Harm reduction is a public health strategy that was developed as an alternative to abstinence-based substance abuse rehabilitation programs. This strategy accepts that in the case of addiction, total abstinence may not be feasible and allows for a certain amount of continuing drug use. The goal of harm reduction is to lower the adverse or harmful consequences of substance abuse and addiction and not necessarily stop the drug use itself. Many methods of harm reduction are employed to attempt to minimize negative health risks like infections and overdose, as well as legal, social, and family issues that harm quality of life.
The United States has had a spotty history with the legality of drug use and abuse. In 1971, President Nixon declared a “War on Drugs.” Today, America has one of the largest prison populations in the world, with many prisoners incarcerated for drug-related causes. Close to a half-million people are behind bars for drug law violations in the United States, as published by CNN.
Harm reduction is hotly debated with opponents claiming it reinforces negative behavior, and supporters claiming it protects basic human rights. Harm reduction is more widely accepted in most European nations and by the United Nations as an official policy, but it is still highly controversial here in the United States.
Harm Reduction Programs
Harm reduction recognizes that drug addicts are going to abuse drugs, and many will not sustain abstinence. So instead of taking a zero-tolerance policy, harm reduction seeks to minimize risk factors. Harm reduction programs may include:
- Needle exchange, safe injection sites, and disposal locations
- Drug substitute treatment or maintenance therapy
- Pharmacy sale of or exclusion of syringes from drug paraphernalia laws
- Providing clean drug resources
- Community outreach programs
These programs accept drug use as a part of life and seek to find ways to make it safer for all involved. Many rehabilitation programs expect complete abstinence and when abusers are unable to comply, they are either dropped from the program or not included in the first place. Harm reduction programs open the doors to drug users with limited other options. Harm reduction also seeks to provide services to drug abusers and their families. Public health for everyone in all communities is the long-term goal of harm reduction programs.
Harm reduction programs may provide educational strategies combined with brief interventions to discuss the perils, consequences, and risky behavior associated with drug abuse in an effort to educate drug users and their families on how to minimize negative outcomes. Harm reduction is not meant to open the doors wide on drug abuse, but rather to help users with a low threshold for total abstinence set realistic goals and maintain safer levels of abuse, lowering associated risks and providing them with necessary health services. Many supporters of harm reduction intend for the programs to be used side by side and in concert with more traditional rehabilitation models.
Most harm reduction programs seek to be cost-effective and easy to implement. They are put in place in locations where they may be needed most. High drug-using communities, poor, and uneducated inner city locations are generally targeted. Community outreach harm reduction programs seek to lower risky health and sexual behaviors related to drug abuse in a nonjudgmental format.
Harm reduction programs like safe needle exchanges may lower the risks of infectious diseases, such as HIV and hepatitis C, which are often transmitted through the sharing of dirty needles. A study done on injection drug users found that after public funding and legal authorization in New York State for syringe exchange programs was enacted, new HIV infections dropped from 4 percent between 1990 and 1992 to 1 percent between 1999 and 2002, as published by the American Journal of Public Health. Clean or sterile drug resources for drug users who are going to use drugs anyway help to protect them from infections and diseases. Many European countries have also instituted safe injection sites for users, providing them with clean drug paraphernalia and a sterile, safer environment than the street. None of these exist yet here in the United States.
Every day in America, drug overdoses kill 114 people, as reported by the Centers for Disease Control and Prevention (CDC).
Drug maintenance or substitute treatments, like methadone clinics, usually dispense opioid replacements for heroin abusers in a controlled and supervised environment in an effort to reduce drug overdose fatalities.
These clinics offer methadone and/or buprenorphine pills or liquid formats as a substitution for injected opioids.
Injecting drugs is one of the more dangerous forms of drug abuse. Not only can infectious diseases be passed through dirty needles, injecting drugs sends them straight into the bloodstream where they rapidly cross the blood-brain barrier, increasing the risks for a potentially life-threatening overdose. By providing drug abusers with an alternative to “shooting up,” the mortality rate for overdoses is thought to decrease. By providing lower or less potent doses of drugs, these clinics can also manage difficult and potentially fatal withdrawal symptoms addicts may suffer from as well. Stopping some drugs cold turkey can lead to cardiac arrest, seizures, coma, and even death.
Harm reduction is controversial, and many believe that by not taking a stand against all drug abuse, we as a nation are condoning it. The opposition to harm reduction argues that accepting drug abuse as a part of life and setting up “safe” drug using programs may only increase the number of people abusing drugs overall. It may also send the wrong message to drug abusers – that drug abuse is socially acceptable and not something to work to avoid. Just as abusing drugs stimulates the reward pathway in the brain and encourages abuse, accepting drug abuse in any form may reinforce negative behaviors.
Opponents of harm reduction also worry that the sites of these “safe” drug locations will cause a rise in crime and may even make drugs more accessible, therefore increasing the drug problem instead of reducing it. More access may mean more people abusing drugs, not fewer.
Harm reduction also doesn’t address the psychological or emotional component of addiction and allows drug use to continue. Addiction is a treatable brain disease that can be managed with behavioral and cognitive therapies that focus on modifying the thought and behavior patterns that drive addiction. By treating the root cause of addiction and substance abuse, health, social and economic risk factors can all be lowered. Harm reduction looks to lower these risks without confronting the underlying issues; however, psychotherapy can produce the same results with an even better and potentially safer outcome.
Whether total abstinence or a reduction of risk is the end goal, rehabilitation programs need to address both the physical and psychological aspects of drug abuse and addiction. Detox can be managed safely in a rehabilitation facility that promotes healthy lifestyle choices and seeks to promote long-term physical and emotional health.
Drug abuse creates a ripple effect; not only the user experiences the consequences, but everyone around that person does as well. Long-term support expands on a strong foundation built by individual, group, and family therapies. Here at Axis, we strive to treat the whole person, working to improve physical and mental well-being and overall quality of life. Intake specialists are standing by to help you, or your loved one, develop a unique and comprehensive plan to ensure the best results for your specific circumstances and goals.
