harm reduction

Harm Reduction: Definition and Key Principles

Excerpted from “Harm Reduction:  What’s in a Name?” by Canadian Centre on Substance Abuse.  Written by: Douglas J. Beirness, Rebecca  Jesseman, Rita Notarandrea and Michel Perron.  For the full paper, go to:

http://www.ccsa.ca/2008%20CCSA%20Documents2/ccsa0115302008e.pdf

I like this paper because it talks about the importance of focusing on harm reduction as a means of reducing risks for drug users, rather than getting caught up in the idea that it “encourages or promotes” drug use.  Abstinence doesn’t work for everyone, and even if people do want to quit using, it can often take months to get into an appropriate treatment program.  While people are actively using, it is essential to provide them with the tools to do so as safely as possible, and to prevent the transmission of HIV/HCV.   To me, harm reduction is part of a treatment continuum that can, but doesn’t necessarily, have abstinence as its end goal.

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Definition

In its most general sense, “harm reduction” refers to any program, policy or intervention that seeks to reduce or minimize the adverse health and social consequences associated with drug use. This broad perspective would include virtually any drug policy, program or intervention since at some level, the objective of all such measures—including enforcement and abstinence-oriented programs—is to reduce the harmful consequences of drug use in some manner.

A narrower definition of “harm reduction” focuses on those policies, programs and interventions that seek to reduce or minimize the adverse health and social consequences of drug use without requiring an individual to discontinue drug use. This latter definition recognizes that many drug users are unwilling or unable to abstain from drug use at any given time and that there is a need to provide them with options that minimize the harms caused by their continued drug use to themselves, to others, and to the community, including overdose, infections, spread of communicable diseases, and contaminated litter. This approach does not exclude discontinuing drug use in the longer term and can serve as a bridge to treatment and rehabilitation services.

It is the latter definition of “harm reduction” that has created the polarization of groups within scientific, public health, clinical, and social policy communities. It would appear that on the one hand, there are those who view “harm reduction” as a way to help drug users minimize the damage they cause to themselves and others through their continued use of drugs. On the other hand, a “zero-tolerance” perspective on illegal drugs views “harm reduction” as an approach that encourages drug use and appears to provide thinly-veiled support for the decriminalization or legalization of drugs.   Strongly-held opinions on both ends of the “harm reduction” spectrum have caused a rift between people who should be working together to improve the lives of drug users and reduce societal problems. This ideological argument is unproductive and threatens the credibility of scientists and practitioners and, more importantly, hinders the implementation of well-intentioned and effective policies, supports, services, interventions, and treatments aimed at protecting all people from the adverse health and social consequences associated with drug use. Programs should neither be accepted nor rejected on the grounds of ideological perspective, but rather on the basis of an objective assessment of their effectiveness.

Key Principles of Harm Reduction

The following are key principles of harm reduction as outlined by the CCSA National Policy Working Group (1996):
Pragmatism: Some level of drug use in society is to be expected. Containment and amelioration of the drug-related harms may be a more pragmatic and feasible option, at least in the short term, than efforts to eliminate drug use entirely.
Humane Values: No moralistic judgment is made about an individual’s decision to use substances, regardless of level of use or mode of intake. This does not imply approval of drug use. Rather, it acknowledges respect for the dignity and rights of the individual.
•Focus on Harms. The extent of a person’s drug use is of secondary importance to the risk of harms resulting from use. The first priority is to reduce the risk of negative consequences of drug use to the individual and others. Harm reduction neither excludes nor presumes the long-term treatment goal of abstinence. In some cases, reduction of level of use may be one of the most effective forms of harm reduction. In others, alteration to the mode of use may be more practical and effective.
• Balancing Costs and Benefits: Some pragmatic process of assessing the relative importance of drug-related problems, their associated harms, and costs/benefits of intervention is carried out in order to focus resources on priority issues. This analysis extends beyond the immediate interests of users to include broader community and societal concerns. This rational approach allows the impacts of harm reduction to be measured and compared with other interventions, or no intervention at all. In practice, such evaluations are complicated by the number of variables to be examined in both the short and long term.
• Priority of Immediate Goals. The most immediate needs are given priority.  Achieving the most pressing and realistic goals is usually viewed as first steps towards risk-free drug use or discontinued use.

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