Harm reduction – in some countries called risk reduction or minimization of damage – is a strategy for addressing the potential harm related to drug use.
Its first objective is to reduce the negative effects resulting from the use of drugs, and from there, building together with the subject which requires more complex goals, in order to improve the quality of life for the drug users.
The harm reduction strategies have focused not only on the individual practices of drug users, but also on understanding their vulnerability to develop appropriate interventions and establish specific relations of caring and reciprocity between the individuals and the groups in the contexts of drug use.
Some harm reduction programs develop activities to involve other habitants of the territory in which they are involved with (residents, social activists or public institutions such as schools or health centers) in the transformation of situations of suffering that affect them.
The origin of the concept of harm reduction was in the Netherlands in the ’70s when professional alternatives identified with the drug user’s perspective appeared, called the “model of acceptance”. In the late ’80s it began to be used in the region of Merseyside (England), in response to two main factors:
1. The problem of HIV infection among injecting drug users (IDUs);
2. The growing suspicion that the strategies taken so far had not improved the situation and in some cases had the opposite effect of increasing the harm associated with drug use.
A harm reduction strategy can involve a wide variety of tactics.
It can include changing the legal penalties associated with the drug use, improving the accessibility of drug users to treatment services, generating direct services for drug users and their social networks in communities, changing the drug user behavior through education, and also changing the social perception of drugs and the drug user.
The intervention strategies that emerge from the harm reduction policy are characterized by:
- Expanding the variety and supply of attention, establishing multiple and intermediate objectives.
- Adapting the interventions to the heterogeneity of drug users and their individual cases.
- Establishing a relationship that is more equitable, flexible, and more participatory in decision-making between professional drug users
- Incorporating measures to promote a controlled substance use. Between the abusive use and the abstinence, working with regulations on drug use.
- More open, friendly and uncensored resources.
These strategies lead to several types of actions that can be implemented together or separately, according to the realties of each community. Among the most common, these can be identified:
- Actions oriented to promote the consumption of less risk, aimed at providing health education; often operated in environments near the consumption sites. In the case of injecting drug users, including exchange programs and / or distribution of syringes, this can be made from different locations (mobile teams of health workers in the street, primary care centers, hospitals, special schools, pharmacies, etc…) and safe injection sites.
- Activities aimed at providing minimal care, social support services and basic health care adapted to the lifestyles of users and access to a socio-health network.
- Actions designed to promote safer sex, providing sex education and prevention, and increase access to condoms.
- Action to replace the use of substances purchased on the illegal market for prescribed substances. This includes methadone maintenance programs or programs for controlled distribution of heroin.
- Actions to promote work among pairs and self-organization of drug users, which encourage the protagonists of the users as agents of prevention and protection of their civil rights