The issue of drug addiction and the harm reduction approach

This article was exclusively written for The European Sting by Mr. IZERE Salomon, a Second Year Medical Student at the University of Rwanda. He is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Harm reduction can be viewed as the prevention of adverse consequences of illicit drug use without necessarily reducing their consumption.

In other words, Harm reduction can be defined as a concept aiming to prevent or reduce negative health consequences associated with certain behaviors. it encompasses a range of health and social services and practices that apply to illicit and licit drugs. These include, but are not limited to, drug consumption rooms, needle and syringe programs, non-abstinence-based housing and employment initiatives, drug checking, overdose prevention and reversal, psychosocial support, and the provision of information on safer drug use. Approaches such as these are cost-effective, evidence-based, and have a positive impact on individual and community health.

There are many consequences associated with drug use including problems related to the user’s psychological or physical health such as Cirrhosis, Cancer, overdose, Addiction, Accidents, depression, Paranoia, etc. [1], [2]Problems are related to relationships, family, friends, intimate partners, and children. Problems related to the user’s professional life (e.g., lack of concentration at work or school) and other non-professional activities such as hobbies.[1] It may also include problems related to illegal drug use, drug acquisition, and/or trafficking, including driving under the influence of drugs.

Regarding these consequences mentioned above and many others I didn’t mention, you understand that harm reduction strategies should be implemented as these strategies save lives and diminish the likelihood of drug use problems for an individual, their families, and the surrounding community.

General Harm Reduction Strategies

Information, education, and communication on the health risks associated with drug use will assist drug misusers to avoid or modify their drug-taking behavior.

■Education strategies. The first step in harm reduction is to provide accurate information about the consequences and risks of drug use and promote behaviors that reduce risk. Education should include information on physical and psycho-social risks of drug abuse, risks of overdose, infectious diseases, driving problems, and cardiovascular, metabolic, and psychiatric disorders.[3]

■Brief Interventions and Counselling. Brief interventions are focused on changing high-risk behaviors. These interventions might include single-session therapy, cognitive behavioral therapy, and/or motivational interviewing.

■Interventions to reduce injury and violence. Drugs such as alcohol have been related to injury, violence, and public disorder. Strategies to change the environment may be helpful, such as changing alcohol containers (from bottles to plastic glasses), banning beverages with high concentrations of alcohol, community mobilization, etc. Other interventions can be aimed at reducing road accidents by promoting public transportation, punishment for drinking and driving, etc.[1], [4]

■Overdose prevention. Naloxone, a short-acting opioid antagonist, overturns the immediate effects of heroin and prevents overdose among injection drug users. Other drugs, such as methadone, which have similar properties to heroin and morphine, help to reduce overdose, risk of HIV and hepatitis infection, and criminal acts, other overdose management strategies include peer-to-peer education in first aid and resuscitation (CPR); establishing collaborations among peers and encouraging peers to seek help and call an ambulance when an overdose is suspected.[1]

■Prevention and services for the management of sexually transmitted infections. It is critical to provide information to drug users about the risk of HIV transmission and the main strategies to reduce such transmission. Strategies may include using condoms, reducing the number of sexual partners or being faithful to one partner, treating sexually transmitted diseases, abstinence, etc.[1], [2]

■ Health care about infectious diseases associated with drug misuse, as well as providing screening and interventions for specific infections, offers support, information, and education. 

■ Needle exchange programs, which aim to ensure that those who continue to use drugs have access to clean injecting paraphernalia as well as to provide safe disposal of used equipment. These programs offer a range of equipment including needles, syringes, filters, cookers/spoons, sterile water, swabs, and citric acid.[2]

■ Drug substitution treatment involves the medically supervised treatment of individuals with opioid dependency based on the prescription of opioid agonists such as methadone.

■Affirms drug 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 that meet their actual conditions of use.[1], [3]

Harm reduction is a practical approach that employs a range of different strategies to minimize the risk of contradicting the infectious diseases, overdose, or suffering other consequences related to the use of substances. Strategies may include changing the way people consume drugs or ensuring that the environment in which they’re using minimizes the risk of negative consequences to their health, or quality of life. Strategies may vary depending on the drug, the type of harm related to its consumption, an individual who consumes the drug, etc.

References

[1]           E. Communities, “Strategies to Reduce Harm and HIV Infection among Drug Using Populations,” 2008.

[2]           I. Literature, National Advisory Committee on Drugs NACD A Review of Harm Reduction Approaches in Ireland and Evidence from the International Literature. 2003. [Online]. Available: https://www.drugsandalcohol.ie/5807/1/2347-A_review_of_harm_reduction_approaches._pdf.pdf

[3]           F. O. R. M. Resources, “Principles of harm reduction,” 2020.

[4]           M. D. Cookson and P. M. R. Stirk, “済無No Title No Title No Title,” 2019.

About the author

IZERE Salomon is a (2^nd) Second Year Medical Student at the University of Rwanda, College of Medicine and Health Sciences In the department of General medicine and Surgery, interested in Research, Surgery, and he’s also Sexual reproductive health and Human Rights Advocate. He’s an active member of the Medical student association of Rwanda, MEDSAR Rwanda NMO of IFMSA. Currently serving as a member of the Standing Committee of Public Health (SCOPH).