Different commentators define 'harm reduction' and 'harm minimisation' in different ways. Discuss your understanding of the terms and, with reference to examples, describe the difference applications to the drug use arena.
The aim of Australian drug policy since 1985 has been harm minimisation. Harm minimisation is the overall policies and programs aimed at reducing harm associated with drug use without necessarily eliminating use (Heather et al. , 1993). Harm minimisation has been a hallmark of Australia's approach to drugs, giving Australia prominent role in international debates on drug related harm (Single & Rohl, 1997). However the use of the term has changed from its inception with the National Campaign Against Drug Abuse in 1985. This easy will discuss the understanding of the term 'harm reduction' and 'harm minimisation' and the different applications to the drug use arena. The paper will unfold firstly by describing the three types of strategies responsible for harm minimisation. Australian drug statistics will be cited before the aim of harm minimisation and reduction is discussed.
Three types of strategies responsible for the success of harm minimisation in Australia are supply control, demand reduction and harm reduction. Supply control refers to strategies based on controlling the production and availability of alcohol and other drugs. This is done mainly through legislation and regulation. Some examples are banning the sale of cigarettes to under 18 year of age, and prohibition of the importation and trafficking of heroin (Gossop 1998).
Demand reduction strategies are designed to prevent the uptake of harmful drug use and reduce the desire for an individual or community to use alcohol or drugs. Some examples of demand reduction are raising the price of alcohol though increased taxation, drug education programs, detoxification and rehabilitation programs for dependent users (Gossop 1998).
Harm reduction strategies are aimed at those individuals who continue to use alcohol and drugs. The focus is reducing harm rather than drug use. Some examples are selling only low alcohol beer at sporting events, providing clean needles and syringes to injecting drug users and teaching users how to use drugs in less harmful ways (Gossop 1998). These strategies involve encouraging people to modify their patterns of drug use. The overall goal is the reduction of drug related harm, to both the community and to individual drug user. By treating the user with dignity and respect rather than a criminal, harm minimisation programs have been successful in bringing addicts into treatment programs (Single & Rohl, 1997).
The objective of the International Narcotics Board, which was established in 1968 is to limit the cultivation, production, manufacture and utilisation of drugs, while at the same time ensuring that there are adequate supplies of drugs available for medical and scientific use (Australian Institute of Criminology 2001). In Australia there were an estimated 22,700 drug-related deaths in 1997, of which 18,200 were due to tobacco, 3,700 attributed to alcohol and 800 to illegal drugs (Healy 2002). As cited in Healy the 1998 national drug household survey showed that 39.3% of the population had tried cannabis, 8.7% amphetamines, 10% hallucinogens, 2.2% heroin and 3.9% inhalants (Healy, 2002).
Harm minimisation refers to policies at reducing related harm (Ministerial Council on Drugs Strategy 1998). Harm minimisation aims to improve health, social and economic outcomes for both the community and the individual and encompasses a wide range of integrated approaches. In the mid 90's the World Health Organisation estimated that 40% of recent AIDS (acquired immune deficiency) cases internationally had been caused by drug users sharing injecting equipment (Cassidy, 2002). In August 1989 the first national HIV/AIDS strategy reported that needle distribution and disposal program were in place in all states of Australia except Tasmania where they were established in 1993 (Ryder, Salmon & Walker 2001). Harm minimisation has become widely accepted as a viable strategy in the international world of drug policy (Moore, 1993).
Controls on advertising of tobacco and alcohol have been progressively introduced in Australia. In 1998 tobacco alone was responsible for 4,400 deaths in Victoria, Australia (Healy 2002 p34). The harm resulting from tobacco are many and occur in the physical, psychological and social domains (Ryder, Salmon & Walker 2001). The world Bank has estimated that about 3 million premature deaths a year (6% of the world total) are attributable to tobacco smoke (Anderson 1994 p1523).
Harm reduction can be applied to all drugs legal and illegal. Harm reduction strategies aim to minimise drug related harm while the individual continues to use their drug (Strong 1993). A comprehensive work place drug policy for harm reduction for tobacco would cover work place smoking restrictions for the protection of non-smokers, employees and customers, clear disciplinary procedures for breaches of the guidelines and support for employees seeking to quite. The use of the cigarette filter is also a means of reducing harmful components of tobacco smoke. As cited in (Ryder, Salmon & Walker 2001) filters were incorporated into cigarettes by tobacco manufactures as a means of reducing the levels of tar and nicotine and was popular in the 1950's.
Alcohol is one of the most commonly used drugs In Australia (Ryder 1987). Demand reduction strategies for alcohol include education, treatment, random breath testing and policy to influence the price of drugs and advertising controls. The function of advertising is to stimulate interest in and demand for a product to create preference for one product over another. Advertising is about creating demand not reducing it. A harm minimisation approach must include strategies to prevent and reduce such harms. Strategies which focus solely on the user will have limited impact. Legislation must have harm reduction as its central objective for significant harms to be reduced.
The effect of policies in any country depends on a complex of interaction between the cultural, political, economic and social characteristics of the country (Heather et al, . 1993 p271). In Australia needle exchange programs have been authorised and subsidised by governments and some states and territories have legislated that police may deal with persons possessing less than a specified quantity of cannabis with fines (Gossop 1998). Harm reduction has been typified by innovative methods for contacting populations, by having appropriate, attractive and accessible services for reaching the hard-to -reach (Stimson 1998).
Harm minimisation is a concept that has developed in Australia over recent decades. The Acquired Immune Deficiency (AIDS) epidemic, identified in the early 1980s accelerated the development of a formal harm minimisation policy in Australia. These policies addressed the sharing of injection equipment by users who injected drugs. The establishment of needle and syringe exchange programs with the provision of clean injecting equipment, condoms and education about safe sex and drug us, are some of the initiatives that have been particularly effective (Ryder, Salmon & Walker, 2001).
The general view in Australia has been the dangers regarding the spread of HIV/AIDS from drug users into the general population is a greater threat to health than the danger of drug use itself (Gossop 1998). A major review of Australia's National Drug Strategy in 1997, recognised harm minimisation as fundamental to the Strategy's success. Less than 5% of Australian injecting drug users are HIV positive compared to 14% in the United States (Gossop 1998). The United Stated have a zero tolerance approach rather than a harm minimisation policy. Zero tolerance has been described as "a recipe for harm maximisation" (Healy, 2002 p2). Harm minimisation is associated with opposition to the US policy of "war on drugs" and to the Nordic concept of a "drug free society".
The above information provides support for the view that Research has confirmed that strategies which are based on harm minimisation principles are more effective than previous approaches which were focused only on abstinence (Heather et al 1993). Harm minimization however does not and should not necessarily mean support for legalisation (Single & Rohl, 1997). Harm minimization has become accepted as a viable strategy in the international world of drug policy (Moore, 1993).
The medical supervised injecting rooms and discussions of heroin trails and methadone programs has caused much debate in Australia. There has been much opposition from religious groups and political groups. However needle & syringe provision has two functions, to give out sterile injecting equipment and to provide a safe place to dispose of used injecting equipment (Strong 1993). Needle and syringe exchange programs are, to many people, the epitome of the harm reduction approach. They were first established in a few European countries in the mid- 1980s and, by the end of the decade, were operating in numerous cities around the world. The rationale behind syringe exchanges is that many people who are currently injecting are unable or unwilling to stop, and intervention strategies must help reduce their risk of HIV infection and transmission to others. Provision of sterile needles and syringes is a simple, inexpensive way to reduce the risk of spreading HIV infection. It is also a way of providing contact with drug users through outreach services. Methadone programs also can be used to stabilize heroin users, and to detoxify and treat users. By providing methadone contact can be made with large sections of the heroin-using population.
Meanwhile Australia can be proud, as Australia one of the lowest HIV infection rates because of its needle and syringe program (Heather et al, .1993). Harm minimisation measures adopted in Australia in the mid 1980s are thought to be largely responsible for this country averting a similar epidemic in injecting drug users. Other country's such as Britain and America showed frightening statistics of HIV infection among drug users (Heather et al, . 1993). Issues regarding medical supervised injecting rooms and controlled heroin administration trials are still being debated in Australia today. Under harm minimisation policies these medical supervised injecting rooms are possible.
In conclusion it takes a mix of strategies to achieve the goal of harm minimisation. Australia's harm minimisation has been embraced as a national policy. Australia has made considerate progress in reducing the harm associated with drug use (Gosop,1998). As discussed in this easy harm reduction is an approach to dealing with drug-related issues that places first priority on reducing the negative consequences of drug use rather than on eliminating drug use or ensuring abstinence. This approach has been the focus of both heightened interest and considerable controversy in Australia. A primary catalyst for this surge of interest in harm reduction has been the emergence of AIDS, linked to drug use through sharing of injection equipment.
Harm reduction has emerged as an alternative approach to abstinence-oriented drug policies. Harm reduction focuses on reducing the adverse consequences among persons who cannot be expected to cease their use of drugs at the present time, but it can be compatible with an eventual goal of abstention. This paper attempts to clarify the issues regarding the definition and practice of harm reduction and harm minimisation. Harm minimisation encompasses a wide range of integrated approaches all aiming to improve health, social and economic outcomes for both the community and the individual.
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