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Drug Abuse

by Gerry V Stimson


Harm reduction works from straightforward assumptions. Many people do things that might cause harm to themselves or others. They might be persuaded to stop doing such things, or do them less often. But this is not always possible. The alternative then is to try to reduce the likelihood ­ or risk ­ that harm will follow.

In fact most people do things that might damage themselves or others. Driving cars, using electrical appliances, exercising, eating, drinking alcohol, and doing household DIY repairs can be hazardous. There are many things that we cannot or will not avoid. But there are usually ways to make them safer. Sometimes we control the ability to reduce risk. Sometimes we cannot reduce the risks because we do not have the means to do so.

Harm reduction is therefore a fundamental aspect of ensuring the health of populations. The public health task is to assess the hazards associated with the activity and the risk that harm will follow. The options are to reduce the frequency of the activity or to make it safer. Usually it is a combination of the two.

Harm reduction for people who inject drugs is no different. Given that some people want to inject drugs ­ or presently are unable or unwilling to stop injecting them ­ it is a public health obligation to help them reduce the risks from doing this.

Injecting drugs is a risky business. But there is now much experience of making it less so, mostly gained in the UK ­ which has been at the lead in the global effort to reduce drug-related harms. That effort has been shown to be remarkably successful with respect to the prevention of HIV infection. Large numbers of infections ­ and deaths ­ have been avoided. More needs to be done to prevent other harms ­ as The Safer Injecting Briefing shows.

Harm reduction is a grass roots response. Although widely accepted, it has been only grudgingly tolerated by British governments. It was downgraded in the 1995 White Paper Tackling Drugs Together, as too in the 1998 White Paper Tackling Drugs to Build a Better Britain. More the pity: harm reduction has taken off globally, and the UK government has missed an opportunity to bring some pragmatism to international drugs policy.

The large body of harm reduction knowledge grew from practical needs and questions encountered by community-based drugs agencies. Until now it has rarely been seen in print. For the first time, The Safer Injecting Briefing provides a comprehensive manual of practical advice for people working on harm reduction with drug injectors. It will be valuable as a practical reference book ­ but it should also be read as a tribute to the unsung heroes who developed the harm reduction approach in front-line drugs agencies.

Gerry V Stimson
The Centre for Research on Drugs
and Health Behaviour

April 1998


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