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At least 19 recordsLinked to original sources
PubMed1995

Defining harm reduction.

Harm reduction attempts to reduce the adverse consequences of drug use among persons who continue to use drugs. It developed in response to the excesses of a "zero tolerance approach". Harm reduction emphasizes practical rather than idealized goals. It has been expanded from illicit drugs to legal drugs and is grounded in the evolving public health and advocacy movements. Harm reduction has proved to be effective and it has gained increasing official acceptance; for example, it is now the basis of Canada's Drug Strategy. However, the concept is still poorly defined, as virtually any drug policy or programme, even abstinence-oriented programmes, attempt to reduce drug-related harm. The principle feature of harm reduction is the acceptance of the fact that some drug users cannot be expected to cease their drug use at the present time. Harm reduction is neutral about the long term goals of intervention while according a high priority to short-term realizable goals. Harm reduction should be neutral about legalization. The essence of the concept is to ameliorate adverse consequences of drug use while, at least in the short term, drug use continues.

Journal Article↗
PubMed1999

Harm reduction or harm facilitation? A reply to Maletzky.

The concept of harm reduction applied to sexual offending is very upsetting to some clinicians. This paper attempts to anchor harm reduction within the larger framework of relapse prevention. It is argued that reducing harm more accurately represents what clinicians do with sexual offenders rather than preventing or eliminating relapses. There are numerous common misconceptions about harm reduction with sexual offenders and explanations are provided for each of these. Finally, it is argued that harm reduction acknowledges that sexual abuse and all forms of interpersonal violence are actually public health issues. Adoption of this viewpoint, however, requires acceptance of a more humanistic perspective rather than a medical, psychological, legal, or political solution to a grievous social problem.

Behavior Therapy↗
PubMed2003

Putting an Ecstasy test kit to the test: harm reduction or harm induction?

OBJECTIVE: To evaluate the DanceSafe Complete Adulterant Screening Kit for Ecstasy with regard to its accuracy in identifying 3,4-methylenedioxymeth-amphetamine (MDMA) and methylenedioxyamphetamine (MDA) derivatives and its ability to detect certain contaminants. METHODS: In part 1, 39 street-grade tablets purported to be MDMA were tested with the Marquis, Mecke, and Simon's reagents provided by the DanceSafe testing kit. The tablets then were submitted to gas chromatography-mass spectrometry for identification of active ingredients. In part II, seven known drugs of abuse were tested with the Marquis, Mecke, and Simon's reagents. These drugs were codeine, dextromethorphan, dihydrocodeine, ketamine, MDMA, morphine, and d-norpropoxyphene. RESULTS: The Marquis, Mecke, and Simon's reagents did not differentiate pure MDMA from adulterated forms. They lacked both sensitivity and specificity for the purpose of MDMA identification when tested by persons unfamiliar with these reagents. Also, experienced toxicologists using this unfamiliar procedure generated false-positive results. CONCLUSIONS: Neither the Marquis, Mecke, nor Simon's reagents should be used by the public for harm reduction purposes. These agents do not help identify pure MDMA tablets. Gas chromatography-mass spectrometry remains the most sensitive and specific testing method for identifying MDMA and its contaminants.

3,4-Methylenedioxyamphetamine↗
PubMed1997

Setting goals for drug policy: harm reduction or use reduction?

Historically, United States drug policy has focused on use reduction; harm reduction is a prominent alternative. This paper aims to provoke and inform more debate about the relative merits of these two. Since harm is not necessarily proportional to use, use reduction and harm reduction differ. Both terms are somewhat ambiguous; precisely defining them clarifies thinking and policy implications. Measures associated with use reduction goals are poor; those associated with harm reduction are even worse. National goals influence the many decentralized individuals who collectively make drug policy; clearly enunciating goals makes some policy choices transparent and goals serve a variety of purposes besides guiding programmatic decisions. We recommend that the overall objective be to minimize the total harm associated with drug production, distribution, consumption and control. Reducing use should be seen as a principal means of attaining that end.

Decision Making↗
PubMedDate not supplied

An invisible barrier to integrating HIV primary care with harm reduction services: philosophical clashes between the harm reduction and medical models.

Overall AIDS mortality in the United States has declined in recent years, but declines have not been consistent across all populations. Due to an array of barriers to care, minorities and poor people who are active substance users have not benefited as others have from advances in the treatment of HIV disease. One way to address this problem is to integrate HIV primary care into harm reduction programs that already effectively serve this population. Such collaborations, however, are difficult to initiate and sustain. Philosophical differences between the medical model and the harm reduction model, which often remain invisible to the parties involved, underlie these difficulties. This article addresses the issue by describing a partnership in the Bronx, NY, between CitiWide Harm Reduction Inc. (CitiWideHR) and the Montefiore Medical Center. It focuses specifically on the sources of philosophical differences between models, and briefly assesses the potential for successful collaborations of this sort.

Community-Institutional Relations↗
PubMedDate not supplied

The Association of Nurses in AIDS Care. Position paper on harm reduction and HIV care for drug users: integrating harm-reduction methods and HIV care.

As the epidemic of HIV disease continues to grow among drug users and their sexual partners, new ways must be adopted to do prevention work, outreach, and service delivery to this population. The Harm Reduction Model offers methods of working with drug users, which are in contrast to traditional methods based on confrontation and that require abstinence before change can occur. This position paper examines the Harm Reduction Model and outlines areas in which the Association of Nurses in AIDS Care can play a role in the expansion of harm-reduction-based intervention and policies.

Attitude of Health Personnel↗
PubMedDate not supplied

Treatment as harm reduction, defunding as harm maximization: the case of methadone maintenance.

Despite numerous research studies demonstrating the efficacy of methadone maintenance treatment (MMT) in general and the value of retention in particular, the increasing defunding of this modality has compromised its potential. From 1990 to 1995 the lead author conducted a longitudinal research project to determine the impact of the cost of treatment on 233 San Francisco Bay Area study participants seeking, enrolled in, or defunded from MMT. This paper reports on selected findings from that study. Using variables of drug use, crime, gender and HIV risk, qualitative and quantitative results comparing those seeking treatment with those enrolled in treatment indicated that MMT functioned as a harm-reduction tool. When clients were defunded, however, drug use, crime and HIV risk increased and harm was maximized.

HIV Infections↗
PubMed2002

Harm reduction, public health, and human rights: smokers have a right to be informed of significant harm reduction options.

Public health policy needs to be assessed for effects on human rights as well as public health. Although promoting harm reduction products to cigarette smokers might lead to greater total public health harm, if the products become too popular, human rights issues also need to be considered. Avoiding, or objecting to, the fair presentation of information on effective harm reduction products to smokers to allow them to make an informed choice to reduce health risk can represent a violation of a human right - the right to information. The necessary conditions are not met for protecting public health by restricting information on certain risk reduction products. As examples, based on current evidence, smokers have a right to information on snus (Swedish moist snuff) and medicinal nicotine as harm reduction options that would reduce substantially the risk of death to individuals. Smokers also have a right to truthful information about lower-tar cigarettes that have been erroneously promoted as risk reducing.

Access to Information↗
PubMed2006

Public health implications of smokeless tobacco use as a harm reduction strategy.

Harm reduction strategies involve promoting a product that has adverse health consequences as a substitute for one that has more severe adverse health consequences. Smokeless tobacco low in nitrosamine content offers potential benefits in reducing smoking prevalence rates. Possible harm arises from the potential for such products to serve as a gateway to more harmful tobacco products, public misinterpretation of "less harmful" as "safe," distraction from the public health goal of tobacco elimination, and ethical issues involved in advising those marketing these harmful products. We offer a research agenda to provide a stronger basis for evaluating the risks and benefits of smokeless tobacco as a means of reducing the adverse health effects of tobacco.

Advertising↗
PubMedDate not supplied

Strategies for implementation of harm reduction in treatment settings.

Harm reduction is a set of strategies that we all use everyday to protect us from the harms of living in a complex world. Central to the principles of harm reduction is the need to respect the client's autonomy and develop a relationship of mutual collaboration with the goal of reducing drug- and alcohol-related harm. Additional principles stress the need to develop a hierarchy of client needs, a list that includes all other services, with the importance for each set by the client. Harm reduction implementation includes a range of interventions including abstinence. Some interventions are controversial, including needle exchange, but most are traditional health promotion activities such as videos, health fairs, and drug education. Essential to implementing harm reduction is a recognition that, even for those who wish to become abstinent, this goal is difficult to achieve and maintain. We must acknowledge this and stop the practice of imposing punitive sanctions on clients who use drugs while in treatment. Exclusion or expulsion from treatment settings does nothing to reduce drug use and greatly increases the harm to the client. In conclusion, just as we need to respect diversity among our clients, staff must find a way to respect each others' ideas and concerns as we develop new ways to implement harm reduction in our work.

Humans↗
PubMed1999

Introduction: the three phases of harm reduction. An examination of emerging concepts, methodologies, and critiques.

The prevention and reduction of harm related to the use and distribution of psychoactive substances has gone through three stages in the last 35 years of this century. The first saw the articulation of public health concerns for the legal drugs, alcohol and tobacco, and the provision of methadone to heroin users. The second phase, building on the public health lessons of other infectious diseases, focused on illicit drugs and the importance of specific strategies for the prevention of HIV transmission among injection drug users. The third, emerging phase is the shift toward an integrated public health perspective in the convergence of approaches to both licit and illicit drugs. The success of harm reduction as a unifying concept will depend on its innovative application in both prohibitory and regulatory frameworks, and careful evaluation of its effectiveness in a variety of cultural contexts. The papers in this special issue illustrate the types of research and critical thinking that are essential for the continued evolution of the harm-reduction paradigm.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Bangkok 2004. The spread of harm-reduction programs in Brazil.

A harm-reduction law implemented in the state of São Paulo in 1998 paved the way for Brazil to implement an extensive network of harm-reduction programs across the country. In his plenary address to the XV International AIDS Conference in Bangkok on 16 July 2004, Luiz Paulo Teixeira outlined the history of harm reduction in São Paulo, described how the Brazilian government adopted harm reduction as a national policy, and put forward some recommendations for extending harm-reduction policies and addressing key issues in drug-law reform. Mr Teixeira explained that leadership from both the political sector and civil society is necessary for harm reduction to be successfully implemented.

Brazil↗