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MAKING THE CASE FOR HARM REDUCTION

July 1, 2007
by SHAWN BAYES, MM, BA
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A provider organization cites the success of harm reduction efforts in Vancouver, British Columbia

Medicine has long recognized the detrimental effects of addiction. For more than 40 years, physicians have attempted to provide those struggling with addiction solutions to moderate substance abuse's consequences. Dole and Nyswander often are recognized in the United States for their work in methadone treatment for heroin drug addiction. However, predating their work, Dr. Robert Halliday began methadone treatment for heroin addiction in Vancouver, British Columbia, in the late 1950s and introduced a methadone maintenance program in 1963.1-3 Since that time, Vancouver has continued its pragmatic approach to moderate the effects of addictions through harm reduction, and has led the country and North America in the introduction of harm reduction measures.

Harm reduction is based on the principles that we do no harm to those suffering from substance addiction, and that we focus on the harm caused by problematic substance use, rather than substance use per se. Communities have adopted such strategies as a means of reducing the social and economic costs of addiction, including crime and familial difficulties. Harm reduction involves establishing a hierarchy of achievable goals that, when taken step by step, can lead to a healthier life for drug users and a healthier community for everyone. Harm reduction accepts that abstinence may not be a realistic goal for some drug users, particularly in the short term. Harm reduction involves an achievable, pragmatic approach to drug issues. Furthermore, these interventions have proven successful in decreasing the open drug scene, the spread of HIV/AIDS and hepatitis, and overdoses and overdose deaths in countries such as Germany, Switzerland, and Australia.4

In contrast, a study by the British Columbia Centre for Excellence in HIV/AIDS found that the large-scale Vancouver police crackdown in 2003 to control illicit drug use did not alter the price of drugs or the frequency of use, and nor did it encourage IV drug users to enroll in methadone treatment programs. Instead, several study measures indicated that users moved from the area of the crackdown into adjacent areas of the city, having implications for both recruitment of new initiates into injection drug use and HIV prevention efforts.5

Vancouver's Four Pillars Drug Strategy emphasizes prevention, treatment, harm reduction, and enforcement. Today, harm reduction measures in Vancouver include the long-standing methadone maintenance treatment programs and a spectrum of other measures, including drug courts, needle exchange programs (NEPs), a supervised injection site, street health outreach services, and clinical trials of methadone for chronic opiate dependency. Through medical training for physicians, a federal drug law exemption, and behavioral healthcare counseling, individuals are provided supports and resources to reduce their personal harm and that to the community from the sale and use of legal and illegal substances.6

The U.S. National Institute on Drug Abuse has documented the many studies that have demonstrated the efficacy of methadone maintenance therapy in reducing use of opioids, decreasing crime associated with drug use, decreasing drug-related deaths, and preventing the spread of blood-borne diseases.7 Methadone maintenance and harm reduction strategies increasingly have become standard practices in many countries and are used to manage a host of consequences, from diminishing risks for developing fetuses in pregnant women to reducing the social costs of criminal behaviors to support addiction.7

Other measures introduced in Vancouver, such as NEPs, have similarly developed a body of evidentiary support.6 Today more than 100 NEPs exist in Canada.8 Health experts say hypodermic needles can harbor more than 20 blood-borne diseases, including HIV and hepatitis B and C. Critics of NEPs say they encourage people to use illegal drugs and result in more needles being dumped in public places. However, according to the Centre for Addiction and Mental Health, which looked at several surveys, NEPs:

  • reduce the transmission of disease in drug users;

  • do not increase injection drug use; and

  • do not increase the number of needles discarded (NEPs collect more needles than they give out).9

BC Partners for Mental Health and Addictions Information reports that in 2000, the Vancouver NEP distributed nearly 3.5 million needles with a return rate of 101%,10 thus disposing of millions of needles safely and ensuring that they are not discarded inappropriately. BC Partners also cites a study by Gibson et al that found injecting drug users in the United States who used a syringe exchange had a sixfold decrease in HIV risk behavior compared to injection drug users who used syringes from other sources, concluding that sterile needles are an inexpensive means of preventing greater healthcare costs.11

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