Harm Reduction FAQs

1. Harm Reduction Definitions

   Harm reduction involves a range of non-judgmental strategies and approaches aimed at providing and enhancing the knowledge, skills, resources and supports for individuals, their families, and communities to be safer and healthier. Harm reduction works through policy and programming to reduce the harmful effects of behaviour (British Columbia Centre for Disease Control, “BC Harm Reduction Supply Services Policy and Guidelines, November 2004).

   Harm reduction is a public health approach that aims to reduce drug-related harm experienced by individuals and communities, without necessarily reducing the consumption of drugs. Harm reduction strategies meet drug users “where they’re at”, addressing conditions of use along with the use itself. (www.harmreduction.org).

   The Canadian Centre on Substance Abuse defines harm reduction as “measures taken to address drug problems that are open to outcomes other than abstinence or cessation of use” (www.ccsa.ca).

2. What are some Harm Reduction strategies?

   Harm reduction strategies include initiatives like designated drivers, needle (or syringe) exchange programs, safe graduations, safer sex campaigns, safe injection sites, and methadone maintenance programs. Interventions also include counseling, education, and referrals for health care.

   Harm reduction is a practical approach to drug use, recognizing that quitting drugs may not be realistic or even desirable for everyone. Harm reduction strategies are community-based, user-driven, non-judgmental and are broad based in that they address systems which isolate and marginalize people.

3. Why are Harm Reduction Strategies needed?

   More than 13 million people globally inject drugs and the number of individuals is rising (particularly young people). It is estimated that injecting drug use accounts for at least 10% of all new HIV infections, rising to an estimated 30% when sub-Saharan Africa is excluded (Joint UNAIDS Statement on HIV Prevention and Care Strategies for Drug Users (data.unaids.org/UNA-docs/CCo_IDUPolicy_en.pdf). The United Nations Office for Drug Control and Crime Prevention estimates that from 1998-2000 worldwide 185 million people each year consumed illicit drugs.

   In Canada in 2002, the overall cost of substance abuse (measured in terms of the burden on services like health care and law enforcement and the loss of workplace productivity) was estimated to be $39.8 billion and illegal drugs accounted for $8.2 billion of that total. A total of 1,695 Canadians died in 2002 as a result of illegal drug use. The leading causes of death linked to illegal drug use were overdose, drug-attributed suicide, and drug–attributed hepatitis C and HIV infection. In 2002, the deaths and illnesses linked to illicit drugs resulted in 62,110 potential years of life lost and accounted for 352,121 days of acute care in hospital (Rehm, J., et al., 2006).

   Drug use happens in every country and in every culture despite efforts to prevent its use or trade. Harm reduction focuses on reducing the harms related to drug use through education, prevention and treatment. A harm reduction approach acknowledges that there is no decisive solution to the problems of drugs in society and that various interventions are needed to address the problems. Such interventions must be based on science, compassion, health and human rights.

   A harm reduction strategy approaches drug use from a realistic and pragmatic pubic health perspective to prevent the spread of infections including HIV/AIDS, Hepatitis C and other blood-borne infections; reduce the risk of overdose and other drug-related fatalities; and lesson the negative effects that drug use may have on individuals and communities. HIV transmission associated with injecting drug use affects drug users, their sexual partners, and through sexual and mother-to-child transmission can spread to the larger non-drug using community. Increasing overlap between sex trade workers and drug injecting populations and growing numbers of young injectors pose particular risks for rapid spread (data.unaids.org/UNA-docs/CCo_IDUPolicy_en.pdf).

4. Do Harm Reduction Programs Promote Drug Use?

   Gibson et al. conducted a comprehensive, critical review of published evidence of the effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among IDU. They identified 42 studies published between 1989 and the end of 1999 that evaluated syringe exchange effectiveness. The studies from different countries and cultures have shown that Harm reduction programs do help to prevent the spread of infections, especially those related to HIV and Hepatitis C.

   An article in the medical journal Lancet estimated that 4,400 to 10,000 HIV infections among U.S. people who inject drugs could have been avoided between 1987 and 1995 if the federal government had implemented needle exchange programs nationally (needle exchange programs being one example of a harm reduction intervention), saving over $500 million in health care costs (Laurie,P. et al., 1997).

   From both an economic and human perspective, harm reduction programs are cost-effective. Harm reduction programs are less expensive than the potential medical care costs, drug treatment and legal fees that would be necessary without the existence of such interventions. Harm reduction programs have shown to reduce crime, making communities safer and reducing the amount of funds spent on courts and prisons (Gold G, et al 1997). It costs approximately $150,000 to treat one AIDS patient in their lifetime, and many harm reduction programs operate from centres whose entire operating budget may only be $300,000 per annum (Ottawa Public Health, 2006).

   Harm reduction programs help to not only improve people’s lives but save human lives allowing drug users to become more integrated into society.

5. Sources

   British Columbia Centre for Disease Control, BC Harm Reduction Supply Services Policy and Guidelines, November 2004.

   www.harmreduction.org

   www.ccsa.org

   Joint UNAIDS Statement on HIV Prevention and Care Strategies for Drug Users, http://data.unaids.org/UNA-docs/CCo_IDUPolicy_en.pdf

   Rehm,J. et al., The Cost of Substance Abuse in Canada 2002, Highlights, Canadian Centre on Substance Abuse, March 2006. www.ccsa.ca

   Marx, M. and Strathdee, S., et al., Impact of Needle Exchange Programs on Adolescent Perceptions about Illicit Drug Use, AIDS and Behavior, vol 5 no 4 December 2001 pp 379-386.

   Watters, JK. et al, Syringe and needle exchange as HIV/AIDS prevention for injection drug users. JAMA, 271:117-120 (1994).

   Paone, D. et al., Syringe Exchange: HIV prevention, key findings and future direction. International Journal of Addictions. 30, 1647-1683. (1995).

   Wolk, J. et al., The effect of a needle and syringe exchange on a methadone maintenance unit. British Journal of Addictions, 85, 1445-1450 (1990).

   Heimer, R. et al., Needle exchange programs as a conduit to drug treatment: the New Haven experience. Paper presented at the 11th International Conference on AIDS, Vancouver, Canada, (1996).

   Doherty, MC., et al., The Effect of a needle exchange program on the number of discarded needles:2 year follow-up., American Journal of Public Health, June, 90(6); 936-939, 2000.

   Lenton, S. et al., Infringement versus conviction: The social impact of a minor cannabis offence in SA and WA. Drug and Alcohol Review. 19, 257-264. (2000).

   Gibson, DR., Effectiveness of syringe exchange programs in reducing HIV risk behaviour and HIV seroconversion among injection drug users. AIDS 15(11),1329-1341 2001.

   Laurie, P., et al., An Opportunity lost: HIV infections associated with lack of a national needle exchange program in the USA., Lancet, (349):604-608, 1997.

   Gold, M., et al., Needle Exchange programs: an economic evaluation of a local experience. Canadian Medical Association Journal. 157(3), 255-262, 1997.

   Lavinge, P., Harm Reduction Project Officer, City of Ottawa, Ottawa Public Health, Communication Plan SITE- Needle Exchange, October 2006.