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

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ndpa@drugprevent.org.ukndpa@drugprevent.org.uk