Harm Reduction and the War on Drugs

As the war on drugs rages on, many question its effectiveness. For decades, the policy of law enforcement agencies has been to restrict the supply of drugs, and to treat those who use drugs as criminals. Meanwhile, experts in the medical and legal field suggest that the war on drugs has not only failed to solve the issue; it has actually made things worse.

“Harm reduction is a framework based on science and human values.”

According to Dr. Ethan Nadelmann, founder and former director of the Drug Policy Alliance as well as a prominent critic of the war on drugs, “Drugs are here to stay whether we like it or not, and we needed to cope with it by building a framework based on science and human values”.  One such approach is harm reduction.

Harm reduction strategies have gained further recognition and traction worldwide since 2020. Governments, NGOs, and public health organizations are increasingly acknowledging the effectiveness of harm reduction approaches in addressing substance use issues.

What is Harm Reduction?

The harm reduction approach incorporates policies, programmes and practices aimed to minimise the negative health, social and legal impact of drug use on users and to communities. This evidence-based, justice and human rights approach does not require people to stop using drugs. Rather it seeks to accomplish positive change by reducing drug-related deaths through non-judgemental, non-discriminative and non-coercion methods.

Keeping someone alive, so that they have the opportunity to make changes seems obvious. However, how you do it is not always as straightforward as providing a drug-free safe space with food and water. Many people who use drugs do not need treatment and those who need it may not want to go into a treatment facility. Furthermore, coercive methods are largely ineffective in facilitating lasting change.

“Harm reduction does not enforce behaviour change, it aims to provide viable options.”

Harm reduction recognises that world-wide there are many people who are unable or unwilling to stop using drugs. Instead of focusing on enforcing behaviour change amongst drug users, the grounding principles of Harm Reduction seek to:

• Preserve the rights of those who use drugs
• Roll out evidence-based interventions
• Decrease discrimination through stakeholder collaboration
• Address stigma
• Positively impact individual and community health

5 Goals of Harm Reduction are to:

1. Keep people alive
2. Protect people’s health
3. Encourage positive change in lives
4. Reduce the harm of drug policies and laws
5. Offer alternative drug prevention, care and treatment programmes

Harm Reduction and Health Care Programmes

Often harm reduction programmes, for example, those aimed at people who inject drugs (PWID), are dovetailed with other health initiatives such as hepatitis or HIV prevention, treatment and care health packages. Regional data shows that HIV prevalence in PWID is high in all parts of the world. According to the World Health Organisation (WHO), PWID HIV linked care programmes should ideally contain these elements:

• Needle/syringe programmes
• Opioid substitution therapy
• HIV testing and counselling
• HIV treatment and care
• Condom programming
• Behavioural interventions
• Prevention and management of viral hepatitis, TB and mental health conditions
• Sexual and reproductive health interventions
• Provision of naloxone and training on overdose prevention for PWID community

Linking harm reduction approaches to health care programmes increases the referral rate to support programmes as well as essential services. Additionally, decreasing stigma has increased overall health seeking behaviour, which reduces the general prevalence of communicable diseases.

“Linking health care with a harm reduction approach is advantageous to individuals and communities.”

Efforts to reach marginalized communities, including people who inject drugs, sex workers, and LGBTQ+ individuals reflect a growing understanding of the importance of inclusivity and equity in public health interventions. 

Harm Reduction for Drug Users

The objective of harm reduction, explains Dr. Singer, a senior fellow at the Cato Institute, is to “avoid measures that exacerbate the harms the black market already inflicts on nonmedical users and to focus strictly on the goal of reducing the spread of disease and death from drug use”. Practices that are incorporated into the harm reduction policy include medication-assisted treatments, safe injection sites, and drug regulation.

Medication-Assisted Treatments

Pro: By providing addicts with medication-assisted treatments they are replacing a drug which is dangerous and would kill them, with one which would allow them to live more normally again. While taking, for example, a legal and titrated opiate, an addict would also be better able to mitigate the effects of withdrawal as they wean themselves off the drug gradually.

Con: The biggest criticism of medication-assisted treatments is that it simply replaces one drug with another. Therefore, shifting an addiction from an illegal to a legal substance rather than solving the problem.

Research: Medication-assisted treatment appears to be backed up by data, which shows a significant reduction in the risk of relapse, overdose, and the spread of infectious diseases.

Safe Injection Sites

Pro: Government-sanctioned injection sites would provide a clean, clinical setting, where health professionals can supply sterilised needles, administer medication in order to treat overdose, and refer patients for medical treatment and rehabilitation programmes.

Con: Safe injection sites risk legitimising substance abuse by providing a safe way to use drugs.

Research: Data shows that supervised injection facilities (SIFs) actually increase the number of drug users entering treatment programmes while reducing the number of deaths caused by overdose and infectious diseases spread through needle use.

Drug Regulation

Pro: Harm reduction policy promotes the deregulation or legalisation of substances that can help prevent drug-related deaths. As a result, the World Health Organization has a “list of essential medicines” for the treatment of opioid dependence

Con: Legalisation of substances that assist drug addicts could be seen as legitimisation of overall drug use and legalisation of a specific drug could be interpreted as condoning the use thereof.

Research: Studies have also observed a correlation between the legalisation of cannabis and a reduction in substance abuse and overdose deaths. A 2018 study by the RAND Corporation of medical marijuana laws in the United States found that states permitting medical marijuana dispensaries saw decreased rates of opioid addiction and overdose.

The Future of Harm Reduction

Pro: Proponents argue that a policy, based on harm reduction, which removes the stigma attached to substance abuse, and mitigates the harm done by misguided drug legislation, could be more effective at promoting positive change for individuals and communities.

Con: Critics warn that the harm reduction approach could set efforts to mitigate drug use back by giving the impression that drug use is safe.

Despite progress, numerous challenges persist in the global harm reduction landscape. Stigma, criminalization, and political opposition continue to hinder the widespread adoption of evidence-based harm reduction approaches. Funding shortages pose a significant barrier to scaling up services, particularly in low- and middle-income countries where resources are limited.

South Africa on Harm Reduction

In South Africa, Harm Reduction initiatives have gained momentum in recent years, although challenges remain. The country has seen increased support for programs such as needle exchange services and opioid substitution therapy, particularly in urban areas. These initiatives aim to reduce the spread of HIV and other blood-borne diseases among people who inject drugs.

Substance abuse remains one of the prevailing issues facing South Africa. If you’re interested in learning more about the psychology behind addiction, and the methods used to treat it, you should consider studying counselling at SACAP. Counselling courses on offer include part-time and full-time as well as online options. For more information, enquire now.

If addiction affects your life or that of someone you know, you might be interested in understanding more about addiction. You might be a counsellor looking to delve deeper into addiction counselling. Register with SACAP Global for foundational knowledge in addiction counselling.