Tuesday, September 13, 2011

Harm Reduction?

This past weekend, I facilitated a workshop in Sault Ste. Marie on improving the health of the community targeting infectious diseases.

As many of you know, I work with a program of the Ontario Lung Association, called the Youth Advocacy Training Institute (YATI) as a workshop facilitator. The curriculum for this workshop was new to me, in particular the focus on infectious diseases (in this case, Hepatitis B, Hepatitis C and HIV).  And so I spent the greater part of the week prior learning all I could on the topic. While doing my background reading, I got to learning about all sorts of approaches to drug policies which I had never really thought about at much length before.  

A while back, I did a blog post on the use of methadone as a treatment for heroin addicts. This is just one example of harm reduction in general. In the 1980s, when HIV/AIDS was growing as a public health threat, it was apparent that stopping the use of illegal drugs would not happen fast enough to stop the spread of the disease. As people who feared getting arrested for their drug use were not getting tested, harm reduction became a more widely used approach to preventing the spread of HIV/AIDS. In short this includes providing education about the dangers of sharing needles, distributing clean needles and cleaning kits and giving out condoms.

Harm reduction programs operate under the assumption that some people who engage in high-risk behaviours are unwilling or unable to abstain from it. So the support becomes about making drug-use safer. On the grander scale, it seems that harm reduction is based on incremental behaviour change, and the hope is to go from safer drug use to abstinence eventually. Prior to this, a zero tolerance approach was more common when it came to narcotics. Criminalizing drugs, and creating a war on drugs was thought of as an effective deterrent. Both are interesting approaches to dealing with drug use, because at the root of it, they use different assumptions on human nature.

When I was younger, everything used to feel so disconnected and compartmentalized. Politics, law, society... I knew they all came together but I never thought about how all of these policies are based on what we assume about human nature. Questions about whether people are able to change, whether fear of punishment will keep people from doing "bad" things, what "bad" is and motivations for us doing what we do are all part of considering how to approach illegal drug policies.

I personally feel conflicted about my thoughts on harm reduction. I do see how it can seem like a gateway to making drugs acceptable in society. On the other hand, we know drugs are not going anywhere. As the safe-house in Vancouver has demonstrated, harm reduction efforts can be effective. At this location, drug users inject themselves, but with clean needles under nurse supervision. The rate of fatalities based on drug use decreased, not to mention the spread of infectious diseases from dirty needles. But is this really helping people? Are people quitting eventually and with support, or does this just keep users sustained on drugs but alive? 

Coming from a tobacco control background, I see how policies to ban various ways of promoting positively impacted the reduction of smoking in North America. The underground nature of illegal substances, and widespread availability and prevalence provide an interesting consideration. Does punishment work as an effective deterrent? I mean, the prison system is based on this concept, along with of course, rehabilitation. But aren't there always going to be people who are drawn to high-risk behaviours? 

This conversation does not even bring into play the fact that there are plenty of legal drugs that cause harm to people and policies have yet to create effectively how to manage those forms of addictions. From what I've learned though, harm reduction work is vital to addressing the existing drug use problems. I think it is important to provide clean needles, condoms and knowledge. In London, I saw harm reduction pamphlets teaching users (in comic book form) about shooting up, and why certain spots are more dangerous and the different between arteries and veins. It seemed contradictory, but I understood why this was important having met people who were already so dependent that sending them to prison for their drug consumption would do nothing for them.

Harm reduction is just the start. There's so much more to consider and once safety concerns can be addressed, risks reduced even a little, steps can be taken to help the user become less dependent. I still have a lot more to learn on the topic, these are thought based on what I've learned recently. I'm curious to know more from people who've been around it or know more about it, and the assumptions they feel these policies are based on.

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