaluation which optimally gives proportional attention to data collection as well as data analysis, and focusses not only on product development but also on its dissemination and impact.

Adolescent↗
PubMed1995

The introduction of a methadone prescribing programme to a drug-free treatment service: implications for harm reduction.

In 1990, a National Health drug treatment service with a non-opiate prescribing policy introduced an oral methadone treatment programme for problem opiate users, in addition to existing counselling services. The present study aimed to evaluate the implications of this policy change by comparing two client groups in terms of defined harm reduction variables. The groups consisted of 39 clients presenting to the service prior to methadone prescribing (pre-methadone group), and 41 clients who attended for treatment after methadone prescribing had commenced (post-methadone group). Data analysis revealed that 83% of the post-methadone group remained in treatment for longer than 6 months, in comparison with 13% of clients in the pre-methadone group (p < 0.00001). Other significant differences were noted in treatment outcome, where findings indicated that clients in the post-methadone group were more likely to report cessation of injecting behaviour and continued illicit drug use. Detected crime in the post-methadone group was reduced, and greater positive change in terms of personal relationships was reported. The study concludes that the introduction of a methadone treatment programme appears to have improved treatment outcome significantly for problem opiate users presenting in the service.

Administration, Oral↗
PubMed1996

Harm-reduction strategies weapon of choice in BC's battle with drug addiction.

British Columbia, which holds the dubious distinction of being the country's heroin capital, has introduced a number of programs in an attempt to reduce the number of drug-overdose deaths. A BC coroner who headed a provincial government task force into overdose fatalities in 1994 has recommended a number of harm-reduction strategies such as needle exchanges to reduce the negative consequences associated with illicit drug use. In addition, the College of Physicians and Surgeons of British Columbia is a world leader in methadone maintenance, with 1800 patients and 250 physicians registered in the program.

British Columbia↗
PubMedDate not supplied

Empowerment through agency-promoting dialogue: an explicit application of harm reduction theory to reframe HIV test counseling.

The counseling that accompanies HIV testing can be an important prevention tool for encouraging people to practice safer sex to avoid AIDS, but there is scant research about how HIV test counseling operates in practice. This article critiques the current Centers for Disease Control and Prevention (CDC) protocol for HIV test counseling for not being genuinely client centered and ignoring the unique needs of clients and offers an alternative approach that adapts and explicitly applies the tenets of harm reduction theory (HRT). Excerpts from actual HIV test counseling sessions illustrate both the weaknesses in the current approach to HIV test counseling and project how the alternative theoretical perspective offered could provide counseling that encourages agency-promoting and empowering dialogue. The implications for the development of HRT as a health communication heuristic and a practical training and evaluation strategy are discussed along with limitations and future research directions.

AIDS Serodiagnosis↗
PubMed1995

Drugs, communities, and "harm reduction" in Germany: the new relevance of "public health" principles in local responses.

Drug policy in Germany currently is subject to dramatic changes away from the dominance of repression and hard-line prohibition. However, a crucial share of the recent initiatives (decriminalization, "low threshold" social services, needle exchanges, opiate substitution programs etc.) that define the new interaction between the public system and the drug user have not occurred through any decisive changes in the main state-policy instruments. A possible legal shift was, for example, explicitly denied in the recent decision of the German Constitutional Court on the constitutionality of the German narcotics control law. Rather, these moves are the result of pragmatic, cooperative action at the front-line of communities directly confronted with drug use and the resulting problems. This paper looks in embracing progressive, "harm reduction"-based approaches for their communities' drug problem despite predominant indifference or resistance from other political levels. An overview is given of how the different actors involved in implementing front-line drug policy--police, social services, health agencies--have changed their approach in order to pragmatically "reduce harm" to drug users and their communities. As assessment of the effects of this substantial shift in public action towards drugs is suggested through changes in indicators of drug-related harm, e.g., the prevalence of drug-related deaths, health problems, provision of social services, effects of substitution programs, and drug-related crime rates.

Community Participation↗