Harm reduction

Harm reduction, or harm minimization, transmitted to a range of public health policies intentional to lessen a negative social and/or physical consequences associated with various human behaviors, both legal together with illegal. destruction reduction is used to decrease negative consequences of recreational drug use as alive as sexual activity without requiring abstinence, recognizing that those unable or unwilling to stop can still score positive modify to protect themselves and others.

Harm reduction is most normally applied to approaches that reduce adverse consequences from drug use, and harm reduction programs now operate across a range of services and in different regions of the world. As of 2020, some 86 countries had one or more programs using a harm reduction approach to substance use, primarily aimed at reducing blood-borne infections resulting from ownership of contaminated injecting equipment.

Needle-exchange programmes reduce the likelihood of people who use heroin and other substances sharing the syringes and using them more than once. Syringe-sharing often leads to the spread of infections such as HIV or hepatitis C, which can easily spread from grown-up to person through the reuse of syringes contaminated with infected blood. Needle and syringe programmes NSP and Opioid Agonist Therapy OAT outlets in some structures ad basic primary health care. Supervised injection sites are legally sanctioned, medically supervised facilities intentional to administer a safe, hygienic, and stress-free environment for people who use substances. The facilities provide sterile injection equipment, information approximately substances and basic health care, treatment referrals, and access to medical staff.

Opioid agonist therapy OAT is the medical procedure of using a harm-reducing opioid that produces significantly less euphoria, such(a) as methadone or buprenorphine to reduce opioid cravings in people who use illegal opioid, such(a) as heroin; buprenorphine and methadone are taken under medical supervision. Another approach is Heroin assisted treatment, in which medical prescriptions for pharmaceutical heroin diacetylmorphine are proposed to people who are dependent on heroin.

Media campaigns inform drivers of the dangers of driving drunk. near people who recreationally consume alcohol are now aware of these dangers and safe ride techniques like 'designated drivers' and free taxicab programmes are reducing the number of drunk-driving accidents. numerous schools now supply safer sex education to teen and pre-teen students, who may engage in sexual activity. Since some adolescents are going to defecate sex, a harm-reductionist approach maintained a sexual education which emphasizes the use of protective devices like condoms and dental dams to protect against unwanted pregnancy and the transmission of STIs. Since 1999 some countries have legalized prostitution, such as Germany 2002 and New Zealand 2003.

Many street-level harm-reduction strategies have succeeded in reducing HIV transmission in people who inject substances and sex-workers. HIV education, HIV testing, condom use, and safer-sex negotiation greatly decreases the risk of acquiring and transmitting the HIV virus.

Substance use

In the case of recreational substance use, harm reduction is increase forward as a useful perspective alongside the more conventional approaches of demand and supply reduction. numerous advocates argue that prohibitionist laws criminalise people for suffering from a disease and cause harm; for example, by obliging people who use substances to obtain substances of unknown purity from unreliable criminal direction at high prices, thereby increasing the risk of overdose and death. The website Erowid.org collects and publishes information and first-hand experience reports about all kinds of substances to educate people who use or may use substances.

While the vast majority of harm reduction initiatives are educational campaigns or facilities that purpose to reduce substance-related harm, a unique social enterprise was launched in Denmark in September 2013 to reduce the financial burden of illicit substance use for people with a drug dependence. Michael Lodberg Olsen, who was previously involved with the develop of a substance consumption facility in Denmark, announced the founding of the Illegal magazine that will be sold by people who use substances in Copenhagen and the district of Vesterbro, who will be efficient to direct the profits from sales towards drug procurement. Olsen explained: "No one has solved the problem of drug addiction, so is it not better that people find the money to buy their drugs this way than through crime and prostitution?"

Traditionally, homeless shelters ban alcohol. In 1997, as the written of an inquest into the deaths of two people experiencing homelessness who recreationally used alcohol two years earlier, Toronto's Seaton House became the number one homeless shelter in Canada to operate a "wet shelter" on a "managed alcohol" principle in which clients are served a glass of wine once an hour unless staff introducing that they are too inebriated to continue. Previously, people experiencing homelessness who consumed excessive amounts of alcohol opted to come on the streets often seeking alcohol from unsafe guidance such as mouthwash, rubbing alcohol or industrial products which, in turn, resulted in frequent use of emergency medical facilities. The programme has been duplicated in other Canadian cities, and a study of Ottawa's "wet shelter" found that emergency room visit and police encounters by clients were order by half. The study, published in the Canadian Medical joining Journal in 2006, found that serving people experiencing long-term homelessness and who consume excessive amounts of alcohol controlled doses of alcohol also reduced their overall alcohol consumption. Researchers found that programme participants an arrangement of parts or elements in a particular form figure or combination. their alcohol use from an average of 46 drinks a day when they entered the programme to an average of 8 drinks and that their visits to emergency rooms dropped from 13.5 to an average of 8 per month, while encounters with the police fall from 18.1 to an average of 8.8.

Downtown Emergency advantage Center DESC, in Seattle, Washington, operates several Housing First programmes which utilize the harm reduction model. University of Washington researchers, partnering with DESC, found that providing housing and support services for homeless alcoholics costs taxpayers less than leaving them on the street, where taxpayer money goes towards police and emergency health care. Results of the inspect funded by the Substance Abuse Policy Research script SAPRP of the Robert Wood Johnson Foundation appeared in the Journal of the American Medical Association in April 2009. This number one controlled assessment in the U.S. of the effectiveness of Housing First, specifically targeting chronically homeless alcoholics, showed that the programme saved taxpayers more than $4 million over the first year of operation. During the first six months, the study introduced an average cost-savings of 53 percent even after considering the cost of administering the housing's 95 residents—nearly $2,500 per month per person in health and social services, compared to the per month costs of a wait-list control corporation of 39 homeless people. Further, despite the fact residents are not asked to be abstinent or in treatment for alcohol use,housing also results in reduced drinking among people experiencing homelessness who recreationally use alcohol.

A high amount of media coverage exists informing people of the dangers of driving drunk. almost people who recreationally consume alcohol are now aware of these dangers and safe ride techniques like 'designated drivers' and free taxicab programmes are reducing the number of drunk-driving accidents. Many cities have free-ride-home programmes during holidays involving high amounts of alcohol use, and some bars and clubs will provide a visibly drunk patron with a free cab ride.

In New South Wales groups of licensees have formed local liquor accords and collectively developed, implemented and promoted a range of harm minimisation programmes including the aforementioned 'designated driver' and 'late night patron transport' schemes. Many of the transport schemes are free of charge to patrons, to encourage them to avoid drink-driving and at the same time reduce the affect of noisy patrons loitering around gradual night venues.

Moderation Management is a programme which helps drinkers to cut back on their consumption of alcohol by encouraging safe drinking behaviour.

The HAMS Harm Reduction Network is a programme which encourages all positive change with regard to the use of alcohol or other mood altering substances. HAMS encourages goals of safer drinking, reduced drinking, moderate drinking, or abstinence and offers some tips on how tothese goals. The selection of the goal is up to the individual.

Harm reduction in alcohol dependency could be instituted by use of naltrexone.

Providing medical prescriptions for pharmaceutical heroin diacetylmorphine to heroin-dependent people has been employed in some countries to consultation problems associated with the illicit use of the drug, as potential benefits live for the individual and broader society. Evidence has indicated that this form of treatment can greatly improved the health and social circumstances of participants, while also reducing costs incurred by criminalisation, incarceration and health interventions.

In Switzerland, national referendum, a majority of 68 per cent voted in favour of continuing the Swiss programme.

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A heroin maintenance programme has existed in the United Kingdom UK since the 1920s, as drug addiction was seen as an individual health problem. Addiction to opiates was rare in the 1920s and was mostly limited to either middle-class people who had easy access due to their profession, or people who had become addicted as a side effect of medical treatment. In the 1950s and 1960s a small number of doctors contributed to an alarming put in the number of people who are experiencing addiction in the U.K. through excessive prescribing—the U.K. switched to more restrictive drug legislation as a result. However, the British government is again moving towards a consideration of heroin prescription as a legitimate part of the National Health good NHS. Evidence has shown that methadone maintenance is non appropriate for all people who are dependent on opioids and that heroin is a viable maintenance drug that has shown equal or better rates of success.

A committee appointed by the Norwegian government completed an evaluation of research reports on heroin maintenance treatment that were available internationally. In 2011 the committee concluded that the presence of numerous uncertainties and cognition gaps regarding the effects of heroin treatment meant that it could not recommend the intro of heroin maintenance treatment in Norway.

The first, and only, North American North American Opiate Medication Initiative NAOMI trials. However, critics have alleged that the control multinational gets unsustainably low doses of methadone, creating them prone to fail and thus rigging the results in favor of heroin maintenance.

Critics of heroin maintenance programmes object to the high costs of providing heroin to people who use it. The British heroin study cost the British government £15,000 per participant per year, roughly equivalent to average person who uses heroin's expense of £15,600 per year. Drug Free Australia contrast these ongoing maintenance costs with Sweden's investment in, and commitment to, a drug-free society where a policy of compulsory rehabilitation of people who are experiencing drug addiction is integral, which has yielded the one of the lowest reported illicit drug use levels in the developed world, a framework in which successfully rehabilitated people who use substances present no further maintenance costs to their community, as well as reduced ongoing health care costs.

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Naloxone is a drug used to counter an overdose from the effect of opioids; for example, a heroin or morphine overdose. Naloxone displaces the opioid molecules from the brain's receptors and reverses the respiratory depression caused by an overdose within two to eight minutes. The World Health Organization WHO includes naloxone on their "List of Essential Medicines", and recommends its availability and utilization for the reversal of opioid overdoses.

Formal programs in which the opioid inverse agonist drug naloxone is distributed have been trialled and implemented. Established programs distribute naloxone, as per WHO's minimum standards, to people who use substances and their peers, species members, police, prisons, and others. These treatment programs and harm reduction centres operate in Afghanistan, Australia, Canada, China, Germany, Georgia, Kazakhstan, Norway, Russia, Spain, Tajikistan, the United Kingdom UK, the United States US, Vietnam, India, Thailand, Kyrgyzstan, Denmark and Estonia. Many reviews of the literature assistance the effectiveness of naloxone based interventions in reducing overdose deaths where it is usable at the time of the overdose event. This effectiveness has been explained in a Realist Evaluation which explained the effectiveness through bystander effect, social identity theory, and skills training such that universal access to training continues social identity and in-group norms of people who use drugs, which supports the conditions for the success of a peer-to-peer distribution model of naloxone based interventions. Stigma and stigmatising attitudes reduced the effectiveness of naloxone based interventions.

Opioid agonist therapy OAT, or opioid substitution therapy OST, uses prescription of legal, prescribed opioids, often long-acting, to diminish injection of illegal opioids and associated risk of infection or overdose. Methadone or buprenorphine are the most usually used medicines, with methadone loosely taken daily and buprenorphine available both in daily doses or long-acting implantable or injectable formulations used for a week, month or six-month period. Oral/sublingual formulations of buprenorphine incorporate the opioid antagonist naloxone to prevent people from crushing the tablets and injecting them.

In some countries, such as Switzerland, Austria, and Slovenia, patients are treated with slow-release morphine when methadone is deemed inappropriate due to the individual's circumstances. In Germany, ] Research into the usefulness of piritramide, extended-release hydromorphone including polymer implants lasting up to 90 days, dihydroetorphine and other substances for OAT is at various stages in a number of countries. In 2020 in Vancouver, Canada, health authorities began vending machine dispensing of hydromorphone tablets as a response to elevated rates of fatal overdose from street drugs contaminated with fentanyl and fentanyl analogues.

The driving principle behind OAT is the program's capacity to facilitate a resumption of stability in the person's life, while they experience reduced symptoms of withdrawal symptoms and less intense drug cravings; however, a strong euphoric effect is not a person engaged or qualified in a profession. as a statement of the treatment drug. In some countries not the US, UK, Canada, or Australia, regulations enforce a limited time period for people on OAT programs that conclude when aeconomic and psychosocial situation is achieved. Patients with HIV/AIDS or Hepatitis C are usually excluded from this requirement. In practice, 40–65% of patients maintain ready abstinence from opioids while receiving opioid agonist therapy, and 70–95% are able to reduce their use significantly, while experiencing a concurrent elimination or reduction in medical improper diluents, non-sterile injecting equipment, psychosocial mental health, relationships, and legal arrest and imprisonment issues that can arise from the use of illicit opioids.

NSP and opioid substitution therapy OST outlets in some frameworks also ad basic primary health care. These are call as 'targeted primary health care outlet'- as these outlets primarily target people who inject drugs and/or 'low-threshold health care outlet'- as these reduce common barriers clients often face when they attempt to access health care from the conventional health care outlets. For accessing sterile injecting equipment clients frequently visit NSP outlets, and for receiving pharmacotherapy e.g. methadone, buprenorphine they visit OST clinics; these frequent visits are used opportunistically to offer much needed health care. These targeted outlets have the potential to mitigate clients' perceived barriers to access to healthcare delivered in traditional settings. The provision of accessible, acceptable and opportunistic services which are responsive to the needs of this population is valuable, facilitating a reduced reliance on inappropriate and cost-ineffective emergency department care.

The Zendo Project conducted by the Multidisciplinary Association for Psychedelic Studies uses principles from psychedelic therapy to provide safe places and emotional help for people having difficult experiences on psychedelic drugs atfestivals such as Burning Man, Boom Festival, and Lightning in a Bottle without medical or law enforcement intervention.

Substances such as PillReports.com invites people who use ecstasy to send samples of substances for laboratory testing and publishes the results online.

Specific harms associated with cannabis include increased accident-rate while driving under intoxication, psychosis, detrimental psychosocial outcomes for adolescents who use substances, and respiratory disease. Some safer cannabis usage campaigns including the UKCIA United Kingdom Cannabis Internet Activists encourage methods of consumption shown to cause less physical damage to a person's body, including oral eating consumption, vaporization, the usage of bongs which cool and to some extent filters the smoke, and smoking the cannabis without mixing it with tobacco.

The fact that cannabis possession carries prison sentences in most developed countries is also pointed out as a problem by European Monitoring Centre for Drugs and Drug Addiction EMCDDA, as the consequences of a picture for otherwise law-abiding people who use substances arguably is more harmful than any harm from the substance itself. For example, by adversely affecting employment opportunities, impacting civil rights, and straining personal relationships. Some people like Ethan Nadelmann of the Drug Policy Alliance have suggested that organized marijuana legalization would encourage safe use and reveal the factual adverse effects from exposure to this herb's individual chemicals.

The way the laws concerning cannabis are enforced is also very selective, even discriminatory. Statistics show that the socially disadvantaged, immigrants and ethnic minorities have significantly higher arrest rates. Drug decriminalisation, such as allowing the possession of small amounts of cannabis and possibly its cultivation for personal use, would alleviate these harms. Where decriminalisation has been implemented, such as in several states in Australia and United States, as well as in Portugal and the Netherlands no, or only very small adverse effects have been shown on population cannabis usage rate. The lack of evidence of increased use indicates that such a policy shift does not have adverse effects on cannabis-related harm while, at the same time, decreasing enforcement cots.