Harm Reduction 101! Or, “Why the war on drugs is a war against people and why I think we should be using another approach …”! Jacqui Brown BA BPsych (Hons) MPsych (Clinical)! Harm Reduction & Program Management Advisor! Salvation Centre Cambodia, Siem Reap!
Why is Harm Reduction interesting to me?!The 1990s (a snapshot for those too young to remember) …!
Okay … so what does it mean?! " Fairly self-explanatory:! ! " Aims to reduce the harms associated with the use of psychoactive substances.!! " Maintains a judgment neutral stance on drug use!! " Acknowledges that psychoactive substances are a part of human culture!
But aren’t drugs bad and shouldn’t we “just say no”?!! " No, we shouldn’t “just say no” – Why? Because there is signiﬁcant evidence it doesn’t work and makes things worse.! ! " “Just say no” can create a sense of failure and self- stigmatization when the individual does not stop using! ! " “Just say no” doesn’t take into account the broader environment and individual psychology! ! " “Just Say No” doesn’t really give you anywhere else to go if it doesn’t work.!
But drugs are bad for you!!!!!! " Yes … in some circumstances, drugs (legal and illegal) can be bad for you, however …! ! " Just because something is bad for you, doesn’t mean we shouldn’t do it. Health is a means to achieving our goals, not necessarily a goal of its own.! ! " If we lived our lives trying to avoid anything that is bad for us, we would have to compromise many things we like, and our lives would be incredibly constrained.!
Background to Harm Reduction! " Term “war on drugs” introduced by Richard Nixon in 1971, however history goes back to alcohol prohibition.!! " Prior to the “war on drugs” the US had slowly pressured other countries into criminalizing the use of certain substances despite objections – “zero tolerance”!! " The use of certain substances deemed illegal became stigmatized and punishable by imprisonment in most countries.!
History of Harm Reduction! " Early to mid 1980s, HIV changes everything. !! " Once established that HIV was blood borne, people realised that sharing injecting equipment was a high risk!
History of Harm Reduction! " First informal Needle and Syringe Programs (NSPs) set up by drug user activists !! " In an act of “civil disobedience” an Australian medical practitioner (with the support of drug user activists) started supplying sterile injecting equipment in Darlinghurst, Sydney.!! " First NSP in world was in Amsterdam, then shortly after in England (1984)!!
History of Harm Reduction cont …! " By late 1980s, governments in Australia, Canada, UK and some parts of Western Europe had some harm reduction programs to prevent the spread of HIV amongst people who injected drugs.!! " Reports have found that for every $1 spent by the government on Harm Reduction programs in Australia, between $4 and $16 is saved.!
Harm Reduction Deﬁnition‘Harm Reduction’ refers to policies, programmes andpractices that aim primarily to reduce the adverse health,social and economic consequences of the use of legal andillegal psychoactive drugs without necessarily reducingdrug consumption. Harm reduction beneﬁts people who usedrugs, their families and the community. !
Type of Harm Reduction interventions! " Needle & Syringe Programs (NSPs)! ! " The US government has a ban on using any federal funds for NSPs! ! " Cities that introduce NSPs, have a mean annual decrease in HIV of 18%, compared to a mean increase of 8% for cities that don’t introduce NSPs.! ! " There is no evidence to suggest that making syringes more available makes people more likely to inject, in fact evidence suggests the opposite.!
Type of Harm Reduction interventions! Medically Supervised Injecting Rooms (MSICs)! ! " Exist in 7 countries! ! " Sydney MSIC ! ! " has around 170 injections per day! ! " mostly street based people with nowhere else to go or who can’t wait until they get home.! ! " has responded to 4,400 overdoses, with none being fatal! ! " made over 9,500 referrals to drug treatment, health and other services.! ! " generally has the support of the local community because of less public injecting and less needles left laying around!
Type of Harm Reduction interventions! Drug Law Reform! ! " Refers to range of options, including controlled decriminalization to legalization! ! " Gaining momentum, especially due to “drug war” in Mexico! ! " Recent high proﬁle supporters! ! " US government spends $500 a second on their war on drugs.! ! " Health issue, not law and order issue! ! " Portugal experiment – reduced use!
Type of Harm Reduction interventions! Prescription diacetylemorphine (Heroin)! ! " Switzerland, Germany, Holland & Denmark, with other countries considering.! ! " Swiss evidence shows signiﬁcant beneﬁts (less crime, less health problems, and interestingly, less use in general)! ! " Can reduce people off slowly! ! " The drug is manufactured under strict conditions, not in a caravan in Burma or Afghanistan.!
Type of Harm Reduction interventions! Drug User Groups! ! " Common in many countries and often government funded. In Asia, Asian Network of People who Use Drugs (ANPUD)! ! " No such thing exists in Cambodia, however currently trying!! ! " Groups of people who openly acknowledge they are drug users and advocate for user rights!
Type of Harm Reduction interventions! Peer Workers! ! " Employed in health and other services because of their personal experience.! ! " Clients often trust them more! ! " Have a unique set of skills. In Australia, we trained “peers” to provide some clinical interventions (taking blood, responding to overdose with oxygen)!
So … if Harm Reduction is so great and evidenced based, why do so many people hate it?"! " Fear from politicians to take the ﬁrst step (it might not be popular)!! " Drug Users aren’t seen as a high priority politically because they are so stigmatized!! " Highly emotional issue!! " Naïve belief that drug use can be stopped !! " Some conspiracy theories exist (some more realistic than others)!
Something to think about when we consider the “war on drugs” and “just say no”" The deﬁnition of stupidity is doing the same thing over and over again and expecting a different result! Albert Einstein! ! !
Something to think about when we consider Harm Reduction."! " It is based on solid scientiﬁc evidence.! !! " It treats people with respect no matter what they decide to put in their bodies! !! " Almost 40% of Australians and about the same amount of Americans admit to illicit drug use!! " The last three Presidents of the US have used drugs, two of them cocaine.!
Thank you!! " Thanks to Andy Sinclair, who none of you will know ! because he works in Melbourne, but he sent me some information for this.! !! " Thank you for listening!! " Som Aw Kun!! " Questions?!