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FILM DISCUSSION CARD 1
WHAT IS ‘HARM REDUCTION’?
Policies and programmes that are aimed at reducing
the harms from drugs but drug use per se
Reducing harms from drugs more important that
reducing drug consumption
More effective as it seeks to achieve realistic
objectives – 80% of something is better than 100% of
nothing
HARM REDUCTION: KEY CONCEPTS
A Practical Approach
• Some drug use in society is normal; reduce the immediate harms
Focus on Harms, not drug use
• Let us reduce harms not necessarily the drug use
Prioritization: Deal with more severe harms first
• Let us set immediate and realizable goals, though eventual goal
may be abstinence
Flexibility; Maximum options
• Each drug user is different; let us provide a range of options
Autonomy
•5 Let us respect the drug user's decision and choice
PRINCIPLES OF HARM REDUCTION
Recognizes
Seeks to
Does not judge
Encourages
Recognizes the
Challenges
• The intrinsic value and dignity of human beings
• Maximize social and health assistance
• Minimize repressive and penalizing measures
• Drugs and drug use as good or bad, rather it
emphasizes the reduction of drug-related harm
• Safer drug use
• Competency of users to make choices and change
their lives
• Conventional drug policies and their consequences
HARM REDUCTION FOR HIV PREVENTION
 Harm reduction is a framework in which effective HIV prevention can be
carried out for IDUs and their sexual partners.
 The focus of harm reduction strategies remains on immediate and easily
preventable harms rather than on setting unrealistic goals such as complete
abstinence.
 Harm reduction aims to prevent the transmission of HIV by reducing the
harm associated with high risk behaviours such as sharing needles, syringes
and other equipment for preparing and injecting drugs, and unsafe sexual
behaviours.
 Harm reduction is not limited to HIV prevention alone.
 Other interventions such a abscess prevention, safer injecting practices and
management go beyond HIV prevention.
HARM REDUCTION STRATEGIES
UNDER NACP
METHODS TO REDUCE DRUG-RELATED
HARMS
Educational Interventions
• How to reduce risk
• Safer methods of drug use
Needle syringe exchange programmes
Opioid Substitution Therapy e.g. methadone, buprenorphine
Peer based information on safer injecting and safer sex practices (including
condom demonstration and safer injecting practice demonstration
This entire package = ‘Harm Reduction’
VARIOUS HARM REDUCTION STRATEGIES
 Needle Syringe Exchange Programme
 Agonist Substitution Treatment
 Other Strategies
 Outreach Services
 Safe Injection Facility
 Drop-In Centres
NEEDLE SYRINGE EXCHANGE
PROGRAMMES
FEATURES OF NSEP
More readily associated with the harm reduction approach
than any other type of intervention
Involves supplying new, clean needles and syringes to IDUs, in
exchange of old used, needles and syringes.
Incorporate a variety of other preventive strategies such as
outreach, risk reduction education, referrals to other health
and social services, etc.
12
PHILOSOPHY OF NSEP
• Unclean
• Infected
• Previously
used by
others
• Risk of HIV
transmission
• Clean
• Uninfected
• For use by
client only
(expected)
• No risk of
HIV
transmission
OPIOID SUBSTITUTION TREATMENT
PHILOSOPHY OF AGONIST SUBSTITUTION
15
BENEFITS AND LIMITATIONS
Benefits
•
•
•
•
•
Reduces drug consumption, promotes abstinence
Reduces risky behaviours, risk of HIV transmission
Reductions in lethal overdose – decrease use and high tolerance
Reductions in sex work
Reduction in crime
Limitations
• Patient still chemically dependent on opioids
• Limited availability, due to cost and logistic reasons
• Risk of diversion to unregistered drug users
OTHER STRATEGIES
1. OUTREACH SERVICES
2. SAFE INJECTION FACILITY
3. DROP-IN CENTRES
OUTREACH SERVICES
 Reaches out to hidden drug users
 Within own communities, closer home
Finding drug users
Observing them
Establishing contact and rapport with them in
their natural environments
Providing information about risk behaviours
Promoting and supporting safe behaviours
SAFE INJECTION FACILITY
 Also known as ‘injection rooms’
 Provides not only clean syringes or needles, but a safe injection
facility
 Provides opportunity to IDUs to inject pre-obtained illicit drugs
under the supervision of and/or by the medical staff
Controversial strategy, used in few countries
till date
DROP-IN CENTRE (DIC)






Also known as DIC
Provides clean Needles and Syringes (N/S)
Collects used N/S from IDUs for disposal
Is a safe ‘hang-out’ for recreational purposes
Provides risk reduction education
Provides abscess identification and treatment services
Other Services
• Overdose management
• Condom distribution
• Referral for medical complications
• STI treatment and other general illness
CONCLUSIONS
Harms associated with drug use can be dealt with in a number of ways
Harm reduction strategy provides the most practical and flexible approach
to reduce these harms
Focus is on immediate and easily preventable harms rather than setting
unrealistic goals such as complete abstinence
NSEPs and Agonist substitution treatment are the most common and
effective strategies
Combination of strategies and individualization of intervention are
important aspects of a harm reduction approach
QUIZ - KAUN BANEGA CROREPATI
QUESTION 1
• Drugs cause disruption of every aspect of the users life
• Drug use is associated with risky behaviours
• Drug-related harms are inter-related
• Drug use affects life of only those who use them
QUESTION 2
• Loss of job, heavy debt
• Involvement in illegal activities
• Infections like HIV, HBV
• Frequent arguments with family members
QUESTION 3
• Stigmatization of substance users
• Loss of employment
• Sharing of needles with risk of HIV
• Respiratory diseases
QUESTION 4
• Community A: less IDU, increasing number of wine shops in residential areas and
alcohol using adults
• Community B: large number of IDUs, high prevalence of HIV/AIDS amongst IDUs
• Community C: Recent trend of adolescents getting into smoking and occasional
cannabis (ganja) use
• All of the above
QUESTION 5
• Involve religious leaders in the community and put pressure on him to abstain
• Wait till he develops certain complications, then he may be more amenable to
reason
• Discuss with the person about which harmful behaviours can he reduce even
with continued drug use
• Ask the police to arrest him
QUESTION 6
Which of the following methods is used to reduce drug-related
harms?
• Education
• Needle and syringe programmes
• Substitution therapy
• All of the above
QUESTION 7
Which of the following are goals of the harm reduction
approach?
• Eliminate all forms of drug use from society
• Create an environment of “zero tolerance” for drugs
• Make drugs illegal so drug use may be criminalised
• Reduce immediate harms of drug use and drug-related
activities on individuals and society
QUESTION 8
Which of the following is a key feature of the Needle and Syringe
Exchange Programme (NSEP)?
• Supplying new clean needles and syringes to IDUs, in exchange
for old used, needles and syringes
• Encouraging users to inject drugs rather than consume them in
other ways
• Making drugs available freely so IDUs can easily access them
QUESTION 9
Which of the following benefits is offered by Opioid Substitution
Therapy (OST)?
• Increases chemical dependence of opioids
• Increases drug-related crime rather than sex work, and therefore
reduces HIV risks
• Reduces drug consumption, and thereby, promotes abstinence
• Reduces lethal drug overdose