Alexander DeLuca, M.D.
Addiction, Pain, & Public Health website
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Statement
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"Principles
of Harm Reduction"
and,
"The Need for Harm Reduction"
[Print version] Harm reduction is a set of
practical strategies that reduce negative consequences of drug use,
incorporating a spectrum of strategies from safer use, to managed use to
abstinence. Harm reduction strategies meet drug users "where they're at,"
addressing conditions of use along with the use itself.
The Principles of
Harm Reduction
Because harm reduction demands that interventions and policies designed to serve drug users reflect specific individual and community needs, there is no universal definition of or formula for implementing harm reduction. However, HRC considers the following principles central to harm reduction practice.
Harm Reduction:
- Accepts, for better and for worse, that licit and illicit drug use
is part of our world and chooses to work to minimize its harmful effects
rather than simply ignore or condemn them.
- Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.
- Establishes quality of individual and community life and
well-being--not necessarily cessation of all drug use--as the criteria
for successful interventions and policies.
- Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
- Ensures that drug users and those with a history of drug use
routinely have a real voice in the creation of programs and policies
designed to serve them.
- Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.
- Recognizes that the realities of poverty, class, racism, social
isolation, past trauma, sex-based discrimination and other social
inequalities affect both people's vulnerability to and capacity for
effectively dealing with drug-related harm.
- Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.
The Need for Harm Reduction
With American drug treatment and prevention policy rooted in criminal law enforcement and incarceration, most approaches to drug-related problems help only a tiny fraction of the people who use illicit drugs. We recognize that families and communities (especially communities of color) are frequently devastated not only by addiction, but also by arrest and incarceration, the lack of available drug treatment, infectious disease, poor housing, unemployment, etc. Drug related problems continue to baffle communities across the country, leaving them frustrated and hopeless in their inability to respond to the harms they experience. The harm reduction movement grows from the need for a conscientious response to drug use that is less damaging to the fabric of our nation's diverse communities. Harm reduction works to redress the following injustices, among others:
- There is a shocking lack of the
basic services that help reduce drug-related harm. Most areas in the United
States still have neither needle exchange programs, nor over-the-counter
sale of syringes, as HIV prevention measures. Drug treatment is not
available at all in some states, and there are no methadone maintenance
treatment programs in nearly one-fifth of them. Where treatment is
available, it is not funded to meet the level of demand.
- The lack of universal health care
and the movement toward privatization and managed care threaten to reduce or
eliminate some the few therapeutic services that currently exist for illicit
drug users particularly drug treatment.
- While personal difficulty in
maintaining housing, family, employment and health may be worsened by
chronic drug abuse, the problems are equally worsened by policies that
create obstacles to housing, family, employment and health care for drug
usees.
- Most therapeutic services for drug
users, including drug treatment, are designed to serve the priorities of
providers instead of the needs of consumers. Drug education and prevention
campaigns are largely ineffective, attempting to scare people away from
using drugs instead of equipping them with accurate information about drugs
and drug use, including their adverse and harmful effects.
- Current drug control strategies
criminalize a huge proportion of the country's population. Since 1980, the
number of adults incarcerated in state and federal prisons, local jails, and
on probation or parole has more than tripled, with one-third of this
expansion due to an increase in the number of drug law violators put behind
bars. Women, African-Americans, and Latino/as have been disproportionately
affected.
- A struggle exists between law
enforcement and medical providers to define drug users as either criminals
or medical patients, with communities and families left out of the debate
and unable to define users as community and family members. Effective
community planning for drug treatment and post-incarceration support for
drug users have no priority in the allocation of drug intervention funding.
- The HIV epidemic has killed hundreds of thousands of people in the United States and continues to rage on. Swift public policy changes and the implementation of critical services could have prevented an untold number of deaths and HIV infections among injection drug users, their sexual partners, and children.
[END]
| Alexander DeLuca, M.D., FASAM. |
Originally posted: 7/3/2004 |
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Most recently revised:
7/3/2004 |
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