Harm Reduction: A Comprehensive Approach
Harm reduction, as defined by the United Nations Office of Drugs and Crime and endorsed by over 200 drug-related, nongovernmental organizations from throughout the world, is an effort primarily to address and prevent the adverse health and social consequences of illicit/harmful drug use, including reducing HIV and other blood-borne infections. The International Narcotics and Control Board has reinforced this concept by stating that within the process of reducing harm “any prophylactic measures should not promote and/or facilitate drug abuse” and condemns facilities “where injecting drug abusers can inject drugs that they have acquired illicitly.”
In the field of drug policy, interdiction, treatment and prevention, harm reduction is surrounded by controversy because of the history and frequent misuse of this term. Harm reduction emerged in Great Britain from a compassionate intent - to reduce the drug-related illnesses that co-occur within the intravenous drug using community - but was co-opted by groups and individuals trying to soften the public's perception about the harms of drug use with the intent of ultimately legalizing drugs. This skewed concept of harm reduction was primarily associated with needle exchange and so-called safe injection site programs which not only accepted drug use without attempting to prevent use or help people to become drug free but also were established without solid evidence that such programs were reducing HIV and other blood-borne infections. The drug legalization proponents who advocated for these programs claimed (and still claim) that abstinence is unrealistic and not a desired goal of their strategy.
The United Nations Office on Drugs and Crime issued this statement about harm reduction in the drug control system:
“Improving the performance of the drug control system … requires us to do four things simultaneously: enforce the laws; prevent the drug-related behaviour; treat those who are neither deterred or prevented from entering into illicit drug use; and mitigate the negative consequences of drugs, both for those who are caught in the web of addiction, as well as for society at large. The last of those four is what is normally called ‘harm reduction.’ There cannot be anything wrong with it provided it is done along with the other three things: enforcement, prevention and treatment. If ‘harm reduction’ is done exclusively, namely without the other three components, it will make a mockery of any control system, send the wrong message and only perpetuate drug use.”
Thus, drug use prevention, education, treatment and law enforcement should constitute the major part of legitimate harm reduction efforts and include demand and supply reduction. For the full UN document that addresses harm reduction, please click here (see page 18).
The only sure way to prevent drug-related harm is to prevent or to stop drug use. Any efforts that fail to strive toward this goal should be viewed with skepticism and challenged as “harm promotion” rather than harm reduction. As a means to help the most severely addicted persons, proper harm reduction methods such as methadone treatment have their place when prevention and other forms of treatment fail. Clearly, primary prevention has no place for harm reduction strategies.
Drug policies that embrace harm reduction strategies without a goal of leading the user to abstinence inevitably ignore the harms of the drugs themselves and instead focus solely on the harm caused by their use. They create the perception that drugs are not dangerous, a perception that undoubtedly increases drug use. These strategies undermine prevention messages as they prolong addiction. Some harm reduction tactics even ask society to accept drug use by adults and youth, alleging that drugs can be used safely and responsibly. Legitimate forms of harm reduction within treatment are administered by a licensed physician and may include methadone or other legally prescribed opioid substitution programs intended to lead to abstinence.
The legitimate concept of harm reduction understands minimizing harm within the context of prevention, treatment and law enforcement with a primary focus on prevention – a dramatic difference from sustaining the addiction of individuals and losing sight of their human rights to be drug-free and productive members of society. To quote the UNODC: “The United Nations Drug Conventions do not accept drug abuse as an inevitable fact of life. UNODC specific mandate is to counteract the dramatic phenomenon of drug abuse and dependence that devastates the health of young people, undermines development and empowerment, and compromises progress and democracy.”
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