“Harm Reduction saves lives, though it has been misunderstood by a majority of people and some governments are even against it.”

Although I had an idea about the concept and appreciate any method that reduces death rates, I didn’t know an organization regarding “harm reduction” exists. Therefore, I thank you for bringing this to my attention! If you don’t mind, I have a question about the definition you provide. In addition, I would like to add some personal insight into the reason “Governments” may be weary of “Harm Reduction” techniques.

• Is the International Harm Reduction Association, “ihra”, definition meant to be the most general?

I ask this because I performed a literature research on Entrez, The Life Sciences Search Engine, and found an article related to Harm Reduction and the tobacco industry. In that article, the definition is similar but one that is more general and based on Article 12 of the International Covenant of Economic and Cultural Rights.”: A “Right to health based on autonomy-engancing right”. I provide the article below and believe you will enjoy it!

As a chemical engineer, who has pharmaceutical validation experience, earned three Vice-President’s Awards, had a personal visit by a CEO, optimized my area of the process, and had the head of technical operations ask me to accompany him to evaluate another process, I value the importance of data, defined variables, verification, validated methods, and manufacturing of product according to Quality System Regulations. In truth pharmaceutical validation is very similar to Six Sigma. In addition, I have been certified in Hazard Analysis and Critical Control Point for seafood processing. All of these methods are similar to Harm Reduction.

Sadly, I witnessed illegal activity as well, and reported it to the Food and Drug Administration. By the way, data is important and consumers should know what information is available. For this reason, I would like to provide the following US Food and Drug Administration links. It is kind of a passion of mine since I witnessed illegal activity and know that, in some cases, lives could be at stake:

US Food and Drug Administration: For Consumers, which has a link to reporting problems as well.

US FDA, Inspections, Compliance, Enforcement, and Criminal Investigations: Warning Letters.

Although the pharmaceutical industry is a heavily regulated, and there are many who abide by regulations and laws, there are people who break these laws for financial gain. I’m sure most “logical” people understand the reasoning behind laws and regulations and manufacture product accordingly, but there are deaths, or “adverse reactions”, that may be caused by improper manufacturing. Therefore, consumers and health professionals should report any problems with US FDA regulated products. In these cases, the more data we report the more return on the science. In fact, the US Food and Drug Administration is developing the Sentinel Initiative, which will hopefully become an in-situ data gathering process.

You mention that some Governments are weary about Harm Reduction methods. According to the below document, some governments, United States included, have been “bitten” by Corporations who did not share important data related to health outcomes. Specifically, the document provides the following example:

• When using a “smoking machine”, the smokers made use of “compensatory smoking behavior” (inhaled more deeply, smoking more cigarettes, covering the filter) to counterbalance any mitigating effects of the filter and thereby ingest an even greater amount of nicotine and its attendant carcinogens. The tobacco companies took advantage of the “filter” and “increased” inhaling to produce “light cigarettes” knowing that the Government’s machine didn’t properly measure the relationship between the nicotine and carcinogens, filter, and increased pressure-drop from increased inhaling by the consumer. Therefore, people were actually increasing their nicotine intake, which increased the probability of addiction. In turn, future cancer rates were affected as well.

As I previously mentioned, I, as a chemical engineer, have witnessed some very illegal and dangerous activity while working in the pharmaceutical industry. As you know, many Governments have experienced the horrific side of corporations as well, and corporations love to take advantage of “harm reduction” techniques.

“Countries can improve health without falling prey to corporate malfeasance, so long as governments create evidence-based mechanisms to study these products and survey those who use them.Yet these countries should not have to face such difficult scientific, psychological, and human rights issues alone, allowing transnational tobacco corporations to more easily “divide and conquer” in manipulating individual national policies. Through a process termed “leap-frogging,” scientific research and policy dissemination can allow “the adoption of measures in a forerunner state to serve as models elsewhere.”

As a final point, I know that corporations also engage in wonderful humanitarian activity as well. As with any population of people, there are evil people included with the population. The only way to put an end to their activity is through discussion, which is an activity they can’t stand. Actually, I took the Reid technique of Interviewing and Interrogation as well, and, during this training, I learned that”psychopaths” hate factual analysis.

Once again, I would like to thank you for introducing “ihra” to me! I wish you all well!

1. Shelley, Donna, MD, MPH; Meier, Benjamin Mason, JD, LLM. The Fourth Pillar of the Framework Convention on tobacco Control: Harm Reduction and International Human Right to Health. Public Health Rep.[online].2006. vol.121(5), pp. 494-500. Available from: Entrez, The Life Sciences Search Engine. Search Entrez. PMCID: 1564445.

My response to: Harm Reduction-It saves lives! by Kishalaya (dodo) Namaram.

In addition to my Conversations for a Better World Blog, Chris Harding, I have a Gather Network as well: QuidnuncSimcha

IHRA Release Position Statement Defining Harm Reduction

After months of discussion and consultation with partners, the International Harm Reduction Association (IHRA) Board of Directors and staff have released a detailed position statement defining the term ‘harm reduction’. The statement outlines a set of underlying principles which best describe this approach, and offers the following definition:

‘Harm Reduction’ refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without
necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families and the community.

The term ‘harm reduction’ came to prominence after the emergence of HIV in the 1980s, but the underlying principles of the approach can be traced back much further. However, as the approach developed gradually and in several places at once, there has always been an element of debate regarding an exact definition. More recently, this has led to concerns that some organisations may ‘hijack’ the term to justify interventions and policies which would not normally be classed as harm reduction. Therefore, IHRA is offering this definition of harm reduction – which applies equally to policies, programmes and practices, and to all psychoactive drug use (including controlled drugs, alcohol, tobacco and pharmaceutical drugs).

What is Harm Reduction?
A position statement from the International Harm Reduction Association
Harm reduction refers to policies, programmes and practices that aim to reduce the harms associated with the use of psychoactive drugs in people unable or unwilling to stop. The defining features are the focus on the prevention of harm, rather than on the prevention of drug use itself, and the focus on people who continue to use drugs.

Harm reduction began to be discussed frequently after the threat of HIV spreading among and from injecting drug users was first recognised. However, similar approaches have long been used in many other contexts for a wide range of drugs.

Harm reduction complements approaches that seek to prevent or reduce the overall level of drug consumption. It is based on the recognition that many people throughout the world continue to use psychoactive drugs despite even the strongest efforts to prevent the initiation or continued use of drugs. Harm reduction accepts that many people who use drugs are unable or unwilling to stop using drugs at any given time. Access to good treatment is important for people with drug problems, but many people with drug problems are unable or unwilling to get treatment. Furthermore, the majority of people who use drugs do not need treatment. There is a need to provide people who use drugs with options that help to minimise risks from continuing to use drugs, and of harming themselves or others. It is therefore essential that harm reduction information, services and other interventions exist to help keep people healthy and safe. Allowing people to suffer or die from preventable causes is not an option. Many people who use drugs prefer to use informal and non-clinical methods to reduce their drug consumption or reduce the risks associated with their drug use.

This short statement sets out the main characteristics of harm reduction. This statement is designed to be relevant to all psychoactive drugs including controlled drugs, alcohol, tobacco and pharmaceutical drugs. The specific harm reduction interventions may differ for different drugs. Readers can refer to the IHRA website (www.ihra.net) for more detailed guidance on harm reduction interventions.

Definition
‘Harm Reduction’ refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families and the community.

Principles
The harm reduction approach to drugs is based on a strong commitment to public health and human rights.
Targeted at risks and harms Harm reduction is a targeted approach that focuses on specific risks and harms. Politicians, policymakers, communities, researchers, frontline workers and people who use drugs should ascertain:
What are the specific risks and harms associated with the use of specific psychoactive drugs?
What causes those risks and harms?
What can be done to reduce these risks and harms?
Harm reduction targets the causes of risks and harms. The identification of specific harms, their causes, and decisions about appropriate interventions requires proper assessment of the problem and the actions needed. The tailoring of harm reduction interventions to address the specific risks and harms must also take into account factors which may render people who use drugs particularly vulnerable, such as age, gender and incarceration.

Evidence based and cost effective
Harm reduction approaches are practical, feasible, effective, safe and cost-effective. Harm reduction has a commitment to basing policy and practice on the strongest evidence available. Most harm reduction approaches are inexpensive, easy to implement and have a high impact on individual and community health. In a world where there will never be sufficient resources, benefit is maximised when low-cost/high-impact interventions are preferred over high-cost/low-impact interventions.

Incremental
Harm reduction practitioners acknowledge the significance of any positive change that individuals make in their lives. Harm reduction interventions are facilitative rather than coercive, and are grounded in the needs of individuals. As such, harm reduction services are designed to meet people’s needs where they currently are in their lives. Small gains for many people have more benefit for a community than heroic gains achieved for a select few. People are much more likely to take multiple tiny steps rather than one or two huge steps. The objective of harm reduction in a specific context can often be arranged in a hierarchy with the more feasible options at one end (eg measures to keep people healthy) and less feasible but desirable options at the other end. Abstinence can be considered a difficult to achieve but desirable option for harm reduction in such a
hierarchy. Keeping people who use drugs alive and preventing irreparable damage is regarded as the most urgent priority while it is acknowledged that there may be many other important priorities.

Dignity and compassion
Harm reduction practitioners accept people as they are and avoid being judgemental. People who use drugs are always somebody’s son or daughter, sister or brother or father or mother. This compassion extends to the families of people with drug problems and their communities. Harm reduction practitioners oppose the deliberate stigmatisation of people who use drugs. Describing people using language such as ‘drug abusers’, ‘a scourge’, ‘bingers’, ‘junkies’, ‘misusers’, or a ‘social evil’ perpetuates stereotypes, marginalises and creates barriers to helping people who use drugs. Terminology and language should always convey respect and tolerance.

Universality and interdependence of rights
Human rights apply to everyone. People who use drugs do not forfeit their human rights, including the right to the highest attainable standard of health, to social services, to work, to benefit from scientific progress, to freedom from arbitrary detention and freedom from cruel inhuman and degrading treatment. Harm reduction opposes the deliberate hurts and harms inflicted on people who use drugs in the name of drug control and drug prevention, and promotes responses to drug use that respect and protect fundamental human rights.
Challenging policies and practices that maximise harm. Many factors contribute to drug-related risks and harms including the behaviour and choices of individuals, the environment in which they use drugs, and the laws and policies designed to control drug use. Many policies and practices intentionally or unintentionally create and exacerbate risks and harms for drug users. These include: the criminalisation of drug use, discrimination, abusive and corrupt policing practices, restrictive and punitive laws and policies, the denial of life-saving medical care and harm reduction services, and social inequities. Harm reduction policies and practice must support individuals in changing their behaviour. But it is also essential to challenge the international and national laws and policies that create risky drug using environments and contribute to drug related harms.

Transparency, accountability and participation
Practitioners and decision makers are accountable for their interventions and decisions, and for their successes and failures. Harm reduction principles encourage open dialogue, consultation and debate. A wide range of stakeholders must be meaningfully involved in policy development and programme implementation, delivery and evaluation. In particular, people who use drugs and other affected communities should be involved in decisions that affect them.

(Courtesy : http://www.ihra.net/September2009#IHRAReleasePositionStatementDefiningHarmReduction)
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