Harm reduction

Harm reduction, or harm minimization, is a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction policies are used to manage behaviors such as recreational drug use and sexual activity in numerous settings that range from services through to geographical regions. Critics of harm reduction typically believe that tolerating risky or illegal behaviour sends a message to the community that such behaviours are acceptable and that some of the actions proposed by proponents of harm reduction do not reduce harm over the long term. Needle-exchange programmes reduce the likelihood of users of heroin and other drugs sharing the syringes and using them more than once. Syringe-sharing can lead to infections such as HIV or hepatitis C, which can spread from user to user through the reuse of syringes contaminated with infected blood. Needle and syringe programme (NSP) and Opioid Substitution Therapy (OST) outlets in some settings offer basic primary health care. Supervised injection sites are legally sanctioned, medically supervised facilities designed to address public nuisance associated with drug use and provide a hygienic and stress-free environment for drug consumers. The facilities provide sterile injection equipment, information about drugs and basic health care, treatment referrals, and access to medical staff. Opioid replacement therapy (ORT), or opioid substitution therapy (OST), is the medical procedure of replacing an illegal opioid, such as heroin, with a longer acting but less euphoric opioid; methadone or buprenorphine are typically used and the drug is taken under medical supervision. Another approach is Heroin assisted treatment, in which medical prescriptions for pharmaceutical heroin (diacetylmorphine) are provided to heroin-dependent people. Toronto's Seaton House became the first homeless shelter in Canada to operate a 'wet shelter' on a 'managed alcohol' principle in which clients are served a glass of wine once an hour unless staff determine that they are too inebriated to continue. Previously, homeless alcoholics opted to stay on the streets often seeking alcohol from unsafe sources such as mouthwash, rubbing alcohol or industrial products which, in turn, resulted in frequent use of emergency medical facilities. To reduce the likelihood that street users will consume adulterated or misidentified drugs, such as MDMA, some agencies offer drug checking to reduce overdose risks. Media campaigns inform drivers of the dangers of driving drunk. Most alcohol users are now aware of these dangers and safe ride techniques like 'designated drivers' and free taxicab programmes are reducing the number of drunk-driving accidents. Many schools now provide safer sex education to teen and pre-teen students, who may engage in sexual activity. Since some adolescents are going to have sex, a harm-reductionist approach supports a sexual education which emphasizes the use of protective devices like condoms and dental dams to protect against unwanted pregnancy and the transmission of STIs. Since 1999 some countries have legalized prostitution, such as Germany (2002) and New Zealand (2003). Many street-level harm-reduction strategies have succeeded in reducing HIV transmission in injecting drug users and sex-workers. HIV education, HIV testing, condom use, and safer-sex negotiation greatly decreases the risk to the disease. In the case of recreational drug use, harm reduction is put forward as a useful perspective alongside the more conventional approaches of demand and supply reduction. Many advocates argue that prohibitionist laws criminalise people for suffering from a disease and cause harm; for example, by obliging drug addicts to obtain drugs of unknown purity from unreliable criminal sources at high prices, thereby increasing the risk of overdose and death. The website Erowid.org collects and publishes information and first-hand experience reports about all kinds of drugs to educate (potential) drug users. While the vast majority of harm reduction initiatives are educational campaigns or facilities that aim to reduce drug-related harm, a unique social enterprise was launched in Denmark in September 2013 to reduce the financial burden of illicit drug use for people with a drug dependence. Michael Lodberg Olsen, who was previously involved with the establishment of a drug consumption facility in Denmark, announced the founding of the Illegal magazine that will be sold by drug users in Copenhagen and the district of Vesterbro, who will be able to direct the profits from sales towards drug procurement. Olsen explained: 'No one has solved the problem of drug addiction, so is it not better that people find the money to buy their drugs this way than through crime and prostitution?' The use of some illicit drugs can involve hypodermic needles. In some areas (notably in many parts of the US), these are available solely by prescription. Where availability is limited, users of heroin and other drugs frequently share the syringes and use them more than once. As a result, infections such as HIV or hepatitis C can spread from user to user through the reuse of syringes contaminated with infected blood. The principles of harm reduction propose that syringes should be easily available or at least available through a needle and syringe programmes (NSP). Where syringes are provided in sufficient quantities, rates of HIV are much lower than in places where supply is restricted. In many countries users are supplied equipment free of charge, others require payment or an exchange of dirty needles for clean ones, hence the name.