Harm Reduction in Drug Dependence

These health care programs are designed to cushion the effects of addiction.

Dampening the negative effects of drugs

As Alan Marlatt, author of Relapse Prevention, and a reference in the treatment of addictions, argued, these programs aim not so much at abstinence from drug use, but admitting the difficulty of achieving this goal for some people, and given that there is a significant number of drug users, they try to reduce the harm or consequences of drug use, to try to reduce the damage or consequences caused by drug use..

The importance of minimizing the harms associated with injecting drug use as a strategy in the prevention of HIV infection is recognized, and risk reduction is shown to be compatible with primary prevention of drug use. Harm reduction programs are an effective an effective alternative to prevent HIV infection and transmission.The approach is not only a model of approach and treatment of problems caused by drug use, but also of HBV and HCV.

Why is this health intervention perspective useful?

The model accepts the evidence that people will continue to use drugs, that not all drug users are in a position to undertake detoxification treatment, and that many of those who use do not approach or contact existing health services.

Policies and programs cannot be based on utopian ideals about a "drug-free society" or a society in which everyone always uses drugs safely. Along these lines, drug use should be defined as a complex and multi-causal phenomenon, involving a "continuum" from severe dependence to abstinence, which implies extending interventions to all stages of the process.

These programs obviously cannot solve all the problems associated with drug use and should therefore be considered as integrated programs within the framework of an overall policy. integrated programs within the framework of an overall policy (which also includes treatment aimed at achieving abstinence for users, care for families, etc.).

It should be borne in mind that the risk potential derived from drug use depends on the type of drug consumed, the frequency and quantity, how it is administered, and the physical and social circumstances of this use. It is important to note that in some cases policies to reduce drug use may increase the risk associated with drug use, such as when drug users are not informed about available health services or when only abstinence-oriented services are offered.

Levels of intervention

Harm reduction interventions span different levels: individual, community and socio-political.. From this model, interventions are proposed that have an impact on each of these levels, aimed at modifying social norms and perceptions, knowledge, attitudes and behaviors, identifying and overcoming existing obstacles.

Many drug-related risks can be eliminated without necessarily reducing drug use. An obvious example is intravenous drug use with sterile injecting equipment versus such use with HIV-contaminated equipment.

The harms associated with drug use are multidimensional. The recipient of the harm may be the individual himself, his immediate social context (family, friends, neighbors) or society in general.

These programs are characterized by an approach to drug users on the part of the workers involved in these interventions, that allows for the involvement of the users in these programs.. 

Only in this way can these programs be expected to have adequate contact with an important part of the "hidden" population of users, and they can become "bridge" programs to other social and health services.

Harm reduction is compatible with the belief that everyone has the right to use drugs if he or she wants to. However, harm reduction does recognize the possibility that drug use can impair judgment, and that many drugs can produce physiological and psychological dependence.

CDs should be treated with the respect that every human being deserves, and they should be integrated into society rather than excluded and marginalized. Many of the risks associated with drug use are the result of social stigmatization are the result of the social stigmatization of drug users of drug users rather than drug use itself.

The competence and responsibility of drug users themselves is promoted, including but not limited to the consumption of these substances. To this end, the opinion of the drug users themselves is solicited. the opinion of the users themselves is sought in the design of policies and programs created to respond to their needs. and programs created to respond to their needs and their active participation in them.

At the same time, it is recognized that situations of social precariousness, isolation, marginalization and poverty affect people's autonomy and their ability to reduce harm and act in a healthy manner.

The effects of Harm Reduction

According to the World Health Organization, this type of intervention has several effects.

Modify the person's behavior

First of all an individual behavioral changeThis is often manifested in an interpersonal context and is affected by a series of elements that go beyond simple information; for example, the person's beliefs about the risks of a certain habit for their health, their intentions and motivations for modifying this behavior, and their capacity to effect this change.

Collective change

On the other hand, significant change is also pursued not at the individual level, but at the collective and group level, which recognizes that the person's attempts to change behavior are influenced by the opinions and actions of the social groups in which individuals tend to move, as well as by the social circles in which substance use and sexual behaviors occur. This is what is called the "subjective or peer norm."

Peer group norms influence the way people behave. Peer norms are important because they determine whether a behavior is acceptable or normal for the individual and the group. For example, there is a widespread false belief in some communities of injecting drug users (IDUs) that having the syringe before the drug brings them bad luck, so they always seek the drug before the syringe, making it easier to share a syringe that is "at hand".

Thus, individual change is facilitated by changing peer norms. Working with peers evolves peer norms regarding sexual behavior and drug use, and addresses both group and individual behavioral changes.

Types of programs

There are several types of Harm Reduction programs.

Programs with opiate substitutes

Programs with opioid substitutes such as low and high threshold, fixed and mobile Methadone Maintenance Programs (MMP), or controlled heroin dispensing programs.

Patients on methadone maintenance provide lower HIV seroconversion rates than those who are not in treatment or are in other treatment programs. They also reduce overdose episodes and risk behaviors (less injecting and less sharing of injecting equipment), with much lower mortality rates than those who are not in treatment.

In these programs, lower levels of heroin use have been recorded among those in PMM than among those in other types of treatment limited to abstinence 26, 29, 34 and better conditions of use.

Opiate substitution programs have also had a significant impact on reducing crime with fewer criminal acts, arrests and prison stays. Currently, the use of methadone is warranted because of its safety in opioid-tolerant individuals, with no significant adverse effects or toxicity having been found in ten to twenty-five year follow-up studies.

Heroin programs are one of the resources that have received most attention among risk reduction programs. Their controlled distribution from the social and health care network has the immediate advantages of other programs and also has medium and long-term benefits. also has medium- and long-term benefits by distancing its use from exclusion (it reduces collective delinquency linked to illegal markets, stabilizes or reduces the number of users as there is no need to traffic drugs).

Programs against risk behaviors

At a second level are programs aimed at reducing "collateral" risk behaviors, directly or indirectly associated with substance use.

In order to avoid high-risk practices to the transmission of HIV, HBV and HCVWithin a Harm Reduction strategy, several types of programs have been developed

These include: syringe exchange and distribution programs that can be carried out from various locations (pharmacies, mobile teams with educators and "health agents" on the street, primary care centers, hospital emergency services, specific centers, etc.).

One example is the "Safer Sex Workshops" (TSMS). that provide health education on sexuality and prevention, as well as programs or campaigns that promote access to condoms. Although in most countries Harm Reduction programs have been developed basically around injecting drug use, their field of action is much broader and their methodology is applicable to any type of drug user and to various types of harm.

• To increase the quality of life of drug users, i.e., to improve the health and social status of this group.
• To decrease the transmission of HIV, HBV and HCV infection from, among and to drug users.
• drug users.
• To increase drug users' awareness of the risks and harms associated with drug use.
• To decrease or eliminate the risks and harms associated with drug use, as well as risky sexual behaviors among drug users.
• Encouraging and promoting the emergence of risk-free behaviors against HIV, HBV and HCV infection.
A model that seeks participationCombating stigmaSeeking empowermentReduced-risk consumption programsSafer sex promotion programs