youth against drugs norway international conference 2005
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YOUTH AGAINST DRUGS NORWAY International Conference 2005. Winners of the PRIDE International Award, 2003. www.drugprevent.org.uk. Harm Reduction - Where’s the Harm in it?. Peter Stoker Director, NDPA. Harm Reduction. How did it begin?. Harm Reduction. How does it work ?. - PowerPoint PPT PresentationTRANSCRIPT
YOUTH AGAINST DRUGSYOUTH AGAINST DRUGSNORWAYNORWAY
International Conference 2005International Conference 2005
Winners of the PRIDE Winners of the PRIDE
International Award, 2003.International Award, 2003.
www.drugprevent.org.ukwww.drugprevent.org.uk
Harm Reduction -
Where’s the Harm in it?
Peter StokerDirector, NDPA
Harm ReductionHarm Reduction
How did it begin? How did it begin?
Harm ReductionHarm Reduction
How does it work ?How does it work ?
Harm ReductionHarm Reduction
Is Harm Reduction Is Harm Reduction any better than any better than
Primary Primary Prevention? Prevention?
Harm ReductionHarm Reduction
Is there anyIs there any contradictioncontradiction between Harm between Harm Reduction and Reduction and Primary Prevention?Primary Prevention?
The DRUG PROBLEM …The DRUG PROBLEM …
HowHow
BIG BIG is it ?is it ?
EuropeEurope
Europe’s Europe’s LegalisersLegalisers
Have Their Eyes Have Their Eyes On YouOn You
Harm ReductionHarm Reduction
How did it begin? How did it begin?
‘‘REAL’ HARM REDUCTIONREAL’ HARM REDUCTION
Used for decadesUsed for decadesWith known users onlyWith known users only‘‘1 to 1’ interface1 to 1’ interfacePart of treatmentPart of treatment
Aim: Abstinence from useAim: Abstinence from use
GlamorGlamoriseise
NormalNormaliseise
TrivialTrivialiseise
SympathSympathisisee
DepenalDepenaliseise
DecriminalDecriminaliisese
LegalLegalisisee
The Beast with The Beast with
7 Eyes7 Eyes
‘‘REAL’ HARM REDUCTIONREAL’ HARM REDUCTION
Used for decadesUsed for decadesWith known users onlyWith known users only‘‘1 to 1’ interface1 to 1’ interfacePart of treatmentPart of treatment
Aim: Abstinence from useAim: Abstinence from use
‘‘So-Called’ HARM REDUCTIONSo-Called’ HARM REDUCTION
invented in 1980sinvented in 1980spromote to everyonepromote to everyoneusers or non-usersusers or non-usersnot linked to treatmentnot linked to treatment
Aim: Maintenance of useAim: Maintenance of use
The Trojan HorseThe Trojan Horse
Societal FactorsSocietal Factors
Conspicuous ConsumptionConspicuous ConsumptionRapidRapid Gratification Gratification ‘‘Values Clarification’ :Values Clarification’ :
‘‘Self’ before ‘Society’Self’ before ‘Society’ ‘ ‘Rights’ but noRights’ but no ResponsibilitiesResponsibilities The ‘Right’ to be HappyThe ‘Right’ to be Happy
Youth are ‘Supreme’Youth are ‘Supreme’Political CorrectnessPolitical Correctness
LEGALISATION
ALARMREDUCTION
HARMREDUCTION
NORMPROMOTION
LAWDESTRUCTION
Germany
Nederlands Australia
Canada
USA
UK
Hungary
Switzl’d
Arnold TrebachArnold Trebach
George $oro$George $oro$
Who said this? ….Who said this? ….
“ “ By making readily available drugs of By making readily available drugs of various kinds …various kinds …
by giving a teenager alcohol by giving a teenager alcohol by praising his wildness …by praising his wildness …by strangling him with sex literature …by strangling him with sex literature …
… … there must be continued propaganda to there must be continued propaganda to undermine the loyalty of citizens in general undermine the loyalty of citizens in general and teenagers in particular.”and teenagers in particular.”
Josef StalinJosef Stalin
United KingdomUnited Kingdom
LiverpoolLiverpool
ManchesterManchester
LondonLondon
O’HareO’Hare ZinbergZinberg
ParryParrySchmokeSchmoke
‘…‘…Liverpool cabal … hijacked Harm Liverpool cabal … hijacked Harm Reduction … advocate change … break Reduction … advocate change … break with … existing policies … unworkable with … existing policies … unworkable dogmas … abstinence’dogmas … abstinence’
‘…‘…radical kernel … political power.’radical kernel … political power.’
Peter McDermottPeter McDermott
WHAT DO WHAT DO THEYTHEY MEAN BY ‘HARM?’ MEAN BY ‘HARM?’
Harm to userHarm to userPhysical harmPhysical harmHarm because illegal (police)Harm because illegal (police)Harm from disapproval (stress)Harm from disapproval (stress)Need to commit crimeNeed to commit crime
WHAT HARMS DO WHAT HARMS DO THEYTHEY IGNORE?IGNORE?
Harm to the users Harm to the users themselvesthemselves
Harm to other people, andHarm to other people, and
Harm to all, in pre-addiction Harm to all, in pre-addiction stagesstages
WHO DOESDRUG MISUSE
AFFECT?
ONLY THE USER
ONLY THE PHYSIQUE
ONLY THE ADDICT
IT AFFECTS ALL OF US , DIRECTLY/ INDIRECTLY
IT AFFECTS ALL OF US , DIRECTLY/ INDIRECTLY
•Physical•Mental•Intellectual•Social•Emotional•Spiritual•Environmenta
l
Costs start from just day of use
Regular user greatlyOutnumber addicts andCost society more
•Family•Health services•Schools•Religion
•Workplace•Justice Systems•Police•Therapists +++
WHOLE HEALTHWHOLE HEALTH
EmotionalEmotional
Physical
Mental –
IntellectualSocial
Environmental
SpiritualSOURCES:
WHOAncient Greeks
Buddhism, Judaism…
Christianity…
COST TO SOCIETYFROM DRUG MISUSE
NOVICE REGULAR HABITUAL
NO USE OCCASIONAL HEAVY ADDICTED
COST TO SOCIETY
Harm ReductionHarm Reduction
How does it work ?How does it work ?
(…. and (…. and doesdoes it ?) it ?)
NEEDLE EXCHANGE
NEEDLE EXCHANGE
NEEDLE GIVE-AWAY
CONDOM ISSUE
METHADONEMAINTENANCE
PRESCRIPTION HEROIN
MODERATION
SHORT BREAKS
SUBSTANCETESTING
Bridgeport, Connecticut - 1997Bridgeport, Connecticut - 1997
Kit to use crack “safely”Kit to use crack “safely”
Excerpts from “Safe” Crack Excerpts from “Safe” Crack Kit BrochureKit Brochure
““If you smoke indoors, make sure it is If you smoke indoors, make sure it is ventilated. Poorly aired rooms can be ventilated. Poorly aired rooms can be risky for tuberculosis (TB). Cover your risky for tuberculosis (TB). Cover your mouth when coughing.”mouth when coughing.”
““If you have problems breathing or are If you have problems breathing or are coughing up dark stuff, slow down or coughing up dark stuff, slow down or stop smoking for a while. See a doctor stop smoking for a while. See a doctor is [if] it continues!”is [if] it continues!”
Needle Exchange Programs Needle Exchange Programs Do Not Reduce HIV and Do Not Reduce HIV and
Hepatitis CHepatitis CMontreal Study:Bruneau J. et al: “High Rates of HIV Infection Among Injection Drug Users in Needle Exchange Programs in Montreal: Results of a Cohort Study.”Am. J. Epidemiology 1997; 146:904 – 1002.
Seattle Study:Hagan H, et al. “Syringe Exchange and Risk Infection with Hepatitis B and C Viruses.”Am. J. Epidemiology 1999; 14-:203 – 218.
Vancouver Injection Drug Study
NEP NEP Review - Shortcomings Review - Shortcomings of Studiesof Studies
Inadequate outcome measures. Few Inadequate outcome measures. Few measure HIV incidence. Most often self measure HIV incidence. Most often self reported change of risk behaviourreported change of risk behaviour
Often systematic control for covariates is Often systematic control for covariates is lackinglacking
NEP use vs. non-use often poorly defined. NEP use vs. non-use often poorly defined. Sometimes “ever used” vs. “never used”Sometimes “ever used” vs. “never used”
Needle HistoryNeedle History
131 NEP programs identified131 NEP programs identified107 reported a total of 19,397,527 handed 107 reported a total of 19,397,527 handed
out with 62% returned out with 62% returned i.e. 7,371,060 not returnedi.e. 7,371,060 not returned
MMWRMMWR
CDC May 18, 2001CDC May 18, 2001
Chicago - Needle SharingChicago - Needle Sharing
39% of NEP participants shared needles 39% of NEP participants shared needles vs. 38% of non-participantsvs. 38% of non-participants
68% of participants displayed injecting 68% of participants displayed injecting risks vs. 66% of non-participants risks vs. 66% of non-participants
National Research Council/ Institute of Medicine, Preventing HIV Transmission: the Role of Sterile National Research Council/ Institute of Medicine, Preventing HIV Transmission: the Role of Sterile Needles and Bleach, National Academy Press, Washington DC, p. 302-304, 1995.Needles and Bleach, National Academy Press, Washington DC, p. 302-304, 1995.
Seattle-Conversion RiskSeattle-Conversion Risk
Conversion riskConversion risk
SporadicSporadic NEP users vs. non users- NEP users vs. non users-
Hepatitis B 2.4 Hepatitis B 2.4 Hepatitis C 2.6Hepatitis C 2.6
RegularRegular NEP users vs. non users- NEP users vs. non users-
Hepatitis B 1.81Hepatitis B 1.81 Hepatitis C 1.3Hepatitis C 1.3
Puerto Rico NEPPuerto Rico NEP
No significant change in injection habits No significant change in injection habits Only 9.4% entered treatment, increased in the Only 9.4% entered treatment, increased in the
last month by aggressive outreachlast month by aggressive outreach At the low only 12.4%, at the high only 40.3% of At the low only 12.4%, at the high only 40.3% of
needles were returned needles were returned 26.6% of the needles turned in were zero 26.6% of the needles turned in were zero
positive for HIVpositive for HIV No prospective evaluation of NEP participantsNo prospective evaluation of NEP participants
Robles Robles Health PolicyHealth Policy 1998;45:209-220 1998;45:209-220
NEP IndiaNEP India
In 1996 prevalence of HIV, Hepatitis B, In 1996 prevalence of HIV, Hepatitis B, and Hepatitis C were respectively 1%, 8%, and Hepatitis C were respectively 1%, 8%, and 17% and 17%
In February 2002, prevalence was 2%, In February 2002, prevalence was 2%, 18%, and 66% respectively18%, and 66% respectively
Sarkar K, Mitra S, Bal B, Sarkar K, Mitra S, Bal B,
Chakraborty S, Bhattacharya SK. Chakraborty S, Bhattacharya SK.
LancetLancet 2003;361:1301-1302 2003;361:1301-1302
HollandHolland
Adolescent Marijuana Use Increased Adolescent Marijuana Use Increased 142% from 1990-1995142% from 1990-1995
Organized Crime Groups 3-1988 to 93-Organized Crime Groups 3-1988 to 93-19931993
Leading Exporter of EcstasyLeading Exporter of Ecstasy73% of Dutch Feel Laws Too Lax73% of Dutch Feel Laws Too Lax
Australia Injecting RoomsAustralia Injecting Rooms
36 times greater overdoses in the injecting 36 times greater overdoses in the injecting room than rest of Kings Cross arearoom than rest of Kings Cross area
Actual improvement in lives saved only Actual improvement in lives saved only 0.18 life vs. claim of 6-13 lives0.18 life vs. claim of 6-13 lives
EnglandEngland
Decriminalizing marijuana (in effect)Decriminalizing marijuana (in effect)From 1999-2001 the use of cannabis in From 1999-2001 the use of cannabis in
14-15 year olds has increased by 53% 14-15 year olds has increased by 53% from 19% to 29%from 19% to 29%
In girls use has increased by 38% from In girls use has increased by 38% from 18% to 25% 18% to 25%
BMJ 2003;326:942-943BMJ 2003;326:942-943
EnglandEngland
NorwayNorway
FDAP Conference 2005
“Plata” - Oslo
So-called Harm ReductionSo-called Harm Reduction
How does itHow does it
really really work? work?
the the
Gentle Gentle
Slope Slope
down … down …
The Gentle Slope down …The Gentle Slope down …
PreventionPrevention
********************************
‘‘Real’ HRReal’ HR
******************************
>> Abstinence>> Abstinence
The Gentle Slope down …The Gentle Slope down …
PreventionPrevention********************************So-Called HRSo-Called HR******************************>> Abstinence>> Abstinence
The Gentle Slope down …The Gentle Slope down …
Kill PreventionKill Prevention******************************** So-Called HRSo-Called HR******************************Kill AbstinenceKill Abstinence
The Gentle Slope down …The Gentle Slope down …
No PreventionNo Prevention******************************** So-Called HRSo-Called HR******************************>> Maintenance>> Maintenance
The Gentle Slope down …The Gentle Slope down …
No PreventionNo Prevention
********************************
So-Called HRSo-Called HR
******************************
Maintain + Maintain + legallegal fixes fixes
The Gentle Slope down …The Gentle Slope down …
Legal for allLegal for all******************************** So-Called HRSo-Called HR******************************MaintenanceMaintenance
… … destination destination
achieved ?achieved ?
So – called So – called Harm ReductionHarm Reduction
Is Harm Reduction Is Harm Reduction any better than any better than
Primary Primary Prevention? Prevention?
So – called So – called Harm ReductionHarm Reduction
Is there anyIs there any contradictioncontradiction between Harm between Harm Reduction and Reduction and Primary Prevention?Primary Prevention?
Alternatives to Alternatives to so-called ‘harm reduction’ ?so-called ‘harm reduction’ ?
RealReal harm reduction harm reductionConstructive Intervention, Constructive Intervention, includingincluding
Workplace, Schools etc – random testing,Workplace, Schools etc – random testing,
and Abstinence-focused Treatment; and Abstinence-focused Treatment;
all these supporting:all these supporting:Abstinence-focused Education,Abstinence-focused Education, Effective, community-wide Prevention,Effective, community-wide Prevention, Health Promotion across the nation.Health Promotion across the nation.
Good foundations:Good foundations:Create Positive Culture.Create Positive Culture.
Prevention-oriented strategy, across Prevention-oriented strategy, across
whole community, evidence- whole community, evidence-
based.based. Early intervention with users, withEarly intervention with users, with
abstinence focus.abstinence focus. Balance of Rights: Balance of Rights:
Individual v Society.Individual v Society.
“All that is
Necessary for
The triumph of
Evil is that
Good men
Do nothing.” Edmund Burke
1729 - 1797
