Current problems with harm reduction and future direction

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Any individual hoping to investigate what the problems and limitations of harm reduction are as it stands now and the direction it should go in, must be aware of the development of harm reduction as a solution to drug use. The individual will also need to further investigate the benefits and advantages of harm reduction. Five areas are particularly important when examining what the problems and limitations of harm reduction are. How harm reduction is defined and how it has developed over the past twenty-five years, the importance of harm reduction in relation to drugs and addiction, what the problems and limitations associated with harm reduction are, what the benefits and advantages associated with harm reduction are and what future direction harm reduction should go in. Each of these areas all need to be understood, with the awareness that the advantages of harm reduction far outweigh the disadvantages, allowing it to remain the one of the most important solutions for dealing with drug use and drug users.

Of critical importance when examining what the problems and limitations of harm reduction are as it stands now and the direction it should go in, is to have some understanding of how harm reduction is defined and how it has developed over the past twenty-five years. Although very similar to one another, harm reduction and harm minimisation must be separated, with 'harm minimisation' referring to Australia's National Drug Strategy which includes supply reduction, demand reduction and harm reduction and 'harm reduction' referring to programs designed to reduce harm (Australian National Council on Drugs 2004: 2). The term harm reduction itself can be defined as those policies and programs which seek to reduce or minimise the adverse health and social consequences of drug use without requiring an individual to discontinue drug use (Inciardi & Harrison 1999: 3). By defining harm reduction in this way, it is able to recognise that many drug users are unwilling or unable to refrain from drug use and that there is a need to provide them with options which reduce the harms of continued use including overdose and the spread of disease (Inciardi & Harrison 1999: 6).

Not only does harm reduction aim at reducing the risks and harms associated with drug use it is also formulated around three central principles which have been proposed and developed by drug expert, Robert Westermeyer (Hanson et al. 2006: 534). The first is that "excessive behaviours occur along a continuum of risk", in which moderate drug use has a lower risk of harm than that of extreme drug use (Hanson et al. 2006: 534). The second principal is that "changing addictive behaviour is a stepwise process, complete abstinence being the final step", where in any move away from harms of drug use is a positive one (Hanson et al. 2006: 534). The final principal is that of "sobriety simply isn't for everybody", which relates to the fact that some individuals are unable to cope with whatever circumstances they are in without drug use and that unfortunately drug use is a fact of life for some (Hanson et al. 2006: 534). Over the past twenty-five years, harm reduction has risen in prominence to become one of the central aspects of many drug policies and programs not only in Australia but around the world (Moore & Fraser 2006: 3036).

In the case of Australia harm reduction has been incorporated into the principles of harm minimisation which have been the framework for Australia's National Drug Strategy since 1985 (Waller & Rumball 2004: 40). Further adding to the rise in harm reduction's popularity is acknowledgement that drug use and abuse is and has become a public health issue rather than a legal issue which can be solved with sanctions and prison (Inciardi & Harrison 1999: 9). Not only has harm minimisation changed the way in which Australia deals with drug use and users but it has also changed many of society's attitudes and stereotypes about drug users (The Drug Prevention Network 2010). Rather society now thinks about the drug user in relationship to both the environment and circumstances in which they are using drugs and how best to reduce the harms of this drug use (The Drug Prevention Network 2010). Having gained an understanding of how harm reduction is defined and how it has developed over the past twenty-five years, the importance of harm reduction in relation to drugs and addiction can now be examined.

It is also of crucial importance when examining what the problems and limitations of harm reduction are as it stands now and the direction it should go in, is to have some understanding of the importance of harm reduction in relation to drugs and addiction. The term drug itself has been best defined as being any substance which when entered or absorbed into the body may modify, alter and change one or more of its normal physical or mental functions (Cornwell & Cornwell 1993: 7). The benefits of employing such a broad definition in relation to harm reduction, is that it incorporates any substances which are considered to be drugs but it also includes those which are not normally thought of as being drugs, such as food or sex as drugs, which are often perceived and understood differently within society but may also cause harm to the individual (Cornwell & Cornwell 1993: 7).

As the term addiction itself is rather ambiguous and difficult to define, alternate terms have often been adopted in place of or associated with addiction particularly that of drug or substance dependence which often serves to be most useful, especially in relation to harm reduction, as harm reduction may not completely eliminate the dependence (Marlatt 2002: 200). The term drug dependence has been defined as, the continual or persistent use of alcohol or other such drugs regardless of the problems related to the use of the drug, the uncontrollable and repetitive use of the drug may also result in a build up of tolerance to its effect as well as withdrawal symptoms when its use is reduced or stopped (American Psychiatric Association 2000: 192). Drug dependence can also be further expanded to incorporate the persistent desire that an individual may have to use a drug in large amounts or over extended periods, irrespective of its harmful effects (American Psychiatric Association 2000: 194).

The importance of harm reduction in relation to drugs and addiction is further highlighted by the use of harm reduction methods and strategies on individuals who have become addicted to a drug (DiClemente 2006: 231). Harm reduction aims at reducing and preventing the harms of addictive drug use rather than stopping the addiction itself, although efforts to help the addict practise safer or decreased drug use may often lead to a complete abstinence from the drug (DiClemente 2006: 232). Although harm reduction methods can be controversial, they are often very effective, particularly in decreasing the spread several diseases often associated with drug use and addiction including HIV and hepatitis C (DiClemente 2006: 232). With a deeper understanding of the importance of harm reduction in relation to drugs and addiction, it can now be understood what the problems and limitations associated with harm reduction are.

Furthermore it is of crucial importance when examining what the problems and limitations of harm reduction are as it stands now and the direction it should go in, is to have some understanding of what the problems and limitations associated with harm reduction are. There are several problems and limitations that are often associated with harm reduction, with the first of these being that harms are identified according to dominant middle class values (Miller 2001: 175). As harms are established according to these dominant values, they often do not take into account the values of those at greatest risk from harm, choosing rather to construct harm reduction strategies based upon the dominant values of society (Miller 2001: 176). Furthermore these same strategies are also based on cost efficiency, with economically beneficial strategies often being favoured over health or community beneficial ones (Miller 2001: 175).

The next problem which will be examined is that, harm reduction often condones or encourages drug use even though it is attempting to reduce the risks (Abadinsky 2008: 417). As the main aim of harm reduction is to reduce the risks and not the use of drugs, messages may often be conveyed which condone the use of harmful drugs (Dale 2005). This criticism is particularly prevalent within school education as excessive education about the risks associated with drug use may instead create an aura of intrigue around the subject, which often appeals to a child's curiosity (Abadinsky 2008: 417). The third problem associated with harm reduction which will be examined is that, needle exchange schemes facilitate and make the transition to intravenous drug use easier and more appealing (Ghodse 2008: 264). These schemes actively provide drug users with easy access to injecting equipment, which makes the transition to injecting easier, which gives users less incentive to give up injecting and may also persuade younger drug users to start injecting (Ghodse 2008: 265). The establishment of needle exchange facilities also create safe meeting spots for intravenous drug users, which strengthens both the social networks of users as well as the prevalence of intravenous drug use (Ghodse 2008: 265).

The last problem associated with harm reduction which will be examined is that, harm minimisation fails to address the underlying reasons for drugs' current legal status (Miller 2001: 173). As harm minimisation focuses on supply reduction, demand reduction and harm reduction it fails to examine the status of different drugs, choosing to rather label distinctions between them as irrelevant and unnecessary (Miller 2001: 173). Furthermore harm minimisation also fails to address the reasoning behind the massive profits which drug companies reap through the sale of drug substitutes particularly that of methadone, which indicates that the government also benefits financially from the sale of these substitutes (Miller 2001: 173). With a deeper understanding of what the problems and limitations associated with harm reduction are, it can now be understood what the benefits and advantages associated with harm reduction are.

Equally, it is crucial when examining what the problems and limitations of harm reduction are as it stands now and the direction it should go in, is to have some understanding of what the benefits and advantages associated with harm reduction are. Just as there are several problems associated with harm reduction, there are also many benefits and advantages which are associated with it too, with the first of these being that harm reduction maintains a value-neutral standpoint (Keane 2003: 228). As harm reduction acknowledges that there is no ultimate solution to drug problems, pragmatic and rational strategies and solutions can be constructed and assessed through the objective calculation of consequences (Keane 2003: 228). Further adding to the value-neutrality of harm reduction is its refusal to support or oppose any view about drug use and drug users, except to the extent that its aims are based around reducing the harms of drug use (Keane 2003: 228).

The next benefit which will be examined is that, needle exchange schemes are becoming more and more successful and widespread within society (Ghodse 2010: 264). Following the establishment of needle exchange schemes, their main aim is at keeping injecting drug users from sharing needles and transmitting blood bore diseases particularly that of HIV and hepatitis C (AVERT 2010). By providing injecting drug users with access to sterile equipment, they are also given access to drug treatment services (AVERT 2010). Since the implementation of needle exchange schemes within Australia, studies have found that needle sharing has decreased dramatically, with 32,000 HIV and around 100,000 hepatitis C infections being prevented in the last decade (AVERT 2010).

The third benefit which will be examined is that, harm reduction is extremely cost beneficial (Petersen & McBride 2002: 126). These cost benefits are particularly evidenced in relation to needle exchange schemes, as it is much cheaper and easier to implement these schemes than it is to treat people who have contracted HIV and hepatitis C (Petersen & McBride 2002: 126). Harm reduction strategies also demonstrate their cost benefits through the ease in which these strategies have been adopted and implemented into the National Drug Strategy since 1985 (Inciardi & Harrison 1999: 181).

The last benefit associated with harm reduction which will be examined is that, education about the risks of drug use has profound and long term benefits particularly amongst children (Abadinsky 2008: 270). Education often occurs in several forms with many of these having no effect or harmful effects in the uptake of drugs, it is often education which teaches about the risks associated with drug use that have the greatest and most beneficial effect (Abadinsky 2008: 270). By educating and providing information to children about the risks of drug use, particularly those of potential health consequences, negative attitudes often develop towards drug use which deter them from using drugs (Abadinsky 2008: 270). With a deeper understanding of what the benefits and advantages associated with harm reduction are, it can now be understood what future direction harm reduction should go in.

It is also of crucial importance when examining what the problems and limitations of harm reduction are as it stands now and the direction it should go in, is to have some understanding of what future direction harm reduction should go in. Although harm reduction has its problems and limitations, they are far outweighed by its benefits and advantages. In order for harm reduction to gain further strength and support it must continue in the same direction as it has been over the past twenty-five years, with an emphasis being placed upon retaining its value-neutrality where in does not support or oppose any one particular belief about drug use (Keane 2003: 228). Furthermore, in order for harm reduction remain as effective as it is, its main aim and priority must remain that of reducing the risks and consequences associated with drug use and the effect it may have on the individual and others within society (DiClemente 2006: 232).

Although harm reduction must continue in the same direction, it must also gain improvement in several key areas particularly that of education about risks as well as the greater promotion of needle exchange schemes. Current education policies which aim at providing children with information and knowledge about the risks associated with drug use, often carry with them certain aspects of intrigue which appeal to a child's curiosity (Abadinsky 2008: 274). In order to improve and place a greater emphasis on education, campaigns such as 'just say no' must be eliminated with an enhanced focus being placed upon imagery and documentaries which highlight the risks of drug use (Abadinsky 2008: 274). It is only by using imagery and presenting stories about these risks which have been experienced firsthand by many individuals, that education about the risks of drug use will improve and remove drug curiosity (Abadinsky 2008: 417).

As effective as needle exchange schemes are, there is still much room for improvement, particularly in relation to the number and accessibility of these locations. The greatest downfall which faces needle exchange schemes is that they are not widely accessible throughout Australia, either because they have yet to be constructed or are unable to provide a suitable health services to injecting drug users (Hagan 2010). Government studies are also contributing to the need to increase and improve needle exchange locations, as almost 60,000 HIV and over 120,000 hepatitis C infections have been prevented over the past twenty years, which has also led to healthcare cost savings of over $1 billion (AVERT 2010). It is only by increasing and improving these facilities that the future spread of blood bore diseases will be reduced even further, as a direct result of implementing harm reduction strategies (AVERT 2010). With an understanding of what future direction harm reduction should go in, individuals must remain aware that harm reduction must remain at the forefront of combating drug problems and issues, particularly in conjunction and alignment with harm minimisation.

In conclusion, there are five particular areas that an individual should examine when investigating what the problems and limitations of harm reduction are as it stands now and the direction it should go in. They should gain an understanding of how harm reduction is defined and how it has developed over the past twenty-five years, along with the importance of harm reduction in relation to drugs and addiction as well as what the problems and limitations associated with harm reduction are and what the benefits and advantages associated with harm reduction are, which will allow them to understand what future direction harm reduction should go in. It is only by gaining an understanding into these areas that an individual can hope to be successful in examining what the problems and limitations of harm reduction are as it stands now and the direction it should go in.

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