Harm reduction in drug treatment services has now a background of emerging HIV infections (Ghodse, 2002). Associated services like needle changing, prescribing substitutes and provision of outreach services need to be addressed in the context. A permanent change is expected when a person comes forward with a drug problem. This permanent change is not achieved most of the time. Moreover this exercise would be time consuming and impractical to many including the treating physician. A consensus seems to have been reached whereby the harm associated with the abuse and dependence is reduced.
Harm minimization is now the focus of many programs for reduction of drug abuse (Ghodse, 2002). Harm reduction has been practiced even previously. Opiate addicts were prescribed injectable heroin rather than the much safer oral methadone so that the users do not resort to black marketers for their requirement. Many a time, harmful effects arise due to poor administration techniques and adulteration of the drug. Harm reduction has many goals like “stopping (or reducing) injecting, sharing injection equipment, illicit drug use, prescribed drug use and offending behaviour” (Ghodse, 2002).
Leading a healthy lifestyle, securing a job, staying away from criminal activity and indulging in safe sex would be some additional factors which could add to the goals mentioned for harm reduction. Intravenous drug users are prone to HIV and Hepatitis C infections which can be fatal. An opinion has arisen to provide sterile injection equipment to drug users as a public health and excellent preventive measure (Ghodse, 2002). Sufficient syringes if distributed would eliminate the concept of needle-sharing which happens to be the basis for most infections.
However this keeps open the possibility of new comers taking advantage of the free availability and the chances that earlier abusers go on without retracting. Some people do not stop the sharing whatever happens. Practical issues about how many to provide, whether any restrictions need to be placed on those who use them or whether it should be provided to whoever asks but has not injected even once yet (Ghodse, 2002). There are authorities who are uncomfortable about this free supply implying that we are condoning the injection drug abuse. This is the situation where we must “judge not”. It is not as if we can always only do the right things.
Sometimes we have to let the line loose so that we get enough fish. That has become the attitude in the handling of drug abusers. Some authorities provide new syringes and needles on an exchange basis. However the drawback is that no one knows how many pricks the needles were used for. The control is again difficult but most of these steps are good to a certain extent though the loopholes have still not been covered. When things are freely available, the tendency for used syringes and needles lying around exposed to young children, other dangers are of the children getting infection from accidental pricks.
Communities have frequently complained of this. The incidence of HIV could hopefully be reduced by the needle exchange system (Ghodse, 2002). The polydrug user who is injecting frequently and in a chaotic manner cannot be expected to be religiously sticking to a new needle for injection each time. Some nations provide “ shooting galleries’ for injection drug use. Young abusers who sniff solvents must be encouraged to use safer surroundings for their drug use. Dangerous areas like roof tops may be fatal. Some cover their heads with a plastic bag when intoxicated. References: Ghodse, A. H. (2002)
“Drugs and Addictive Behaviour; a guide to Treatment” – 3rd Edition, 2002, Cambridge University Press. Johnson H 2004. Key findings from the Drug use careers of female offenders study. Trends & issues in crime and criminal justice no 289. Canberra: Australian Institute of Criminology Makkai T & Payne J 2003. Key findings from the Drug use careers of offenders study. Trends & issues in crime and criminal justice no 267. Canberra: Australian Institute of Criminology Smith, G. P. (2005), Lawmaking and interpretation in the age of biotechnology in The Christian Religion and Biotechnology , Springer, Netherlands