Is it just me, or is there a lot of opposition and misconceptions regarding harm
When people ask me what I do for a living I often end up spending an inordinate
amount of time explaining what harm reduction is, and being challenged regarding
it?s validity. My experience is I can often talk until I?m blue in the face
with no real effect. I wonder maybe if I asked some questions of my own,
whether I might have a greater impact upon people?s consideration of harm
reduction as a valid approach to drug use within our community.
It was with this in mind I decided to develop five really important questions to
ask people when faced with opposition to harm reduction.
1. So saving lives is important right?
Pure and simple, harm reduction saves lives. Want the proof? Here is a little
Independent evaluation of the Sydney Medically Supervised Injecting Centre
(MSIC) has found that since the facility?s opening in May 2001 until the time of
the evaluation report in April 2010, 3, 426 overdoses had been managed by MSIC
staff with no fatalities (KPMG 2010).
Between 2000 and 2009 it has been estimated that 32, 050 new HIV infections
and 96, 667 new Hepatitis C infections were averted in Australia solely due the
operation of needle syringe programs (Sydney National Centre in HIV Epidemiology
and Clinical Research 2009).
Between 1996 and June 2010 there have been 10, 171 opioid overdose reversals
due to community based naloxone distribution programs in the U.S. (Centre for
Disease Control 2012)
I could list many, many more but I want you to hang around to hear my second
2. Is what you?re saying your opinion or a fact?
The spectrum of moral and ethical opinion regarding drug use covers a lot of
ground. Beliefs range from a moral and ethical opposition to any kind of drug
use, through to a belief that the taking of substances is a basic human right
that should not be impeded by law. Given the diverse range of often opposing
moral viewpoints regarding the use of drugs, structuring a model to reduce drug
issues within our communities is highly problematic. The beauty of harm
reduction is that it does not involve itself in questions of right and wrong in
regards to drug use. While often described as being value neutral, harm
reduction in fact enshrines the concept of humanitarianism. We can all agree
after all that regardless of our moral stance that injury and death associated
with the use of drugs is not a good thing. By removing ourselves from the
moral arguments of whether drug use is a good or bad thing, we can focus solely
on the harms experienced by individuals and the communities they reside within,
addressing their needs rather than their beliefs.
3. So would you prefer drug programs that actually work?
Despite the fact that harm reduction has been demonstrated to save lives in a
non judgemental manner, it continues to be opposed by many quarters.
It could be argued that one of the consequences of this continuing resistance to
harm reduction strategies and programmes is that such strategies have come under
far greater scrutiny than other forms of alcohol and other drug intervention.
Needle and syringe programs in Australia have undergone two major economic
evaluations nationally in the past decade, testing their economic viability,
methadone as an opiate substitution therapy is one of the most well researched
and evidenced pharmacotherapies utilised in drug treatment and the medically
supervised injecting centre in Sydney has operated under a trial status for over
In fact it could be argued that harm reduction has one of the most comprehensive
evidence bases comparative to other approaches to alcohol and other drug issues
in our society. When considering how we want to approach alcohol and other drug
issues in our society, do we want interventions that align with a particular set
of moral beliefs, or do we want interventions that work? I will go with
interventions that work every time.
4. Would you like to pay more or less taxes?
The treatment of blood borne viruses (BBV) and sexually transmitted infections
(STI) are expensive. Paramedic responses to overdose are expensive. Coronial
inquiries after the advent of a fatal overdose are expensive. Cost effective
measures therefore that reduce the incidence of overdose, or that reduce the
transmission rates of BBV and STI?s reduce expensive outlays of taxpayer dollars.
Perhaps the most compelling demonstration of the financial advantages of harm
reduction is the two national evaluations of Australian needle and syringe
programs (National Centre in HIV Epidemiology and Clinical Research 2002 and
2009) measuring the economic viability of Needle Syringe Programs. Spanning
nearly two decades of provision of needle syringe programs in Australia, the
findings of both reports demonstrated an overwhelming cost saving in regards to
both health and social costs saved due to the prevention of transmission of
blood borne viruses.
In the latter of the two reports it was found that:
?For every one dollar invested in NSPs, more than four dollars were returned
(additional to the investment) in healthcare cost-savings in the short-term
(ten years) if only direct costs are included; greater returns are expected
over longer time horizons.?
Harm reduction then does not only reduce drug related harm to the individual but
significantly reduces the economic costs associated with drug use.
5. Can you describe another approach that does all that?
I don?t know about you but I can?t think of another model of addressing drug
problems in our communities that combines the abilities to:
a) Significantly reduce drug related harms, AND
b) Meet people where they are at regardless of what they believe about drug
c) Is well evidenced to actually work, AND
d) Saves you money
Centre for Disease Control ?Community-Based Opioid Overdose Prevention Programs
Providing Naloxone ? United States, 2010?, in Morbidity and Mortality Weekly
Report February 17, 2012 / Vol. 61 / No. 6 pgs 101-105
http://www.cdc.gov/mmwr/pdf/wk/mm6106.pdf accessed 26th May 2012
KPMG (2010) ?Further evaluation of the Medically Supervised Injecting Centre
during its extended Trial Period (2007-2011)?. Final report
National Centre in HIV Epidemiology and Clinical Research (2002) ?Return on
investment : Evaluating the cost-effectiveness of needle and syringe programs in
Australia?, University of New South Wales,
Sydney National Centre in HIV Epidemiology and Clinical Research (2009) ?Return
on investment 2: Evaluating the cost-effectiveness of needle and syringe
programs in Australia?. University of New South Wales, Sydney
Stonetree Harm Reduction, 26.05.2012
Reference sources are given examplary and serves for information only.
Bezugsquellen werden rein exemplarisch angegeben und dienen nur zur Information