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Home > Drug Treatment Matrix cell A1: Interventions - reducing harm. Effectiveness of harm reduction interventions.

Drug and Alcohol Findings. (2017) Drug Treatment Matrix cell A1: Interventions - reducing harm. Effectiveness of harm reduction interventions. London: Drug and Alcohol Findings. 7 p.

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The Drug Matrix is concerned with the treatment of problems related to the use of illegal drugs by adults (another deals with alcohol-related problems). It maps the treatment universe and for each sub-territory (a cell) lists the most important UK-relevant research and guidance. Across the top columns move from specific interventions through how their impacts are affected by staff, the management of the service, and the nature of the organisation, to the impact of local area treatment systems. Down the rows are the major intervention types implemented at these levels.

What is this cell about?

Reducing the harms experienced by the user as a result of their drug use, without necessarily reducing use or seeking to overcome dependence. Seemingly a straightforward humanitarian objective, our hot topic on the issue reveals the complications and the intense controversy over an approach that seems to imply – and in practice requires – a degree of acceptance of illegal drug use. Fundamental questions include what and whose harms we accept as legitimate intervention targets.

 

Among the harms in practice focused on are infectious diseases spread by shared injecting equipment, in particular HIV – the disease which generated modern-day harm reduction in Britain illustration – but also hepatitis B and C, and the prevention of ‘overdose’ fatalities.

 

Typically, harm is reduced by changing how drugs are used. Common interventions include needle exchanges which try to ensure that only infection-free injecting equipment is used, and education and skills training to help users avoid particularly risky practices. Substituting a legally prescribed drug of the same type for the original (and usually illegally obtained) substance often has both harm reduction and treatment objectives and effects; research on these approaches is also to be found in cell A3. Harm reduction activities may take place in a criminal justice context and services may prioritise preventing harms to the community rather than to the drug user, issues addressed also in cell A5.

 

The current cell is well stocked compared to succeeding cells in the row, reflecting the greater research emphasis given to testing interventions as opposed to the impact of the practitioner delivering them (cell B1), how they and the service are managed (cell C1), the strengths and ethos of the service-providing organisation (cell D1), and the entire service network (cell E1). This should not be taken to mean interventions are primary and the other influences secondary. Systems of interacting services and initiatives synergistically reduce harm to an extent beyond the reach of any one type of intervention. An example is how methadone maintenance reduces the number of injections, making it easier for needle exchanges to meet the remaining need for injecting equipment, while exchanges act as conduit into treatment. Simply providing a harm reduction service is no guarantee it will reduce harm; how services are run is critical. Examples include high doses in substitute prescribing rather than a mentality of trying to get to a drug-free state, and liberal dispensing of injecting equipment rather than the more disciplinarian approach of insisting on the corresponding return of used equipment.

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