Harm reduction

From Wikinfo

Harm reduction is a set of policy beliefs, essentially stating that some people always have and always will perform activities, such as promiscuous sex or drug use that may cause them harm. Therefore, there is a moral imperative to reduce the harm caused by risky activities, rather than an ineffective blanket prohibition of the performance of harmful activities.

Harm reduction has been very controversial in the U.S. (less so in Europe and Australia) due to concerns that some harm reduction initiatives normalize dangerous behavior, treat already stigmatized people with the "subtle racism of low expectations", and involve governments and communities in morally dubious activities.

Harm reduction initiatives range from widely accepted designated driver campaigns, to more controversial initiatives like the provision of condoms in schools, safe injection rooms, drug legalization, heroin maintenance programs, and the provision of sterile surgical facilities for female circumcision (also known as female genital mutilation) in order to reduce infections.

Drugs

Methadone

Harm reductionists advocate the availability of a drug called methadone. Methadone does not cause any sense of euphoria in the user, but it does reduce or eliminate the cravings associated with heroin withdrawal. Therefore, harm reductionists claim, methadone should be made widely available to heroin addicts, who can use methadone on a regular basis, temporarily or permanently, while still leading a fulfilling and healthy lifestyle. Critics of methadone treatment claim that this is merely a substitution of one addiction for another, or that methadone treatment does not work.

Benefits of Methadone Treatment

These are benefits as stated by a Belgian Consensus Conference on Methadone Treatment, conducted by the Belgian Minister of Health. The following conclusions were sent to every Belgian doctor 1.

Methadone is an effective medication for the treatment of heroin addiction.
Methadone reduces heroin consumption and injection, reduces mortality related to heroin addiction, reduces the risk of infection with HIV as well as hepatitis B and C, improves therapeutic compliance of HIV-positive drug addicts, facilitates detection of illness and health education strategies and is associated with an improvement in socio-professional aptitude and a reduction in delinquency.
Prolonged treatment with proper doses of methadone is medically safe. At present, methadone has not been shown to be toxic for any organ.
There is no scientific reason to limit the overall number of heroin addicts admitted for methadone treatment.
Availability of methadone treatment should be increased to respond to the need for such treatment, including by private practitioners.
Psycho-social support is not compulsory and should be adapted to the individual needs of patients.

Syringe Exchange and Related Programs

The use of heroin and certain other illicit drugs involves hypodermic syringes. In some areas, these are available solely by prescription. Because of this, users of heroin and other drugs frequently share the syringes. As a result, one user's infection, such as HIV, quickly spreads through the reuse of syringes contaminated with infected blood. The principles of harm reduction necessitate that syringes should be made more easily available (i.e. without a prescription). Many harm reductionists also argue that users should be able to exchange dirty needles for clean ones at clinics set up for this purpose: so-called needle exchange programs. Critics claim that these measures will encourage addiction by making it safer to inject illicit drugs.

DanceSafe and Related Programs

DanceSafe is a national program in the United States, wherein volunteers situated at raves and similar dances test (for free) pills that participants purchased on the assumption they were Ecstasy. Similar programs have been proposed and, in some cases, implemented to test the purity of other drugs. Harm reductionists support these programs as informing drug users of the purity of their drugs. Thus decreasing the possibility of accidental overdoses and adverse drug reactions. Critics of these policies claim that such programs encourage drug use by making it seem safer.

Drunk Driving and Alcohol-Related Programs

A high amount of media coverage exists informing users 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 programs are reducing the number of drunk-driving accidents. Many cities have free-ride-home programs during holidays involving high alcohol abuse, and some of the more responsible bars and clubs will provide a visibly drunk patron with a free cab ride.

Sex

Safe Sex Programs

Many schools now provide safe sex education to teen and pre-teen students, some of whom, regardless of what they are (or aren't) taught, have been shown to be extremely likely to engage in sexual activity. Given the premise that (at least some) kids are going to have sex, a harm-reductionist approach supports sexual education which emphasizes the use of protective devices like condoms and dental dams to protect against unwanted pregnancy and the transmission of STDs. This runs contrary to the ideology of "abstinence-only" sex education, which holds that telling kids about sex necessarily encourages them to go out and get some.

Supporters of this approach cite statistics which they claim demonstrate that this approach is significantly more effective at preventing teenage pregnancy and STDs than abstinence-only programs; social conservatives disagree with these claims -- see the sex education article for more details on this controversy.

Legalized prostitution

There are many advocates of the legalization of prostitution in jurisdictions where it is illegal. Proponents state that there are several benefits:

legalization allows prostitutes to escape the influence of pimps and organized crime
legalization allows more effective public health measures against sexually transmitted diseases
legalization removes a victimless crime (although one could argue that the customers' families are victims, adultery is not considered a crime in most Western jurisdictions)

Other forms of harm reduction initiative

Other harm reduction programs to be expanded on:

Mandatory seat belt/helmet laws
Laws controlling smoking in public
Safe injecting rooms
Heroin maintenance programs
Encouragement of the use of water pipes as opposed to cigarettes and straight pipes
Not notifying parents about their children receiving contraception
Not notifying parents for youth abortions
State regulated production and marketing of currently illegal drugs

Links

"Getting Off Right is a plain-speaking, how-to survival guide for injection drug users. Written by drug users and service providers, it is a compilation of medical facts, injection techniques, junky wisdom and common sense that aims to provide the necessary information to keep users and their communities healthier and safer." http://www.harmreduction.org/idu/idu_manual.pdf

http://www.harmreduction.org/pamphlets/brochure_exchange.html

http://www.anypositivechange.org

http://www.drugpolicy.org/docUploads/aboutmethadone.pdf