The Importance of Harm Reduction Programs: Why Abstinence-Only Programs Aren’t Enough

It would be pretty nice to rid the world of drug addiction and all of its negative personal and societal consequences.

Unfortunately, no one has any idea of how to do that, despite herculean efforts like the prohibition-style war on drugs that have accomplished very little in actually reducing drug use and abuse!

So if we admit that at the community level we cannot stop drug use and abuse, do we then simply turn a blind eye to the needs and suffering of the tens of millions of Americans who use licit and illicit drugs and the hundreds of millions of Americans who love them as sisters and mothers, fathers and brothers?

Or do we take action to help those who are ready to quit using with effective addiction treatments and interventions and to support the left-over majority with evidence-based initiatives which reduce the personal harms and risks of drug use and which protect communities from some of the fall-out consequences?

The question is – are we ready to look at the facts and to base action on science rather than emotion and to see those who require our help as people like us deserving our compassion rather than our punishments?

Principles of Harm Reduction

Harm reduction is an umbrella term for initiatives which strive to reduce the individual and societal harms associated with drug use. Some common principles of harm reduction programs include:

• Accepting that drug use is an enduring part of our communities, whether we like it or not, but knowing that though we cannot rid the world of drug use we can take steps to reduce the harms associated with drug use.
• Accepting that drug users are deserving of the same human rights, dignity and compassion as anyone else
• Accepting that people who cannot or will not stop using drugs can still make good choices to protect themselves from unnecessary harm¹
• Meeting drug users ‘where they are’. Not trying to convince drug users to seek treatments which they do not want but working with them to help them make small improvements in areas like personal health, employment, crime prevention etc.
• Accepting that some ways of using drugs are safer than other ways, and that helping people to use drugs in safer ways can save lives and reduce harms
• Understanding that people are much more likely to make changes in small steps rather than in giant leaps and most commonly, major life changes are made through a series of many small steps. It makes sense to support people in making these small positive steps and not to only support major leaps (like going from injection drug use to sudden abstinence). At the societal level, there can be greater benefit from helping many people make small improvements than in helping a motivated few make great improvements. ²
  
• Evaluating a harm reduction program’s success by the degree it improves life at the individual or societal level, whether or not the initiative results in a reduction in drug use.³
• Being committed to using the strongest available evidence to justify a course of action and to seeking the greatest possible benefit through programs that maximize impact and minimize costs

Examples of Different Types of Harm Reduction Programs

Some examples of harm reduction programs include:

• Needle or crack pipe exchange programs
• The use of methadone or Suboxone
• Providing condoms to sex workers
• Supervised injection clinics
• Designated driver programs
• Health outreach programs
• Street drug testing (such as testing for the purity of ecstasy in a club to prevent inadvertent overdose or use of a more dangerous drug)
• HIV testing and counseling services
• Care for wounds (injection drug related)
• Peer drug use information outreach programs

Evidence for the Effectiveness of Harm Reduction Policies

• A study of injection drug use harm reduction programs found no convincing evidence that needle exchange programs increased injection drug use (one criticism of certain types of harm reduction programs is that they encourage drug use, however research rarely finds evidence to back these assertions.)⁴ A separate review of 42 studies on the use of needle exchange programs found that these programs were associated with reducing the reuse of injection equipment, reducing the frequency of injecting, reducing the frequency of crack cocaine use, increasing referrals for substance abuse treatment and increasing the use of condoms.⁵
• A review study of harm reduction programs found that methadone maintenance programs were effective in retaining opiate dependent people in treatment and in reducing illicit drug use and crime participation. This same review study also found that needle exchange programs were a very cost effective way to reduce the transmission of HIV among injection drug users.⁶
• A study in published in The Lancet medical journal found that fatal overdoses were down by 35% within 500 meters of the Insite safe injection facility in Vancouver since its opening, compared to a reduction of only 9% across the rest of the city.⁷