Controlled drinking, harm reduction and their roles in the response to alcohol-related problems

This article first distinguishes three meanings of the term ‘harm reduction’ in the literature on alcohol problems: a European sense in which a change in drinking is not necessarily required; an American sense which includes the controlled drinking (CD) goal of treatment; and a government policy sense in which it is seen as an alternative to whole population alcohol policies. The article then goes on to consider the roles of the CD goal and the harm reduction philosophy in response to three groups of people with alcohol problems or increased risk of such problems: the non-treatment-seeking population of hazardous and harmful drinkers; the population of socio-economically disadvantaged street drinkers or others who are thought unlikely to make radical changes in drinking behaviour; and the regular population of treatment-seeking problem drinkers. It is concluded, inter alia, that the equation of harm reduction and the CD goal in the American sense of harm reduction is confusing and may have had a detrimental effect of the practice of CD treatment. The CD goal should imply an aim of harm-free drinking

Use of harm reduction strategies in an occupational therapy life skills intervention

Thesis (M.S.)--Boston UniversityObjectives of Study: Harm reduction intervention strategies have the potential to support positive health outcomes. However, no studies have explored how these strategies can be implemented in an occupational therapy intervention. This study addresses this knowledge gap by examining harm reduction strategies that were discussed during group and individual sessions of an occupational therapist-led life skills intervention for people who have a mental illness and are or were homeless. Methods: This study is a secondary analysis of a larger study that used a longitudinal repeated measures design to implement a life skills intervention. This secondary analysis uses a mixed methods design. Qualitative methods were used for data collection and initial analysis. Quantitative methods were then used to analyze differences between settings. Results: Three major themes emerged from the data: Financial, Physical, and Psychosocial Hann Reduction. The most prevalent theme was Financial Harm Reduction. All three themes were present throughout all of the different life skills intervention modules. There was no significant difference in the themes used between settings. Limitations and Recommendations for Further Research: This study was limited to what was documented in the therapy notes. Although the notes may not include every discussion that occurred, these results suggest that harm-reduction strategies can be utilized in an occupational therapy intervention. Additional research is needed to investigate how harm reduction can be implemented in other areas of occupational therapy practice

Public health, human rights and the harm reduction paradigm: from risk reduction to vulnerability reduction

This paper explores the utility of expanding the harm reduction paradigm to incorporate vulnerability reduction. The thrust of harm reduction interventions to date, particularly in injection drug use, has been risk reduction. Many interventions have been designed to reduce drug-related harm by altering high-risk behaviours. Vulnerability looks behind risk. The notion of vulnerability incorporates the complex of underlying factors that promotes harmful outcomes as a result of drug use, and limits attempts to modify drug use to make harmful outcomes less likely. A conceptual framework will be introduced that looks at harm, risk and vulnerability at the three levels of individual, community and society. This paper uses illicit injection drug use as an example. This conceptual framework will be used to position human rights more centrally in the harm reduction debate. Human rights violations and infringements can contribute to drug-related harm by first creating the preconditions for risky drug use; and second, by limiting access to prevention and care. A human rights framework allows us to better understand vulnerability to drug-related harm, and provides an important advocacy tool for improved interventions. This expanded harm reduction paradigm that incorporates vulnerability and human rights allows for better development of a public health approach in harm reduction, exposes gaps in research, and allows for better development of more effective interventions

Harm reduction among injecting drug users - evidence of effectiveness

This chapter synthesises and evaluates the available direct evidence relating to the impact of needle and syringe programmes (NSPs), opioid substitution treatment (OST), drug consumption rooms (DCRs), and peer naloxone distribution (PND) on HIV/hepatitis C (HCV) incidence/prevalence, injecting risk behaviour and overdose-related mortality. To achieve this, we conducted a review of reviews; a systematic and explicit method used to identify, select and critically appraise relevant findings from secondary level research (systematic reviews and/or meta-analyses) into an evidence briefing. In the absence of high-quality reviews, appraisal of the evidence was supplemented with a targeted review of the primary literature. We find that there is sufficient review-level evidence that OST reduces HIV transmission, while the evidence in support of NSPs reducing HIV transmission is more tentative, and for DCRs currently insufficient. There is tentative evidence that OST has limited effectiveness in reducing HCV transmission, and insufficient evidence to support or discount NSPs or DCRs' ability to reduce HCV transmission. There is sufficient review-level evidence that NSPs, OST and DCRs reduce self-reported injecting risk behaviour. There is sufficient review evidence that OST reduces risk of overdose mortality, but insufficient evidence to support or discount the effect of DCRs or PND on overdose deaths at the community level. Our review shows evidence in support of a variety of harm reduction interventions but highlights an uneven presence of high-quality review evidence. Future evaluation of harm reduction programmes should prioritise methodologically robust study designs

Addressing injecting drug use in Asia and Eastern Europe.

While the global HIV incidence dropped about 20% in the past 10 years, HIV incidences among people who inject drugs (PWID) in Asia and Europe continue to increase and to account for high proportions of new HIV infections among PWID globally. Great changes have been observed in this region, such as progressing from rejection to acceptance of harm reduction strategies in Asian countries, but no such change has occurred in Eastern European countries. China has quickly scaled up harm reduction activities nationwide, resulting in the decline of HIV incidence and HIV prevalence among PWID since 2006. However, insufficient scaling up of harm reduction programs in other countries has failed to slow down their HIV epidemics. In Eastern European countries where the spread of HIV among PWID is the most severe, only about 15% of funding for harm reduction programs are from domestic sources. Strong political and financial commitment from countries in this region is urgently needed to quickly scale up evidence-based harm reduction strategies in order to prevent the HIV epidemic from spreading rapidly from PWID to the heterosexual general population

Supply-side reduction policy and drug-related harm

Large-scale seizures of cocaine, heroin and amphetamine-type substances (ATS) do not result in any reduction in overdoses on these drugs or on arrests for use and possession of these drugs, according to this report. Aim: The aim of this study was to examine the question of whether seizures of heroin, cocaine or amphetamine type substances (ATS) or supplier arrests for heroin, cocaine or ATS trafficking have any effect on the ED admissions related to or arrests for use and possession of these drugs. Method: Two strategies were employed to answer the question. The first involved a time series analysis of the relationship between seizures, supplier arrests, emergency department (ED) admissions and use/possession arrests. The second involved an analysis of three specific operations identified by the NSW Crime Commission as has having had the potential to have affected the market for cocaine. Results: Over the short term (i.e. up to four months), increases in the intensity of high-level drug law enforcement (as measured by seizures and supplier arrests) directed at ATS, cocaine and heroin did not appear to have any suppression effect on ED admissions relating to ATS, cocaine and heroin, or on arrests for use and/or possession of these drugs. The three major operations dealing with cocaine listed by the NSW Crime Commission as significant (Operation Balmoral Athens, Operation Tempest and Operation Collage) did exert a suppression effect on arrests for use and possession of cocaine. Conclusions: Increases in the quantities of ATS, cocaine and heroin drugs seized by law enforcement authorities are normally a signal of increased rather than reduced supply. Very large seizures, however, may temporarily suppress consumption of these drugs. Even if drug seizures and drug supplier arrests have no short term effects on ED admissions and arrests for drug use and/or possession, they may still suppress drug consumption through risk compensation

BP Reduction, Kidney Function Decline, and Cardiovascular Events in Patients without CKD.

BACKGROUND AND OBJECTIVES: In the Systolic Blood Pressure Intervention Trial (SPRINT), intensive systolic BP treatment (target <120 mm Hg) was associated with fewer cardiovascular events and higher incidence of kidney function decline compared with standard treatment (target <140 mm Hg). We evaluated the association between mean arterial pressure reduction, kidney function decline, and cardiovascular events in patients without CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We categorized patients in the intensive treatment group of the SPRINT according to mean arterial pressure reduction throughout follow-up: <20, 20 to <40, and ≥40 mm Hg. We defined the primary outcome as kidney function decline (≥30% reduction in eGFR to <60 ml/min per 1.73 m2 on two consecutive determinations at 3-month intervals), and we defined the secondary outcome as cardiovascular events. In a propensity score analysis, patients in each mean arterial pressure reduction category from the intensive treatment group were matched with patients from the standard treatment group to calculate the number needed to treat regarding cardiovascular events and the number needed to harm regarding kidney function decline. RESULTS: In the intensive treatment group, 1138 (34%) patients attained mean arterial pressure reduction <20 mm Hg, 1857 (56%) attained 20 to <40 mm Hg, and 309 (9%) attained ≥40 mm Hg. Adjusted hazard ratios for kidney function decline were 2.10 (95% confidence interval, 1.22 to 3.59) for mean arterial pressure reduction between 20 and 40 mm Hg and 6.22 (95% confidence interval, 2.75 to 14.08) for mean arterial pressure reduction ≥40 mm Hg. In propensity score analysis, mean arterial pressure reduction <20 mm Hg presented a number needed to treat of 44 and a number needed to harm of 65, reduction between 20 and <40 mm Hg presented a number needed to treat of 42 and a number needed to harm of 35, and reduction ≥40 mm Hg presented a number needed to treat of 95 and a number needed to harm of 16. CONCLUSIONS: In the intensive treatment group of SPRINT, larger declines in mean arterial pressure were associated with higher incidence of kidney function decline. Intensive treatment seemed to be less favorable when a larger reduction in mean arterial pressure was needed to attain the BP target.info:eu-repo/semantics/publishedVersio

From the Mountaintops: What the World Can Learn from Drug Policy Change in Switzerland

Reviews Switzerland's drug policy of policing, prevention, treatment, and harm reduction, including low-threshold methadone programs, needle exchanges, and safe injection rooms. Outlines political contexts, health and social outcomes, and lessons learned