Harm reduction programmes seek to promote positive change by reducing the number of drug-related deaths, rather than the number of drug users.
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.
Many are calling for drastic changes, not just in the policies of governments and law enforcement agencies, but in the attitude of society as a whole toward drugs and drug users.
Dr. Ethan Nadelmann, founder and former director of the Drug Policy Alliance, and a prominent critic of the war on drugs, told delegates at the SA Drug Policy Week in Cape Town in 2017 that “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 alternative approach is ‘harm reduction’.
Harm reduction policy: First, do no harm
The term describes an overall strategy that has the ultimate objective of reducing the amount of drug-related deaths, rather than the amount of drugs in circulation. Dr. Jeffrey A. Singer, MD, a senior fellow at the Cato Institute, says that harm reduction policies are based on the premise that “there has never been, and will never be, a drug-free society”, and that the first principle of drug policy leaders should be the same as that of the Hippocratic Oath, “first, do no harm”.
The objective of harm reduction, explains Dr. Singer, 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.
The idea behind medication-assisted treatments is to provide patients with drugs that mitigate the effects of withdrawal, thereby enabling addiction sufferers to gradually wean themselves off substances to which they are addicted. For example, providing opiate addicts with a legal opiate that affects the brain in a similar way, but to a lesser degree; staving off the craving they would otherwise have felt for the more dangerous, illegal substance.
Critics of the approach, such as the former US Secretary of Health and Human Services, Tom Price, claim that medication-assisted treatments simply replace one drug with another, but Dr. Stuart Gitlow, past president of the American Society of Addiction Medicine, argues that the drug being replaced “is a dangerous one that will kill you”, while the replacement drug will “allow you to live normally again”.
Either way, medication-assisted treatment appears to be backed up by the data, which shows a significant reduction in the risk of relapse, overdose, and the spread of infectious diseases.
Safe injection sites
The haunting image of dark and dingy drug dens, where the floors are strewn with dirty mattresses and discarded needles, is one of the tragic legacies of the drug war. Government-sanctioned injection sites could serve to eradicate that image for good. They provide a clean, clinical setting, where health professionals can supply sterilised needles, administer naloxone in order to treat overdose, and refer patients for medical treatment and rehabilitation programmes.
The first such site was established in Rotterdam, Netherlands in the 1970’s. As of 2016, there were about 100 safe injection sites in 66 cities around the world. For people with more conservative views on drug policy, safe injection sites come across as an extremely radical measure that risks legitimising substance abuse. But the 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.
A 2005 report by Canadian Medical Association Journal found that “twelve weeks after Insite opened in September 2003 … the average daily number of drug users injecting in public dropped by nearly half while the average daily number of publicly discarded syringes and injection-related litter also fell significantly”
Harm reduction policy promotes the deregulation or legalisation of substances that can help prevent drug-related deaths. Naloxone, for example, can prevent death from a heroin overdose, and was included by the World Health Organization on its “list of essential medicines” for the treatment of opioid dependence. Many governments have relaxed their restrictions on Naloxone, and proponents of harm reduction policy call for it be made more easily available.
Studies have also observed a correlation between 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.
Treating substance abuse
Critics of harm reduction, such as Cathy Karassellos – a clinical psychologist at the Cape Town Drug Counselling Centre – warn that it could set efforts back by giving the impression that drug use is safe. Proponents argue that a policy 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.
Either way, 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.