Week 8- Harm Reduction

Question 1

What is harm reduction

Answer 1

-Thinking around harm reduction (or harm minimization) has and continues to change over time, but it can be broadly thought of as a philosophy based on a range of principles

-Harm reduction can be applied in a range of areas e.g., driving, sex

-Policies, programmes and practices that aim to reduce negative impacts associated with drug use, drug policy, and drug law

Question 2

Maia Szalavitz on harm reduction

Answer 2

“Harm reduction involves establishing a hierarchy of achievable goals which… can lead to a healthier life for drug users and a healthier community for everyone.”

Question 3

Core principles of harm reduction (8)

Answer 3

1. Drug use is part of our world
2. Drug use is complex
3. Quality of life matters
4. No judgement or coercion
5. Drug user participation
6. Autonomy and empowerment
7. Acknowledging inequality (underlying reasons why people to use)
8. Being realistic about risk and harm

Question 4

Context is important in drug use: risk

Answer 4

-What issue if being presented?

-What other possible sources of harm might be connected to the main issue?

-What drug is being used? What is the risk of overdose?

Question 5

Context is important in drug use: set

Answer 5

-How are they feeling? Confident? Angry? Anxious?

-Are they physically in pain or hurt? Do they need to get well?

-Can they engage with you fully? Are their basic needs being met?

Question 6

Context is important in drug use: setting?

Answer 6

-What is the physical environment where the potential harm is occuring? In a home? At work? On the street?

-Who us around them? Police, bystanders, other participants? How does the person present to these people? How will they react?

Question 7

Three elements of context that are important to consider for drug use:

Answer 7

-Risk (drug use)

-Set (mindset someone berings to the situation e.g. thoughts, mood, and expectations)

-Setting (The physical and social environments of where the person is + perception of how that can promote/ reduce risk)

Question 8

Harm reduction is not

Answer 8

-Abrupt stoppage of medications, failure to prescribe (pain, ADHD)

-Police searches and drug dogs

-WD40

Question 9

What can police searchers and drug dogs lead to? i.e. how is not harm reduction?

Answer 9

-Limited-to-no deterrent effects

-Traumatic experiences, feelings of violation (Also might be needless as drugs are not always the most accurate)

-Behavioural changes -> harm e.g. taking lots at once to get rid of drugs quickly before search

Question 10

WD40

Answer 10

Surfaces sprayed with this to prevent doing lines i.e. it substance sticks or people onboard WD40 - potentially harmful? Was instigated in Dunedin clubs/ bars.

Question 11

Misconceptions are about harm reduction

Answer 11

-Is only for people who use drugs

-Enables/encourages/normalises risky behaviour -> people are going to do it anyway, might as well make them safer while they do so.

-Increases crime and litter

-Opposes abstinence, “replaces one addiction with another” -> abstinence is not the only way to stop dangerous drug use (idea of being californian sober exists -> i.e. just remove drugs that are causing harm).

-Wastes money

-Is unnecessary if we just remove drugs from society -> complete prohibition hasn’t worked in the past.

Question 12

What does harm reduction behaviour look like?

Answer 12

-Needle and syringe programmes

-Access to health and social services

-Opioid agonist / maintenance / replacement therapies

-Drug consumption rooms

-Naloxone

-Drug-checking

-Reducing stigma

-Education

+ more

Question 13

Needle and syringe programmes

Answer 13

-Government funded scheme to reduce harm for people who inject drugs

-NZ was the first country to launch with government support (1987)

-Reduces bloodborne infection
(very low HIV in NZ partially due to implementation of these problems early)

-Allows for peer support, education

Question 14

Dunedin Intravenous Organization (DIVO)

Answer 14

-Needle and syringe program for harm reduction
Also…
-Conducted and participated in research
-Presented at conferences
-Led education sessions
-Partnered with other HR orgs
-Published a magazine

Question 15

Opioid therapy

Answer 15

Another opioid used as an adjunct/replacement for people that are dependent on opioids:
-Usually longer acting, with “less euphoria”
-Methadone, buprenorphine, slow-release morphine
-Mixed success

Question 16

Heroin-assisted treatment as a form of opioid therapy

Answer 16

-Used as early as 1920s in Britain

-Can be more successful than methadone (Haasen et al., 2018; Oviedo-Joekes et al., 2009)

-Legal in Switzerland, Denmark, Germany, Canada, UK and the Netherlands

Question 17

Drug consumption rooms

Answer 17

-Promote safe use, provide space and tools/resources (supervised injection sites)

-Often to prevent opioid overdose but not always just for opioids i.e. other drugs can be smoked/ consumed there

-Around for ~35 years in Europe

-Melbourne DCR . Trialed 2018-2020
Across 18 months, 119,000 visits – zero deaths.

-Proposal by NZ Drug Foundation to pilot in Auckland for 3 years -> but hasn’t gone through.

-There are lower rates of overdose in countries within europe that have consumption rooms as opposed to without.

-Glasgow prevention center = van that peer krykant drives. Acts as a drug consumption room. THis man has been arrested multiple times for providing such a room.

Question 18

Naloxone

Answer 18

-Opioid reversal medication ( e.g. Narcan, Nyxoid). Does this by kicking opioids out of receptors. Blocks opioids for 30 to 90 minutes.

-Essentially no effect if no opioids present

-opioids implicated in 75 overdose deaths in 2021 (NZ Drug Foundation, 2022) -> we need this!

-Many barriers to access in NZ
Prescribing – injection
Lack of peer distribution
Cost of Nyxoid ~$105 per 2 pack (no funding for it)

Question 19

Drug checking : Methods used to help with substance identification

Answer 19

-Colorimetric reagents
-Thin-layer chromatography
-Fentanyl test strips
-FTIR spectroscopy
-GC-MS

Question 20

Is drug checking legal in NZ

Answer 20

Yes, licenses are held by KnowYourStuffNZ, the Drug Foundation, the Needle Exchange and ESR laboratories.

Question 21

In what ways is drug checking critiqued? What evidence goes against these claims?

Answer 21

Consistently critiqued =
-“Encourages drug use” “sends the wrong message”
-“Lack of evidence of impact on people who use drugs”

Some evidence =
-Boom Festival, Portugal – most users will not use a substance when identified as “unexpected” (Valente et al., 2019)

-Large Festival, Western Australia – Providing drug-checking at a festival does not increase intention to use MDMA (Murphy et al., 2021)

-Drug Checking at NZ Festivals – 68% reported changes to drug taking behaviour after using KYSNZ, and 87% said their knowledge of harm reduction improved (Hutton, 2020)

Bottom line = better information allows for better choices

Question 22

Stigma of discrimination associated with substance use (Te Pou, 2022)

Answer 22

Public =
-Stereotypes; aggressive, neglect, blame, unpredictable
-Education, political stance, health literacy, familiarity all influence attribution

Media
-“Tragically, she has the spectral visage of a meth head.”
-“P babies prove problem kids who cause chaos at school.”

-Health settings

-Criminal justice system

There across all aspects of life. If you are the in-group of users exposed to this constantly stigma can become
internalised i.e. think you don’t deserve
treatment/ help, thinking you are a failure

Question 23

Stigma interventions (Brener et al., 2017)

Answer 23

-Online training module

-Online stigma reduction training (40 minutes) for health providers working with people who inject drugs

-Attitudes towards people who inject drugs were more positive and less concern about client behaviour was shown after completing training

Question 24

Stigma interventions (Kennedy-Hendricks et al., 2022)

Answer 24

-Messaging intervention

-Words Matter or Medication Treatment Works (visual campaign, or combination with narrative)

-OUD stigma was reduced in healthcare professionals

Question 25

Harm reduction campaigns: example

Answer 25

-Support don’t punish

-Nice people take drugs ads on london buses: pulled after controversy/ suing but then put back on

-Association of safer drug policies : about 12 show someones face and then call out an aspect of drug use that is misunderstood e.g. sophie did not die when she tried LSD. She’s had the substance tested and knew what it contained.

Question 26

Intersection of public health and human rights when it comes to drug use…. weak rights versus strong rights

Answer 26

-Neil Hunt (2004) discusses the importance of human rights in harm reductionist philosophy, and defines two versions of the overarching philosophy

“Weak rights” – People are entitled to good treatment (health or otherwise)

“Strong rights” – People are entitled to good treatment and have the right to use drugs

How do we balance this?

-Prioritization of health may in some instances lead to prohibitory policies

-A “strong rights” approach may in some cases may lead to policies that increase harm

Question 27

Global drug policy index- NZ profile

Answer 27

-Proportionality of the criminal justice response

-Health and harm reduction

–> in both of these umbrellas Maori and Pacific people are disadvantaged.

Question 28

Complexities and Controversy when it comes to harm reduction (smoking)

Answer 28

-Aotearoa is attempting to be smokefree (<5% smokers)

-This invovled changing regulation of tobacco and vapes (age changes, retail restrictions, taxes, flavours/ devices, Nicotine content)

-We have to be mindful of unintended consequences e.g. lowering the nicotine content in a signal cigarette may seem like a harm reduction approach but people will still crave the same amount and just smoke more to reach this y nicotine content. Problem is that nicotine isn’t actually the most harmful part about use (its the smoke) so this policy = harm induction