Drug use--the harm minimization approach

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Drug use--the harm minimization approach

Postby zavk » Tue Jan 12, 2010 4:16 am

Hi friends

In Australia, there are organisations that adopt what is called a harm minimization approach to drug use--in fact, I have a good friend who is Buddhist and is working in this area. Here's a summary:

Introduction
For the past two decades, Australia has been at the forefront of a unique approach to drug policy and practice, known as 'harm minimisation'. This fact sheet provides an explanation of the principles of harm minimisation, and examples of how community drug initiatives fit within its framework.
What is harm minimisation?

A harm-minimisation approach considers the actual harms associated with the use of a particular drug (rather than just the drug use itself), and how these harms can be minimised or reduced. It recognises that drugs are, and will continue to be, a part of our society.

A change in our thinking and attitudes toward drug use

Harm minimisation encourages a change in our attitudes towards people who use drugs, including those who are physically and psychologically dependent upon illegal drugs such as heroin. This approach moves away from the unhelpful stereotypes of drug users as homeless alcoholics drinking in parks or 'junkies' shooting up in alleyways. Instead, we are encouraged to think about the relationships between the person, the drug and the environment and circumstances in which they are using it. Rather than seeking to 'treat' or 'cure' alcoholics or 'drug addicts' as people who have a disease, this holistic approach considers other problems associated with the person's harmful drug use, such as the availability of the drug in the community, the prevalence of its use, and how much is known about the drug and its effects and harms in the community. Importantly, harm minimisation does not seek to make moral judgments by which people are considered to be 'good' or 'bad' according to their drug of choice or frequency of use.

All drugs can cause harm

Harm minimisation highlights that all drugs have the potential to cause harm, not just the illegal ones. This is especially important when we consider that the legal drugs tobacco and alcohol are responsible for the greatest social and economic harms in our society. Estimates of the economic costs to Australia of harmful drug use in 1999 was a staggering $34.4 billion, with $6 billion due to illegal drug use, $7.6 billion due to alcohol use and $21 billion due to tobacco use.

A public health approach

Another important aspect of harm minimisation is its focus on public health, which has improved co-operation between the health, social, justice and law enforcement sectors and services. For example, one important initiative in harm minimisation has been needle syringe programs which provide sterile equip-ment, information and other services to people who usually are using illegal drugs. Extensive consultation and collaboration between these services and police have been important in their success in reducing the spread of blood-borne viruses in the community.

Better outcomes for clients

A harm minimisation approach includes supporting abstinence as a valid choice or treatment. However, it does not insist on abstinence as the objective of treatment or community prevention initiatives. In other words, people are empowered to make their own choices about their drug use.

This means that health workers can offer their clients a range of options for their desired treatment outcomes, which encourages more people to participate in treatment and prevention programs. The harms associated with a client's drug use can be reduced or minimised simply by their participation.

How does it work?

Using a variety of strategies, harm minimisation works to reduce the harmful consequences of drug use, by reducing:

- demand for drugs
- supply of drugs
- drug harms—assistance for people who choose to use drugs to do so in the safest possible way.

Demand-reduction strategies work to discourage people from starting to use drugs, and encourage those who do use drugs to use less or to stop. A mixture of information and education, along with regulatory controls and financial penalties, help to make drug use less attractive. A good example of a demand-reduction strategy was the graphic health information advertisements that 'Every cigarette is doing you damage'. Treatment is another example; it works to reduce a drug user's need to use drugs.

Supply control strategies involve legislation, regulatory controls and law enforcement. An example of a supply control strategy is liquor licensing laws restricting the sale of alcohol to persons aged 18 and over.

Harm-reduction strategies have been controversial, because they work to reduce the risks of harm, but not necessarily to reduce drug use. For example, introducing low-alcohol beer means that people can still drink beer, but the long-term health risks can be reduced. Another example is providing injecting drug users with access to clean equipment through needle syringe programs. By reducing the risk of blood-borne infections such as hepatitis C and HIV being transferred, the risks are reduced for both the individual and the community as a whole.

Is it effective?

Australia has the lowest rate of HIV infection among injecting drug users in the world, evidence that the harm minimisation approach can be highly effective in reducing harms in our community. Harm-reduction strategies such as needle syringe programs are also effective in attracting drug users who never have contact with other drug services into treatment, medical, legal and social services.

Harm minimisation can best be viewed in the context of community safety. We all want ourselves and those whom we love to be safe from ill health, injury, violence, crime and discrimination. A harm minimisation approach to drug use can help to keep people safe when they choose to use drugs.

From: http://www.druginfo.adf.org.au/druginfo ... tion1.html




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I am personally supportive of harm minimization. I like how it doesn't demonize drug users as inherently flawed individuals but instead tackles the conditions surrounding drug use. To me, this is a skillful approach--not unlike how we tackle the conditions surrounding our 'selves' to transform our unskillful thoughts and actions.

There is, however, a common criticism of harm minimization. Some critics argue that the harm minimization approach sends the message that 'It is OK to use drugs', that it would actually encourage drug use. I do not agree with such a criticism.

But what I'm curious about here is what we might make of this from a Buddhist perspective. There are two possible arguments:

Harm minimization is unskillful because it implicitly suggests that it is ok to break the fifth precept, and and in doing so condones (if not encourages) the abuse of intoxicants. From this perspective, harm minimization encourages people to indulge in actions that generate bad kamma.

OR

Harm minimization is skillful because it educates people about drug use, and in doing so create the space for them to examine their intentions and possibly take the right course of action that befits their circumstances. From this perspective, harm minimization creates the space to allow others to take actions that could possibly generate good kamma.

-----------------------

Now, these two arguments are of course somewhat simplistic. But I'm curious about your thoughts.
With metta,
zavk
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Re: Drug use--the harm minimization approach

Postby BlackBird » Tue Jan 12, 2010 5:19 am

I've done a variety of drugs over my lifetime and smoked marijuana for quite a few years especially as a teenager.

Here's how I feel about the subject:

1. I don't think supply side efforts are the answer, the 'war on drugs' has been a costly exercise which as ruined the lives of many people in the process, and doesn't really deal with the problem in the first place. In Dunedin it can be pretty difficult to score pot, because the police have a good network of informants and are quite efficient at busting growers and suppliers - But I've never met a pot smoker who was discouraged from smoking pot simply because it was hard to come by. Furthermore drugs are the main income of organised crime in NZ which in my opinion are more dangerous to society than the drugs they peddle. Legalise drugs, tax them heavily and take it out of the hands of the criminals, making them safer to use and endangering less lives.

2. Punishing consumers is not the answer. Take posession of Marijuana for example, if one is caught here in NZ with posession under an ounce, one would usually get diversion, meaning no criminal record. However say a person had already had diversion, my understanding is they are no longer eligable. If one is convicted of a drug offence in NZ it is very hard to find work and one is unable to travel to many places overseas. If one can't find a job, then they are ever more likely to turn towards crime. All the same, I've scarcely met anyone who didn't want to try smoking pot because it was illegal, or because there was a risk of being caught, if anything that's one of the things that makes it seductive.

3. Demand side operations definately provide the best hope for reducing drug use, one can see the effect lengthy anti-smoking campaigns have had in NZ, especially getting celebrities who teens look up to, to appear on anti-smoking campaigns. Propaganda is effective, lets use it.

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Re: Drug use--the harm minimization approach

Postby poto » Tue Jan 12, 2010 5:46 am

I'm a big fan of harm reduction strategies. I'd like to see logical, scientific and compassionate drug policies more widely adopted.

For soft drugs like marijuana especially, the arrest/incarceration does far more harm to both individuals and society than the substance itself.

I hope I live long enough to see the end to the war on drugs.
"Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience." -- C. S. Lewis
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Re: Drug use--the harm minimization approach

Postby Ben » Tue Jan 12, 2010 6:58 am

Mmmmm.....Drugs are Bad!...Mmm kay?

Seriously, interesting ethical dilemma you got their Ed! These last few weeks I've been driving around the countryside around Launceston where many farmers have turned to growing opium poppies and its approaching harvest time. Tasmania is the only place in Australia where farmers can grow opium poppies for pharmaceutical companies. Its highly regulated. And the thought occured to me the world of difference between the poppy fields in Tasmania and the poppy fields of Afghanistan where the same product is being produced for altogether different motivations and purposes. Anyway...

I support harm minimalization. I think its important to recognized that some people with addiction issues will continue to use no matter what barriers or disincentives you employ and so removing the health risks around illicit usage at least provides a platform from which one can then deal with the addiction itself. If harm minimalization enters the realm of facilitation of drug use or encouragement then it wouldn't be something I would support.
metta

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Re: Drug use--the harm minimization approach

Postby retrofuturist » Tue Jan 12, 2010 7:26 am

Greetings Ben,

Ben wrote:If harm minimalization enters the realm of facilitation of drug use or encouragement then it wouldn't be something I would support.
metta


What about drug substitution? In other words, the provision of a "lesser drug" in order to transition the user off the "harder drug", when it's believed that going cold turkey is not viable.

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Re: Drug use--the harm minimization approach

Postby Ben » Tue Jan 12, 2010 8:37 am

Hi Retro
Years ago a colleague of mine was a recovering heroin addict who was on the methadone program. From what he told me, the high from methadone was a very poor substitute to the high he got from heroin. He didn't see methadone as anything other than medicine.
kind regards

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Re: Drug use--the harm minimization approach

Postby seanpdx » Tue Jan 12, 2010 11:03 pm

I wholeheartedly support harm reduction policies, though they can be extremely difficult to put into practice. Irresponsible users tend to be... well, irresponsible. =( From a buddhist perspective, the precepts only apply to those who choose to adopt them. For a non-buddhist addict, the fifth precept doesn't apply at all, so they aren't "breaking" it. Harm reduction policies don't encourage drug use, despite what harm reduction opponents want to believe. But a lot of people don't understand that drug use, in and of itself, is not a problem. The "problems" with drug use are generally separate from the drug use itself. Harm reduction policies help mitigate some of these problems, which can, in turn, help to promote an environment more conducive to reaching abstinence, if that is the goal of the user. Addicts who want to use will use. I am not "promoting" drug use if I give a box of clean needles to an injection user. They will use whether I give them needles or not. But they're less likely to get an infection/abscess, less likely to destroy veins (if they IV), less likely to contract blood-borne diseases.

As far as substitution goes, it needs to be approached cautiously. I'm not in favour of maintenance plans, although I know people for whom maintenance has helped them to start living a real life again. My personal inclination is to use substitution as a transitional tool in order to make withdrawals more bearable (and for opiates, I prefer buprenorphine to methadone), and then to wean off the substitute. Relapse prevention is important in this regard, though.

Of course, if we don't care about the welfare of addicts, then harm reduction isn't important. I mean, it's not like they're people. Let them get abscesses. Let them blow all their veins. Let them contract diseases. Serves 'em right. Right?

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Re: Drug use--the harm minimization approach

Postby zavk » Wed Jan 13, 2010 12:43 am

Ben wrote:Tasmania is the only place in Australia where farmers can grow opium poppies for pharmaceutical companies. Its highly regulated. And the thought occured to me the world of difference between the poppy fields in Tasmania and the poppy fields of Afghanistan where the same product is being produced for altogether different motivations and purposes.


What a coincidence. I had a conversation with 'D' (whom you've met) about the very same topic a few days ago. It so happens that she is working on a project involving a leading international pharmaceutical corporation whose products, I dare say, are sitting in all our homes right now. We were musing about how pharmaceutical corporations probably have as much power and influence as petroleum corporations.

Anyway, on reading your comments it struck me that some people would argue (and with good reason) that pharmaceutical corporations are really not that different from drug barons and their organisations. But I get your point.... just being facetious. :smile:
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Re: Drug use--the harm minimization approach

Postby dspiewak » Thu Jan 14, 2010 5:27 pm

While I am firmly in favor of the "harm reduction" idea (what better way to describe Buddhist ethics?) I have a hard time seeing the drug-substitution aspect of it as anything other than a very short-term solution. There are many addicts out there in desperate need of a short-term solution - entrenched opiate or alcohol addicts especially, who may not be getting any pleasure from their addictions - so I don't necessarily discriminate against it on that count.

However, the larger problem as far as I can tell appears to be that people feel the need to use drugs in the first place. It's not a legal or political problem, it's a spiritual one. A healthy and focused mind is a beautiful thing. Not like a sculpture, like a tomato. It cannot be shaped by direct control (which are the aims of law and politics), it can only be grown naturally under a carefully monitored environment. I know this sounds like a platitude but there are almost no resources available to anyone (at least where I live) that can instruct them in ways to find a deeper level of joy in their lives without the use of drugs or alcohol. What does exist is made available by religious organizations, and I find that very revealing.

I'm beginning to wonder lately about the scope of social and spiritual problems, especially in the United States where I live, and if it doesn't have some kind of solution in the constant discussions that the lay community has about self-identifying as "Buddhists." What truly convinced me of the effectiveness of the Dhamma was exposure to monks and observant lay practitioners. I had very little faith in humanity when I came to the Dhamma. I harbored great resentment and I did not believe that people were really capable of acting out of anything but ego. And here I found the nicest people I had ever met, committed to a lifelong course of constantly improving goodness and selflessness. I don't know how I would have found them if I hadn't been able to clearly identify them as Buddhists. To put it bluntly, I had never seen a yellow robe in my life before I found it wrapped around a truly saintly person. People of highly-developed goodwill are capable of so much kindness. Why shouldn't they be more visible?
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Re: Drug use--the harm minimization approach

Postby seanpdx » Thu Jan 14, 2010 9:14 pm

dspiewak wrote:While I am firmly in favor of the "harm reduction" idea (what better way to describe Buddhist ethics?) I have a hard time seeing the drug-substitution aspect of it as anything other than a very short-term solution. There are many addicts out there in desperate need of a short-term solution - entrenched opiate or alcohol addicts especially, who may not be getting any pleasure from their addictions - so I don't necessarily discriminate against it on that count.

However, the larger problem as far as I can tell appears to be that people feel the need to use drugs in the first place.


This is a rather uninformed perspective, I'm afraid. If we're talking about mid- to long-term maintenance programs, and not simply a medical detox, then the rationale is that it helps to counteract the depression (etc) caused by down-regulation of dopamine (etc) receptors. It can take a long-term addict many years to return to a functional baseline, and a maintenance program can help with that. Furthermore, if an addict has a comorbid disorder which initially caused them to self-medicate, then even more work is required; if maintenance can help with the secondary withdrawals, then more focus can be placed on dealing with said disorder.

Spiritual progress cannot be made if the newly-detoxed addict commits suicide. If that means putting them on a mid- to long-term methadone or buprenorphine maintenance program, then so be it.
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Re: Drug use--the harm minimization approach

Postby LauraJ » Thu Jan 14, 2010 9:56 pm

Here in the US we say harm-reduction, from what I've heard.
I think it's sensible :)

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Laura
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Re: Drug use--the harm minimization approach

Postby seanpdx » Fri Jan 15, 2010 6:06 pm

LauraJ wrote:Here in the US we say harm-reduction, from what I've heard.
I think it's sensible :)

Kindly,
Laura


Yep, here in the US the term is "harm reduction". =)
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