JOURNAL FOR DRUG ADDICTION AND ALCOHOLISM
23th year: 2000 no 3 (selection of the articles in English )

"GUIDELINES ON HARM REDUCTION"

 

GLOSSARY

Alcohol

As happens with illegal narcotic drugs, it is possible in the case of alcohol to imagine a process that, based on the personal condition of individuals, helps them to shift from a massive use of substances to a more moderate use, and hence to reduce the respective harmful effects produced. Harm reduction interventions do not therefore focus on the profound reasons and causes behind alcohol dependence, but aim to achieve three closely related objectives: identification of the risks and organization of related information and awareness activities; implementation of environmental and social conditioning and control interventions; reduction of the harm already produced. Another objective of alcohol-related harm reduction strategies is to carry out primary prevention that favors informed choices and the adoption of healthy lifestyles, by proving that alcohol is a psychoactive substance.

Alcohol-related harm reduction

Study of the matter according to fields of cultural interest, known as areas: sensitization, intervention in the users’ social life, driving and safety, availability and administration of alcoholic drinks, treatment, marginalization, strengthening policies, support to non-profit organizations.

Buprenorphine

A drug used to treat opiate addiction; it is a partial agonist of the m receptors and an antagonist of the K receptors, to which it is very similar.

It produces a weaker opiate effect than pure agonists, such as morphine and methadone. It is effective both in detoxification and maintenance programs.

The drug has scarce abuse potential, produces little physical dependence, presents negligible risks of overdose, and is easy to use.

The most important experience based on the use of this medication was carried out in France.

Clonidine

This Alpha2-agonist drug was originally developed as an antihypertensive medicine, and is used in opiate detoxification programs. Its commercial name is Catapresan.

Drop-in centers

These are first care centers that are easy to access since there is no need to follow any care or rehabilitation program in order to be accepted. Their main aim is to provide information and guidelines, and to respond to the basic needs of those referring to them.

Ecstasy

Second generation home made drug that comprises various stimulating substances. A specific harm reduction intervention has been designed to prevent its use, and involves directly contacting youths in the places in which it is used.

Evaluation of the (harm reduction) interventions

A practice that should be carried out every day, since interventions with a strong self-reference component of scarce or dubious efficacy should never be activated.

Fixed unit

Low threshold services that provides informative material on at risk behavior, distributes syringes, condoms, sterile material and – in some cases – provides counseling, and medical and legal advice. In practice, it offers the services that are typically offered in mobile units but within a fixed structure.

Guidelines

Orientations or advice regarding work. These are prepared by experts and take into account the legal and historical contexts of the work setting. They naturally evolve over time, and represent a partial balance between scientific knowledge and the context without pretending to provide exhaustive information on the issues.  

Harm limitation (see Harm reduction)

Harm reduction

Synonyms: harm limitation, risk minimization, risk reduction

Harm reduction is a social policy that gives priority to diminishing the negative effects caused by drug use. It has its roots in a scientific public health protection model based on a humanitarian culture, does not give priority to interventions aimed at decreasing the drug use (abstinence model), but envisages various intermediate objectives as an alternative to the final aim of complete abstinence. These objectives include limiting the harm produced even before the user decides or attempts to stop using drugs (see main objectives of harm reduction).

Harm reduction and HIV

One of the objectives of harm reduction is to reduce the spreading of HIV infection among injecting drug users. Other objectives include discouraging shared syringes, passing from injecting to oral drug use, reducing the quantity of drugs used, disinfecting the tools used, reducing the numbers of contact persons, and passing from illegal to medically prescribed drugs.

Harm reduction and intervention strategies

The intervention tools that can be used by services include: street units, above all for metropolitan out-patient structures, treatment with substitute drugs, distribution of condoms, exchange of syringes, serological screening for the main pathologies, health education, drop-in day centers, centers that provide an alternative to streets and squares, crisis centers, residential and semi-residential centers with very low entrance thresholds, social and care interventions that focus on providing the essential services for persons in particularly serious conditions (food vouchers, beds, work grants, legal advice, etc.), strict collaboration with the penal administration and with the law enforcement, preventing the causes of death.

Harm reduction and penal justice

Harm reduction includes the following four objectives: containing the number of new users, encouraging users to undertake early release processes, limiting the negative aspects of the repressive strategies by substituting arrest with other alternative forms of detention, minimizing the harm produced on the entire community by reducing the drug-related offences.

Harm reduction (main objectives of)

Containing the damage and risks, diminishing deaths due to overdose, reducing HIV transmission, improving the health conditions of drug addicts, limiting the criminalization processes, helping drug addicts to deal with their condition.

Heroin (drug experiment)

A proposal to utilize heroin as a “medication” in detoxification programs, based on experiences in other countries.  

Low threshold

Low threshold programs tend to encourage maximum access to services, even for people that are not normally willing to undergo therapy. These programs, which only require a few requisites for admission, comprise mobile units and drop-in centers.

Low threshold care centers (LTCC)

These are intermediate structures that offer the same services provided by fixed units. Both the day and residential LTCCs allow drug users to pass some time in them, and provide counseling, medical advice, health care and legal advice.

Methadone

A medication that was synthesized for the first time in Germany during the 40s. It is a competitive agonist of the opiate receptors. The aim of methadone treatment is to reduce the use of opiates, and hence of criminal activities, death, illnesses, etc. that are often connected with their use. Long term methadone treatment seems more effective in reducing harm, since it is more effective in modifying at-risk behavior and in stabilizing states of dependency, thus allowing the patients to live more dignified lives.

Minimization of harm (see harm reduction)

Mobile street unit

The mobile street unit naturally extends harm reduction interventions to outside of the services. Its task is to establish forms of contact with the target population represented by social groups, especially those comprising young people, that are already involved with the drug problem. The basic strategy is not to remove the substance, but to help the person by promoting a vital contact that will continue over time and therefore will be more effective. Numerous services are offered (see harm reduction and intervention tools)

Naloxone

Life-saving drug sold over the counter, does not produce side effects when injected in persons that are not taking opiates.

Naltrexone

A drug that was synthesized by Blumberg in 1965; it is a competitive agonist of the opiate receptors and progressively inhibits sensitivity to opiates. It was commercialized in 1987 when it was successively used for treating drug addiction relapses and as part of detoxification programs based on substitute and/or symptomatic drugs. It can cause violent withdrawal effects in persons addicted to narcotic drugs and therefore protocols using naltrexone must only be used 7-10 days after the drug addict has abstained from using opiates. It has proved to be a valid alternative in treatment based on agonists for patients that are motivated to stop using opiates and agonists on a daily basis. It is also reduces alcohol craving. Commercial names: Antaxone; Nalorex.

Organizational complexity

Drug addiction is a complex and multi-faceted problem that cannot be treated with simple therapy. In order to obtain concrete results, the available resources must be rationalized and optimized. Furthermore, the various services should be differentiated, i.e. better services should be provided that avoid overlap and waste.

Outreach work

These activities, which commenced in Italy at the beginning of the 90s, regard the concrete interventions carried out in the field by the street units. These interventions, which were first implemented in order to prevent HIV infection, have extended their activities to reestablishing contacts with those drug addicts that refuse to refer to the formal health structures. They also attempt to reach youths using synthetic drugs and male and females involved in the sex trade. Attempts are made to modify the choices of the users, who are not evaluated, although all requests for assistance are accepted.

Overdose

A high percentage of overdoses occur among abstinent drug addicts that are in contact with therapeutic structures but have sudden relapses. Various specific types of advice are envisaged as part of harm reduction activities.

Prison

Although many drug addicts pass through a prison some time during their life, the peculiar characteristics of prisons that could be utilized for evaluating the addicts and providing them with appropriate treatment are rarely taken advantage of.

Risk reduction (see harm reduction)

Set

Reasons for which people take drugs, including personality, acquaintances, attitudes and states of mind in given moments.

Setting

Importance of the context in which drugs are used in determining risks relating to the use of the substance: for example, it is safer to inhale drugs outdoors rather than indoors.

Shooting galleries

Literally injecting rooms: these are places in which drug addicts can inject themselves in controlled hygienic conditions. They are part of an experimental program being carried in some European countries.

Training

The acquisition of culture with the aim of modifying one's own attitudes. It is different from the acquisition of information which has the main aim of strengthening one's knowledge. This problem is controversial and still open to debate within the sphere of harm reduction, due to the need for people wanting to work in the drug addiction sector to acquire specific basic training, which should then be completed by attending updating/training courses.