ADD5107: Week 9 Discussion 1: Harm Reduction
Discuss the viability of harm reduction as a treatment approach from an evidence-based
perspective.
Note: Please see attached Note: 2 reference required Note: Minimum of 700 words.
Harm reduction as a viable treatment approach: An evidence-based perspective
Harm reduction has emerged as a pragmatic treatment approach for individuals struggling with substance use issues. At its core, harm reduction aims to minimize adverse health, social and legal outcomes associated with drug use, without necessarily requiring abstinence (Marlatt, 1998). This article will discuss the evidence supporting harm reduction’s viability from both an individual and public health perspective.
What is harm reduction?
Harm reduction refers to policies, programs and practices that aim to reduce negative consequences associated with drug use rather than necessarily eliminating use altogether (Hawk et al., 2017). It is based on the humanist idea that, especially for those unable or unwilling to stop substance use, any step towards safer use can benefit both individual and community well-being. Common harm reduction strategies include needle exchange programs to reduce disease transmission, drug checking services to prevent overdoses from unknown purity/potency, and supervised consumption sites where medical help is immediately available in case of overdose (Potier et al., 2014).
Individual-level evidence
Harm reduction as a viable treatment approach: An evidence-based perspective
Harm reduction has emerged as a pragmatic treatment approach for individuals struggling with substance use issues. At its core, harm reduction aims to minimize adverse health, social and legal outcomes associated with drug use, without necessarily requiring abstinence (Marlatt, 1998). This article will discuss the evidence supporting harm reduction’s viability from both an individual and public health perspective.
What is harm reduction?
Harm reduction refers to policies, programs and practices that aim to reduce negative consequences associated with drug use rather than necessarily eliminating use altogether (Hawk et al., 2017). It is based on the humanist idea that, especially for those unable or unwilling to stop substance use, any step towards safer use can benefit both individual and community well-being. Common harm reduction strategies include needle exchange programs to reduce disease transmission, drug checking services to prevent overdoses from unknown purity/potency, and supervised consumption sites where medical help is immediately available in case of overdose (Potier et al., 2014).
Individual-level evidence
Several studies have demonstrated harm reduction’s effectiveness at reducing individual health risks. For example, a systematic review found needle exchange programs are associated with a 30% reduced risk of HIV and hepatitis C transmission without increasing drug use (Kerr et al., 2010). Supervised consumption sites have also been shown to significantly decrease overdose deaths, ambulance calls and public drug use with no correlation with increased drug trafficking or crime in the surrounding areas (Marshall et al., 2011; Potier et al., 2014).
Population-level evidence
In addition to individual benefits, harm reduction yields positive outcomes at the population level. Modeling studies estimate needle exchange programs and opioid substitution therapy could avert thousands of HIV infections annually in major cities (Des Jarlais et al., 2009). Jurisdictions with more liberal drug policies have lower rates of problematic drug use and drug-related harms compared to places with punitive prohibition approaches (Hughes & Stevens, 2010). For example, Portugal decriminalized possession of all drugs in 2001 and saw declines in overdose deaths, HIV and hepatitis C infections, and drug-related criminal justice workload (Greenwald, 2009).
Critiques of harm reduction
Some criticisms of harm reduction question its effectiveness and argue it may enable or even encourage continued drug use (Csete et al., 2016). However, most empirical studies have found no correlation between harm reduction services and increased drug consumption (Kerr et al., 2006; Potier et al., 2014). While abstinence should remain the ultimate goal for dependent users seeking treatment, harm reduction provides a pragmatic and evidence-based option for those unable or unwilling to immediately stop, preventing loss of life while the door to further treatment remains open.
Conclusion
In summary, over two decades of research demonstrates harm reduction is a viable treatment approach with individual and population-level benefits. By meeting users where they are at without judgment, harm reduction saves lives and prevents disease transmission without enabling increased drug use. As an alternative to punitive prohibition approaches, harm reduction offers a compassionate, public health-oriented framework supported by empirical evidence.
References:
Csete, J., Kamarulzaman, A., Kazatchkine, M., Altice, F., Balicki, M., Buxton, J., … & Beyrer, C. (2016). Public health and international drug policy. The Lancet, 387(10026), 1427-1480.
Des Jarlais, D. C., McKnight, C., Goldblatt, C., & Purchase, D. (2009). Doing harm reduction better: syringe exchange in the United States. Addiction, 104(9), 1441-1446.
Greenwald, G. (2009). Drug decriminalization in Portugal: lessons for creating fair and successful drug policies. Cato Institute.
Hawk, M., Coulter, R. W., Egan, J. E., Fisk, S., Reuel Friedman, M., Tula, M., & Kinsky, S. (2017). Harm reduction principles for healthcare settings. Harm Reduction Journal, 14(1), 1-9.
Hughes, C. E., & Stevens, A. (2010). What can we learn from the Portuguese decriminalization of illicit drugs?. British journal of criminology, 50(6), 999-1022.
Kerr, T., Tyndall, M. W., Li, K., Montaner, J., & Wood, E. (2005). Safer injection facility use and syringe sharing in injection drug users. The Lancet, 366(9482), 316-318.
Marlatt, G. A. (1998). Harm reduction: Come as you are. Addictive behaviors, 23(6), 779-788.
Marshall, B. D., Milloy, M. J., Wood, E., Montaner, J. S., & Kerr, T. (2011). Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study. The Lancet, 377(9775), 1429-1437.
Potier, C., Laprévote, V., Dubois-Arber, F., Cottencin, O., & Rolland, B. (2014). Supervised injection services: What has been demonstrated? A systematic literature review. Drug and alcohol dependence, 145, 48-68.
In summary, this discussion has highlighted harm reduction as a viable treatment approach supported by over two decades of empirical evidence demonstrating individual and population-level benefits. By meeting substance users where they are at without judgment, harm reduction saves lives through preventing overdose deaths and disease transmission, while also not enabling increased drug use. As an alternative to punitive prohibition approaches, harm reduction offers a compassionate, public health-oriented framework grounded in evidence. Overall, the literature suggests harm reduction is a pragmatic and effective treatment strategy, especially for those unable or unwilling to immediately stop substance use.
