Harm Reduction acknowledges that drug use occurs and is potentially damaging, and attempts to reduce and prevent these harms in ways, which are pragmatic and humanistic. Although the harm reduction approach and specific harm reduction interventions (including needle and syringe programmed and methadone programmed) have been implemented with resounding success internationally (including in a number of African countries) for more than 20 years, the South African approach to substance use and substance-related harms is still largely informed by the doctrine and strategies of the "War on Drugs", and focuses almost exclusively on prohibition and punishment. Because of the strong link between drug use and poverty, different policy approaches to poverty and homelessness must also be considered. My talk will critically examine these two approaches to drug use, poverty, and displacement (support or punish), as they are being implemented in Cape Town. Opportunity for discussion will be provided.

1. Welcome
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2. SUPPORT OR PUNISH?
RECONSIDERED APPROACHES TO DRUG-
RELATED HARMS
R U D O L P H B A S S O N
S A C A P F E S T I V A L O F L E A R N I N G
1 1 S E P T E M B E R 2 0 1 5

4. Addiction is a primary, chronic disease of brain reward, motivation, memory
and related circuitry. Dysfunction in these circuits leads to characteristic
biological, psychological, social and spiritual manifestations. This is
reflected in an individual pathologically pursuing reward and/or relief by
substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in
behavioral control, craving, diminished recognition of significant problems
with one’s behaviors and interpersonal relationships, and a dysfunctional
emotional response. Like other chronic diseases, addiction often involves
cycles of relapse and remission. Without treatment or engagement in
recovery activities, addiction is progressive and can result in disability or
premature death.
- American Society of Addiction Medicine

5. 0
10
20
30
40
50
60
70
80
90
100
18-29 30-44 45-64 65+
CASESINREMISSION(%)
AGE
Drug Use Disorder Remission [ECA]
(Heyman, 2013)
Males Females

6. 0%
20%
40%
60%
80%
100%
120%
Nicotine Alcohol Cannabis Cocaine
Probability of Remission
White, 2012
First Year First Decade Lifetime

7. 0
5
10
15
20
25
30
35
40
45
50
All illicit drugs Marijuana Cocaine Amphetamine Heroin
Lifetime Use & Addiction
Conway et al., 2006
Ever Used Ever Addicted

8. 0,15
0,05
0,025
0,07 0,07
0,2
0
0,05
0,1
0,15
0,2
0,25
0,3
0,35
0,4
0,45
0,5
Alcohol Any Illicit Drug Marijuana Cocaine Amphetamine Opiates
Probability of Developing Dependence
Series 1

9. Video – Rat park

10. DRUGUSE
BIOPSYCHOSOCIALECONOMIC
Positive and/or negative
effects of the drug on the
health of the body or causing
or improving disease state
Positive and/or negative
effects on mental state,
cognitive functioning, state
of being
Positive and/or negative effects
of drug use on relationships,
community social capital, crime,
environment, governance
Positive and/or negative
economic effects of the drug
on employment, crime,
incarceration, international
trade, protential profit
BIOPSYCHOSOCIALECONOMIC
Genetic predisposition or
medical conditions or
symptoms can affect levels
of drug use.
Issues such as personality,
attachment, trauma, stress,
beliefs around drugas can
affect levels of use.
Peer pressure, community
beliefs, education, law
enforcement, family, religion
influence use
Economic status, employment
status and opportunities and
financial security play a role
in levels of drug use.
Some causes and effects of drug use

11. “The majority of people who use drugs do not
need treatment [but] there is a need to provide
people who use drugs with options that help to
minimise risks from continuing to use drugs,
and of harming themselves or others… to help
keep people healthy and safe. Allowing people
to suffer or die from preventable causes is not
an option.”
Harm Reduction International

12. EXAMPLE: EFFECTIVE HIV RISK REDUCTION
INTERVENTIONS FOR PWID
1. HIV counselling and testing (HCT)
2. Antiretroviral therapy (ART)
3. Needle and syringe programmes (NSPs)
4. Medically assisted treatment (MAT) and other evidence-based drug
dependence treatment
5. Prevention and treatment of sexually transmitted infections (STIs)
6. Condom programmes for people who inject drugs and their sexual partners
7. Targeted information, education and communication (IEC) for people who
inject drugs and their sexual partners
8. Prevention, vaccination, diagnosis and treatment for viral hepatitis
9. Prevention, diagnosis and treatment of tuberculosis (TB)
10.Peer based outreach services
Endorsed by PEPFAR, WHO, UNAIDS, UNODC, the UN General Assembly, the Economic and Social Council,
the UN Commission on Narcotic Drugs, the UNAIDS Programme Coordinating Board, the Global Fund.
Source: WHO, UNODC, UNAIDS, Technical Guide For Countries to Set Targets for Universal Access to HIV
Prevention, Treatment and Care for Injecting Drug Users, 2012.

15. - Destruction of syringes
- Confiscating harm reduction packs
- Illegal searches, including cavity search in
public
- Police observation of service delivery
- Arrest without processing
- “Confiscation” of general belongings
- Refusal of medical treatment

17. “Drug control and enforcement strategies hit those who are already marginalized
hardest, with a disproportionate impact on poor people, racial minorities, and
increasingly, women. They violate many fundamental human rights, including life,
liberty, and privacy, and fuel violence and militarization. They also have little impact
on the drugs trade or the powerful cartels that profit from it. We have known for
years that the war on drugs cannot be won, yet in 2015, governments will spend
over $100 billion pursuing it.
By contrast, global funding for harm reduction services, including needle exchange
and opioid substitution therapy, currently amounts to just $160 million. This is
despite evidence which has shown over and over that these interventions
dramatically reduce rates of HIV and hepatitis among people who use drugs, and
that they save lives and money. Current funding for these harm reduction efforts
amounts to a meagre seven percent of what is needed.”
Open Society Foundation

18. “The real problem is that 20 years into
freedom, poverty is worse and it’s high time we
stop trying to remove the poor from our well-to-
do areas just because they make us feel
uncomfortable or threaten our illusion of
security.”
Greg Andrews, Operations Manager of Service
Dining Rooms and Convenor of the Street
People’s Forum

20. “drugs may have
destroyed many people,
but wrong
governmental policies
have destroyed many
more. Let us not repeat
this mistake. “
Kofi Annan
7th Secretary-General of the united Nations, Chair of the Kofi Annan Foundation, written for
Vice, 27 March 2015.
(http://www.vice.com/read/kofi-annan-the-war-on-drugs-has-failed-in-west-africa-and-around-the-world)

21. ACKNOWLEDGEMENTS
• The Step Up Project Team and Partners
• Step Up service beneficiaries
• The Street People’s Forum
• The South African College of Applied
Psychology

22. FURTHER READING
The Simple Funding Fix That Could Dramatically Reduce Drug-Related
Deaths:
https://www.opensocietyfoundations.org/voices/simple-funding-fix-could-dramatically-
reduce-drug-related-deaths
Making life harsh for street people no solution, say NGOs:
http://www.iol.co.za/weekend-argus/making-life-harsh-for-street-people-no-solution-
say-ngos-1.1856087#.VesqvJclQSE
When healing trumps abstinence:
http://www.memoirsofanaddictedbrain.com/connect/when-healing-trumps-
abstinence/?utm_source=Memoirs+of+an+Addicted+Brain&utm_campaign=83c09bf
bd2-RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_4355f9df26-
83c09bfbd2-329827433
Most People With Addiction Simply Grow Out of It. Why Is This Widely
Denied?
http://www.psmag.com/health-and-behavior/people-addiction-simply-grow-widely-
denied-91605

23. Thank you!
Rudolph Basson
Step-Up Project Coordinator: Cape Town
TB/HIV Care Association
Email: rudolph@tbhivcare.org
Tel: (021) 447 0565
Cell: 082 821 3086

24. Thank you
To view material from this talk visit
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