Reducing Drug-related Harms: An Overview of the Evidence

1. Reducing Drug-related Harms: An Overview of the Evidence Dr. Perry Kendall Provincial Health Officer September 27, 2005

2. Drugs and Community Health • The health of every community in Canada is affected by drug use • Solutions must come from many levels: international, federal, provincial, municipal and community • Informed public discourse is encouraged and should be supported

3. The Nature of Drug Dependence Addiction is a chronic relapsing disorder that involves brain dysfunction and needs to be treated as such.

4. Measures to help individuals who use drugs • It is important for a wide range of treatment options to be available. • However, not all people who may need it can or will access treatment. • This group remains at great risk to themselves, and to the community. • It is therefore important to provide effective interventions to minimize the health-related and social consequences of their drug use.

5. Harm Reduction • A pragmatic response that focuses on keeping people and communities safe and preventing disease and injury, while recognizing the activity may continue despite the risks. • Harm reduction practices are entrenched in our society in many ways, including: • Use of condoms to prevent sexually transmitted infections and unwanted pregnancy • Campaigns to reduce drinking and driving • Designated smoking areas to reduce the harms associated with second-hand smoke • Seatbelts and airbags in automobiles • Helmets for bicycling and skiing/snowboarding • Plastic (rather than glass) mugs in drinking establishments

6. Harm Reduction—examples • Education and outreach • Referral to health and social services • Low threshold support services • Law enforcement policies and practices • Needle exchange programs • Methadone maintenance therapy • Supervised injection facilities • Street drug testing and early warning systems • Diacetylmorphine (heroin) prescription

7. Harm Reduction—Concerns # 1: Introduction of Harm Reduction programs leads to increased drug use and encourages the initiation of new drug users. • There is no evidence that harm reduction interventions encourage drug use, among either current users or non-users. To the contrary, some harm reduction programs appear to have reduced drug use prevalence by engaging users in treatment and separating them from drug markets.

8. Harm Reduction—Concerns # 2: Funding of Harm Reduction interventions drains resources from treatment programs. • Harm Reduction programs complement treatment programs--both are cost effective. • Together, they increase social and financial efficiency by interrupting transmission of infectious disease at low cost, rather than waiting until infected drug users enter more specialized treatment programs, with higher costs for treating serious infectious illness.

9. Harm Reduction—Concerns # 3: Harm Reduction encourages the entrenchment of chemical dependence within the population of drug users and enables addictive behaviour. • There is no substantive evidence that engagement in harm reduction programs, like needle exchange, extends the duration of chemical dependence. • On the contrary, harm reduction services increase the possibility that a drug user will rejoin society, lead a productive life and one day quit using drugs, instead of contracting and succumbing to infectious diseases and/or drug overdose death.

10. Harm Reduction—Concerns # 4: Harm Reduction increases public disorder and threatens public health and safety. • Harm reduction programs that adhere to best practices do not have a “honeypot” effect, meaning they do not attract other drug users to the vicinity of the service. • Poorly planned or implemented programs, like any poorly planned initiative, can have unintended consequences.

11. Harm Reduction—Concerns • #5 – Harm reduction programs do not have independent scientific evaluations • Harm reduction is a relatively new policy and program option as a response to illegal drug use, so research is ongoing and accumulating. • There is a substantial volume of literature supporting the effectiveness of a number of harm reduction interventions.

12. NEX is international established practice • World Health Organization • International Narcotics Control Board • Joint United Nations Programme on HIV/AIDS (UNAIDS) • U.N. Office of Drugs and Crime • U.S. National Institutes of Health Consensus Panel • U.S. National Research Counsel • American Public Health Association • American Medical Association • U.S. National Academy of Sciences • U.S. Institute of Medicine • Ministry of Health, France • Australian National Council on Drugs • Swiss Federal Health Office • National Drug Office, Spain • United Kingdom National Pharmaceutical Association • Dutch Ministry of Welfare, Health and Cultural Affairs • U.S. Surgeon General

13. Considerations • Problematic substance use has a negative impact on public health and safety, generating high social and fiscal costs. • Best results can be achieved by managing this social problem as a health issue. • The problem requires a full-range of evidence-based interventions.

14. Considerations (Continued) • Harm reduction initiatives are part of a comprehensive response to problematic substance use, and can complement and support prevention, treatment and enforcement. • Harm reduction programming is regulated by health policy and guidelines based on evidence. • These guidelines are designed to achieve the best possible outcomes in terms of public health and social order.

15. Conclusion • The province wants to support municipalities in making decisions that improve the health and welfare of British Columbians. • Municipalities are essential partners in the effort to keep people safe from the harmful effects of substance use. • The Ministry of Health or health authority staff would be happy to assist in developing municipal strategies to meet the needs of the community and the individuals who live there.