Download Trainer notes and activities

Trainer Notes
& Activities
Overview
KEY POINTS
1. HM is a national policy and the key concept underpinning the current National
Drug Strategy.
2. HM does not condone drug use but recognises that:
 despite efforts to prevent use, a proportion of the population will continue to
use
 psychoactive drug use is not risk free.
3. HM aims to prevent/decrease the harms associated with psychoactive drug use.
4. Abstinence is one of the range of goals of HM.
5. The HM framework encourages personal responsibility for those who choose to
use drugs.
6. HM has a demonstrated efficacy (e.g., Needle and Syringe Programs significantly
reduced the rate of HIV among injecting drugs users in Australia).
7. GPs are well placed to design and deliver harm reduction interventions and they
are an important source of advice and information for people experiencing AODrelated harms.
8. GPs can help patients change their drug use goals and support those who
choose to reduce harms related to their drug use.
SUGGESTED OBJECTIVES
To enable GPs to:
 understand the efficacy of harm minimisation for their patients

implement strategies to reduce drug-related harm.
Please check that these objectives are relevant for the particular group
you are about to train. If not, write down alternatives.
Resource Kit for GP Trainers on Illicit Drug Issues
Part B2 AOD Background: Harm Minimisation
PAGE 1
2.3: HARM MINIMISATION
Harm Minimisation (HM)
Topic Contents
SLIDES
The slides with slide notes cover:
 development and formulation of the National Drug Strategy

definition, principles and goals of harm minimisation

HM strategies

GPs’ role in HM

application of HM strategies to individuals.
The slides are on the Resource Kit CDROM under this topic. Trainers are
encouraged to select and/or adapt this slide set to meet the focus of the training and
information needs of their participants.
ACTIVITIES
The activities provide opportunities for GPs to:
 discuss various HM issues

develop strategies to implement HM in general practice.
HANDOUTS
1. Potential Harms from Drug-Related Behaviours
Carmichael, C. 2001, ‘Harms Arising from Drug-related Behaviours’, in QADREC
(Queensland Alcohol & Drug Research & Education Centre), The DISE Manual:
A Resource Manual for Direction in Illicit Substance Education, QADREC,
Brisbane, p.16.
Please refer to the Resource Kit CDROM for a copy of the handout (Word).
Slides, Activities & Handouts from other topics may be useful.
Please refer to Part A3 for: Examples of Potential Links to Other Slides,
and for a Listing of Activities and Handouts.
PAGE 2
Resource Kit for GP Trainers on Illicit Drug Issues
Part B2 AOD Background: Harm Minimisation
PATIENT RESOURCES
AIVL 2000, Safer Injecting, Australian Intravenous League, Canberra.
Harm Reduction Coalition no date, Avoiding Arteries and Nerves When You Want a
Vein, http://www.harmreduction.org/pamphlets/arteries.pdf [Accessed 31 July 2003].
Harm Reduction Coalition no date, Getting Off Right: A Safety Manual for Injecting
Drug Users, http://www.harmreduction.org/gor.html [Accessed 31 July 2003].
Harm Reduction Coalition no date, Taking Care of Your Veins: Rotate the Spot.
http://www.harmreduction.org/pamphlets/rotate.pdf [Accessed 31 July 2003].
Patient resources are a valuable tool in the clinical setting. They can be
obtained through ADIS or the publisher – free or at nominal cost.
Resource Kit for GP Trainers on Illicit Drug Issues
Part B2 AOD Background: Harm Minimisation
PAGE 3
2.3: HARM MINIMISATION
Sources of Additional Information
KEY READINGS
Addy, D. & Ritter, A. 2000, Clinical Treatment Guidelines #4, Reducing Harm for
Clients Who Continue to Use Drugs, Turning Point, Melbourne, Victoria.
Carmichael, C. 2001, The DISE Manual: a Resource Manual for Directions in Illicit
Substance Education, QADREC (Queensland Alcohol & Drug Research & Education
Centre), Brisbane.
CDHA (Commonwealth Department of Health and Ageing) no date, Return on
Investment in Needle and Syringe Programs in Australia, report, CDHA, Canberra.
Gossop, M. 2000, Living with Drugs, 5th edn, Ashgate Arena, Sydney.
Hamilton, M. & Cape, G. 2002, ‘History of Drug Use and Drug Policy Responses’, in
G. Hulse, J. White, & G. Cape (eds.), Management of Alcohol and Drug Problems,
Oxford University Press, South Melbourne, pp. 3–15.
Hamilton, M., Kellehear, A. & Rumbold, G. 1998, ‘Addressing Drug Problems: The
Case for Harm Minimisation’, Drug Use in Australia: A Harm Minimisation Approach,
Oxford University Press, South Melbourne, pp.130–144.
Hilton, B., Ann, R., Thompson, R., Moore-Dempsey, L. & Janzen, R. 2001, ‘Harm
Reduction Theories and Strategies for Control of Human Immunodeficiency Virus: A
Review of the Literature’, Journal of Advanced Nursing, vol. 33, issue 3,
pp. 357–370.
Ministerial Council on Drug Strategy 1998, National Drug Strategic Framework 1998–
99 to 2002–03, Building Partnerships: A Strategy to Reduce the Harm Caused by
Drugs in Our Community, Commonwealth of Australia, Canberra.
Roche, A., Evans, K. & Stanton, W. 1997, ‘Harm reduction: Roads Less Travelled to
the Holy Grail’, Addiction, vol. 92, issue 9, pp. 1207–1212.
Ryder, R., Salmon, A. & Walker, N. 2001, Drug Use and Drug-related Harm: A
Delicate Balance, IP Communications, Melbourne.
PAGE 4
Resource Kit for GP Trainers on Illicit Drug Issues
Part B2 AOD Background: Harm Minimisation
Activity 1: Harm Reduction in General Practice
PURPOSE
To demonstrate how harm minimisation principles are applied in many situations,
including everyday clinical practice.
You will need
Copies of Handout 1, Harms Arising From Drug-Related Behaviours, located on the
Resource Kit CDROM.
PROCESS
1.1 Ask participants to give their understanding of ‘harm minimisation’
1.2 Write responses on the whiteboard
1.3 Divide participants into small groups and give each group Handout 1
1.4 Ask each group to list examples of strategies they use in the context of general
practice to reduce harm:
 in general
 in relation to alcohol and other drug use
1.5 Discuss anticipated benefits and costs for patients for implementing those
strategies
1.6 Bring the larger group back together to provide feedback, share strategies, and
identify benefits and costs.
Source: adapted from QADREC (Queensland Alcohol & Drug Research & Education
Centre) 2001, National Needle & Syringe Program (NSP) Workers’ Training
Package, University of Queensland & Queensland Health, Brisbane.
Resource Kit for GP Trainers on Illicit Drug Issues
Part B2 AOD Background: Harm Minimisation
PAGE 5
2.3: HARM MINIMISATION
Harm Minimisation (HM)
Activities
Activity 2: Explore Factors Contributing to Harm
PURPOSE
To explore factors contributing to drug-related harm: is it the drug, the behaviour or
the situation?
PROCESS
2.1 Explain to participants that the activity:
 aims to explore factors associated with certain behaviours and factors which
may influence harm associated with these behaviours
 is an exploratory exercise and there are no right or wrong answers
2.2 Allocate one end of the room as ‘most harmful’ and the opposite end as ‘least
harmful’
2.3 Nominate a drug or a behaviour (from the list below)
2.4 Ask participants to move toward the space that represents their beliefs regarding
the ‘harm’ associated with the nominated drug or behaviour
When all participants have grouped:
 ask one person to describe the rationale for their position and invite comment
from others
 repeat with two to three other participants
 summarise the views expressed in terms of how harms may vary for different
environments, individuals or drug factors
 stress that there are no wrong or right answers to these issues and that many
factors may influence drug-related harms.
Drugs
Cannabis
Heroin
Methadone
Tobacco
Aspirin
Coffee
Alcohol
Ecstasy
Benzodiazepines
Behaviour
Sky Diving
Rock Climbing
Driving a Car
Air Travel
Source: adapted from Pharmaceutical Society of Australia & Pharmacy Guild of
Australia 2003, Illicit Drugs: National Training Package for Pharmacy, Australian
Government Department of Health and Ageing, Canberra.
Topic Cross Reference
2.1 Making Sense of Drugs: Social Interaction Model [slide].
PAGE 6
Resource Kit for GP Trainers on Illicit Drug Issues
Part B2 AOD Background: Harm Minimisation
2.3: HARM MINIMISATION
Activity 3: Identify Harm Reduction Principles
PURPOSE
To identify harm reduction principles relevant to the GP setting.
PROCESS
3.1 Draw three columns on the whiteboard to represent Supply Control, Demand
Reduction and Harm Reduction (but do not label the columns)
3.2 Nominate a licit drug and ask participants to brainstorm how society reduces the
problems related specifically to that drug
3.3 Write the responses in the most appropriate whiteboard column
 Repeat the activity for a prescription drug
 Repeat for an illicit drug
3.4 Ask participants to propose appropriate labels for each column
3.5 Finally, write the labels above each column.
Source: adapted from Munro, G., Illicit Drugs Training Pharmacy Project [training
package], Australian Drug Foundation.
Resource Kit for GP Trainers on Illicit Drug Issues
Part B2 AOD Background: Harm Minimisation
PAGE 7
Activity 4: Thinking about Harm Minimisation Approaches
PURPOSE
To generate thoughts about harm minimisation approaches that GPs may implement
with patients experiencing illicit drug-related harms.
PROCESS
4.1 Divide the group into two
4.2 Provide one group with information about Patient A and the other with information
about Patient B
Patient A is a person with a diagnosis of type 2 diabetes who has high
blood sugars and is unable to stick to the recommended diet
Patient B is an amphetamine user who wants Valium to assist them to
sleep at night but doesn’t want to cease their amphetamine use
4.3 Ask each group to discuss and note:
 how they would raise the issues about the patients’ behaviour
 what information they would provide
 a brief action plan for each patient
4.4 Ask groups to give feedback about their discussion as a whole by:
 comparing and contrasting each group’s approach
 highlighting similarities and differences
 suggesting possible reasons for differences
4.5 Facilitate discussion.
PAGE 8
Resource Kit for GP Trainers on Illicit Drug Issues
Part B2 AOD Background: Harm Minimisation
2.3: HARM MINIMISATION
Activity 5: Relate Advice to Harms
PURPOSE
To generate strategies for reducing harms associated with illicit drug use.
You will need
1. Copies of Cycle of AOD-Related Harms for Individuals. This is in the Harm
Minimisation topic slide set
Cycle of AOD-related Harms for
Individuals
Administration
Drug affected
behaviour
Acquisition
Recovering from
drug use
Withdrawal
Harm Minimisation
2. Copies of Activity 5 Handout: Relating Advice to Harms (on the next page)
3. Overhead pens
PROCESS
5.1 Display the overhead transparency ‘Cycle of AOD-Related Harms for Individuals’
5.2 Divide participants into small groups. Select a particular drug as the topic of the
activity
5.3 Allocate one harm from the cycle (e.g., ‘Administration’) to each group and invite
them to brainstorm:
 sub-harms related to the selected drug
 strategies to provide advice, information or interventions to help reduce subharms related to that drug
5.4 Each group shares their proposed activities and advice with the larger group.
Source: adapted from Pead, J., Lintzeris, N. & Churchill, A. 1996, From Go to Whoa,
Amphetamines and Analogues, The Trainer’s Package for Health Professionals,
Commonwealth Department of Human Services and Health, Canberra.
Resource Kit for GP Trainers on Illicit Drug Issues
Part B2 AOD Background: Harm Minimisation
PAGE 9
ACTIVITY 5 HANDOUT: RELATING ADVICE TO HARMS
1. Write the name of the drug selected for discussion in the first row.
2. Write the drug-related harm from the ‘Cycle of AOD-Related Harms for Individuals’ in
the second row (e.g., ‘Administration’).
3. In the first column, list sub-harms associated with the topic (e.g. list specific subharms associated with ‘Administration’).
4. In the second column, list strategies to reduce/prevent sub-harms related to that
drug.
Name of Drug:
AOD-Related Harm:
Sub-Harms
PAGE 10
Strategies to Reduce/Prevent
Sub-Harms
Resource Kit for GP Trainers on Illicit Drug Issues
Part B2 AOD Background: Harm Minimisation