Harm Reduction, Public Health

Rationale

Promoters of harm reduction strategies begin with the assumption that drug use can never be eliminated from any society. Consequently, it makes little sense to use the legal system to punish drug users because these sanctions do not produce the desired results and they cause harm in the process. Although many people would like to achieve a drug free society, this is not a realistic goal and should not guide public policy. If the premise is accepted that drug free is impossible to achieve, the issue becomes how the harm associated with drug use can be reduced and minimized. As a result, harm reduction advocates have proposed and in many cases, implemented a wide variety of strategies to minimize the problems associated with illicit drug use. Most harm reduction efforts are focused on illegal substances because there are already harm reduction methods in place for those using legal drugs. For example, the use of designated drivers is a harm reduction approach to reduce the possible damage caused by intoxicated drivers. The individual who chooses to drink is not discouraged from drinking to the point of intoxication, only from driving in that condition. It should be noted that people using legal drugs are typically left alone and not subjected to harassment, arrest, and serious punishment, even though they may be damaging their health and causing problems for friends, family members, and employers.

U.S. Public Policy

The position of the federal government toward harm reduction, as reflected in the National Drug Control Strategy formulated by the Office on National Drug Control Policy, is clearly negative. From both Democratic and Republican administrations, this position has been consistently maintained. This position is reflected in the following statement from the 1999 National Drug Control Strategy:

Strategies

Ironically, some harm reduction strategies are widely used in the United States and actively promoted in the National Drug Control Strategy. For example, heroin substitution therapy (e.g. methadone maintenance) has been used in the treatment of heroin addicts since the mid-1960s. Methadone is a synthetic opioid that eliminates the unpleasant withdrawal from heroin but does not produce heroin's euphoria, allowing the patient to maintain a relatively normal life. Although methadone has traditionally been administered in a limited number of specialized clinics, a revision of federal guidelines now allows qualified providers to be certified to administer methadone. The purpose of this change was to make methadone more accessible for heroin addicts, since in most cases, a daily dose of methadone is necessary. Since methadone is an addictive substance, the purpose of methadone maintenance therapy is to reduce the harm caused by injecting heroin. More recently, a new opioid, buprenorphine, has been approved as a treatment for heroin addiction. Buprenorphine is administered in pill form (methadone is a liquid) by qualified physicians. A daily dose does not seem to be necessary, and the withdrawal symptoms are relatively mild. Although methadone can be diverted and abused, the pill form of buprenorphine contains another drug that blocks the euphoric properties if the drug is injected. Federal agencies such as the Center for Substance Abuse Treatment and the National Institute on Drug Abuse have actively promoted buprenorphine. This is a harm reduction strategy to replace a harmful, addictive substance (heroin) with a less harmful, addictive substance (buprenorphine).

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