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Harm reduction is many things. Most often, the term is used to describe a set of approaches to treating addiction that aim to reduce negative outcomes without requiring people to stop using drugs. Harm reduction can also be understood as a social movement, and, in an even broader sense, as a compassionate and strengths-based philosophy. 

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Harm reduction is many things. Most often, the term is used to describe a set of approaches to treating addiction that aim to reduce negative outcomes without requiring people to stop using drugs. Harm reduction can also be understood as a social movement, and, in an even broader sense, as a compassionate and strengths-based philosophy. 

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(try reading these through with the NASW Code of Ethics in mind ... notice any similarities in the concepts and the language used?)

http://harmreduction.org/about-us/principles-of-harm-reduction/

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One of the practices most associated with harm reduction is the
distribution of clean needles to intravenous drug users. Although needle exchanges operate legally in many states, they are prohibited from receiving federal funding.

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One of the practices most associated with harm reduction is the
distribution of clean needles to intravenous drug users. Although needle exchanges operate legally in many states, they are prohibited from receiving federal funding.

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SEATTLE (Reuters) - Occasional crystal meth smoker Richard Russell ambles up to a church storage garage in a Seattle alley and a recovering drug addict hands him two brand new meth pipes, no questions asked.

One of about two dozen methamphetamine users who received free bubble-ended pipes on a recent afternoon, Russell is a participant in a pioneering but illegal program launched in March that aims to indirectly curb infectious diseases.

"Dude's got something to smoke but he doesn't have a pipe, what's he going to do?" Russell said later as he munched on a sandwich. "Panhandle, steal. Inject."

The theory behind the handout program is that giving meth pipes to drug users may steer some away from needles, which are far riskier than smoking, especially if the user is sharing with another person infected with HIV or hepatitis C.

There is little scientific evidence to support that claim, but The People's Harm Reduction Alliance, a privately funded needle-swap group run by drug users, said it has distributed more than 1,000 pipes in Seattle in a matter of weeks and could expand to other cities in Washington state and Oregon.

Its program also draws addicts from society's fringes into its compassionate fold, with links to treatment and housing services, Executive Director Shilo Murphy said.

Even though needle exchanges have faced continued opposition in many parts of the United States since the first legal one opened in Tacoma, Washington in 1988, the programs have been credited with reducing HIV infections and saving lives.

But opponents say giving away meth pipes discourages quitting while wasting resources on an untested scheme that will not solve a city-wide health problem. They note that among methamphetamine-using gay men, HIV is transmitted primarily through unprotected sex, not syringe- or pipe-sharing.

There are no studies to show meth users will resort to injections if pipes are unavailable, or that handing out pipes prevents needle use, said Matthew Golden, a Seattle and King County Disease Control Officer and a University of Washington professor of medicine.

It is also hard to quantify how much the campaign might prevent death or infection, if at all, even if it does give meth users safer options than a needle or smoking out of a jerry-rigged light bulb, Golden said.

"It is plausible the intervention could be effective," Golden said. "It's simply an unstudied idea."

RADICAL PROGRAM

But the Alliance, which says it is the nation's largest needle-exchange program by syringes dispersed, has pushed legal boundaries for years with user-conceived experiments unacceptable to its taxpayer-funded counterparts, Murphy said.

It faced public outcry five years ago with a similarly illegal campaign to hand out crack pipes with extension tubes to prevent the hot glass from blistering addicts' lips, on the theory that disease could spread between pipe-sharers through open wounds, Murphy said. A similar program began in San Francisco last year.

The Alliance launched its meth pipe program after learning from its own survey that 80 percent of area meth users would be less likely to inject drugs if given access to pipes.

On a recent afternoon in an alley near the leafy University of Washington campus, dozens of drug users ambled up to a makeshift table to dump fistfuls of dirty syringes into biohazard bins and retrieve fresh boxes of needles, as well as meth pipes.

Addicts, among them a transient man with a military-style backpack and two glassy-eyed college-age youths, also helped themselves to supplies like cookers, pushers and latex ties, as well as condoms and health pamphlets.

"We don't see this as controversial. We see this as what's needed in our community," Murphy said.

Giving out meth or crack pipes is illegal under state law, but the Seattle Police Department said it has taken no action to actively monitor or shutter the program.

Anti-drug groups say needle exchanges make hard drug use appear acceptable and bring crime to communities, among other concerns.

Phillip Wilson, 56, said the pipe programs were harming the community, adding that he planned to re-sell the glassware he got on the street for about $10.

"Come on man, giving that shit away to people who are trying to quit? I just can't understand it," he said.

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advocacy groups / pressure groups / lobbies

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Largest U.S. needle exchange tries free meth pipes in Seattle

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SEATTLE (Reuters) - Occasional crystal meth smoker Richard Russell ambles up to a church storage garage in a Seattle alley and a recovering drug addict hands him two brand new meth pipes, no questions asked.

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Organized needle exchange programs were pioneered in the 1980s and 1990s, as the AIDS epidemic highlighted the risk of sharing needles. Today, there are roughly 200 needle exchange sites in the United States, and many more worldwide. These sites aim to:

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Organized needle exchange programs were pioneered in the 1980s and 1990s, as the AIDS epidemic highlighted the risk of sharing needles. Today, there are roughly 200 needle exchange sites in the United States, and many more worldwide. These sites aim to:

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Curb the spread of communicable diseases (primarily HIV and Hepatitis C) by providing clean needles, pipes, and other supplies for drug users.

Provide a place where used needles can be properly disposed of, limiting the public safety risk posed by discarded syringes.

Offer numerous other resources to addicts, such as (but not limited to) safe sex supplies, hygiene supplies, educational materials, STD and TB testing, and referrals to substance abuse treatment programs and social services.

Give drug users access to a non-judgmental community of support—a connection to others who will treat them with dignity whether or not they continue to use drugs.

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Incredibly powerful statistics about the rate of transmission of HIV through shared needles, not just between drug users but from mothers to their children as well. You may need to click "source" to access the site.

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Injection Drug Use and Infectious Disease Make Needle Exchange Programs Imperative:

There are an estimated 350,000 regular injection drug users in America - all at increased risk of contracting and spreading fatal blood-borne diseases. 1

Approximately 950,000 U.S. residents are living with HIV/AIDS. 2

More than a quarter of AIDS cases in the U.S. among people age 13 or older are directly linked to injection drug use. 3

When mother-to-child HIV transmission is taken into account, roughly 35 percent of all AIDS infections can be related to injection drug use. 4

An estimated 61 percent of AIDS cases among women are due to injection drug use or sexual contact with someone infected with HIV through injection drug use. 5

Over half of HIV infections in children result from injection drug by a parent. 6

AIDS is the second leading cause of death among African American women and third leading cause of death among African American men. 7

Injection drug users are also at serious risk of contracting Hepatitis B and Hepatitis C. Hepatitis B infects between 140,000 and 320,000 people every year and kills between 5,000 and 6,000 people in the U.S. Hepatitis C infects about 36,000 people in the U.S. every year, killing 8,000 to 10,000 of those infected. 8

Needle Exchange Programs by the Numbers:

There are approximately 185 needle exchange programs (NEP) operating nationwide. 9

A national survey of NEPs found that in addition to exchanging sterile syringes for contaminated ones, 97 percent of programs provide a range of public health services, including referral to substance abuse treatment, prevention education for sexually transmitted diseases, HIV counseling and testing, tuberculosis screening, and primary health care. 10

It costs an average city about $160,000 to run an NEP (about $20 per user per year), whereas one syringe-infected AIDS patient will require upwards of $120,000 per year in public health expenditures. 11

Federal law forbids use of federal funds to support needle exchanges - nonetheless, exchanges operate in 38 states. 12

Needle Exchange Programs Promote Public Safety:

In 2002, NEPs reported removing nearly 25 million used syringes from communities. 13

According to the Centers for Disease Control, the one-time use of sterile syringes remains the most effective way to limit HIV transmission associated with injection drug use. 14

A study by the National Institutes of Health found that NEPs "show a reduction in risk behaviors as high as 80 percent in injecting drug users..." 15

NEP participants have been found five times more likely to enter drug treatment than those who had never used an exchange. 16

NEPs throughout the country have reduced HIV transmission rates by one-third to two-fifths. 17

An analyses of a New York State-approved NEP found that during a 12-month period, an estimated 87 HIV infections were averted as a direct result of the use of needle exchange. 18

Injection drug users who are afraid of being arrested while carrying drug paraphernalia are 1.74 times more likely to share syringes, and 2.08 times more likely to share injection supplies than other users. 19

Sources:

1. Substance Abuse and Mental Health Services Administration's (SAMHSA) 2003 National Survey on Drug Use & Health

2. National Institute of Allergy and Infectious Diseases: HIV/AIDS Statistics

3. Centers for Disease Control and Prevention (CDC): AIDS cases by exposure category

4. CDC: Drug Associated HIV Transmission

5. CDC: HIV Surveillance Report

6. CDC: HIV Surveillance Report

8. National Institute of Allergy and Infectious Diseases: Hepatitus fact sheets

9. Drug Policy Alliance

10. Paone D, Clark J, Shi Q, Purchase D, Des Jarlais DC. Syringe exchange in the United States, 1996: A national profile. Am J Public Health 1999 Jan; 89(l):43-6.

11. Syringe Exchange in the United States: 1995 Update, HIV Capsule Report, United States Conference of Mayors, February 1996

12. Vogt RL, Breda MC, Des Jarlais DC, et al. Hawaii's statewide syringe exchange program. American Journal of Public Health. 1998;88:1403-1404.

13. Morbidity and Mortality Weekly Report 2005;54(27):673-6.

14. CDC: Drug-associated HIV transmission continues in the U.S. 2002.

15. National Institutes of Health: Interventions to Prevent HIV Risk Behaviors. 1997 February 11-13;15(2):1-41.

16. Hagan H, et al. Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. J Subst Abuse Treat 2000; 19(3):247-52.

17. National Institutes of Health: Interventions to Prevent HIV Risk Behaviors. 1997 February 11-13;15(2):1-41.

18. Laufer FN. Cost-effectiveness of syringe exchange as an HIV prevention Strategy. J Acquir Immune Defic Syndr 2001;28(3):273-8.

19. Blumenthal, R.N., Collateral damage in the war on drugs: HIV risk behaviors among injection drug users. International Journal of Drug Policy 10 (1999) 25-38.

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Needle Exchange Programs Promote Public Safety

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Fact Sheet on Needle Exchange ProgramsInjection Drug Use and Infectious Disease Make Needle Exchange Programs Imperative:There are an estimated 350,000 regular injection drug users in America - all at increased risk of contracting and spreading fatal blood-borne diseases. 1 Approximately 950,000 U.S. residents are living with HIV/AIDS. 2

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The War on Drug Users: Are Syringe Exchanges Immoral?

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The War on Drug Users: Are Syringe Exchanges Immoral?

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An important article about the continued political opposition to needle exchange.

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In short: Politics. Despite the data, some still struggle with the idea of helping drug users inject, arguing that these programs hurt society by encouraging addiction and promoting a no-work, dependent-on-the system lifestyle. Congressman Hal Rogers (R-KY) is chair of the House appropriations committee and played a key role in the decision to reinstate the ban. "Chairman Rogers ... is concerned that needle exchange programs only encourage drug addicts to remain addicted to drugs and perpetuate the cycle of drug crime," Jennifer Hing, a spokeswoman, explained.

But many advocates for syringe exchanges say that in allowing an outdated moral agenda to trump science, politicians like Rogers are launching a misguided attack on both drug users and taxpayers in general. Eight federally-funded research reports have concluded that these programs reduce HIV transmission without increasing the use of illicit drugs. In New York City, the rate of new HIV infections among drug users fell 80 percent after the city implemented syringe exchanges. And the cost savings from such programs have been enormous: A clean syringe costs about $0.97 (PDF), according to Human Rights Watch. The average lifetime cost for treating HIV, in contrast, is around $300,000.

What's more, advocates reject the idea that syringe exchanges are immoral. The vast majority of syringe exchange programs are not just anonymous offices where drug users pick up equipment. These programs host support clubs, link people to housing and health care, and serve as meeting spaces for individuals to learn about their rights. For drug users accustomed to daily rejection by family, friends, and society, syringe exchanges are often the last outposts of acceptance, the only places where they can recover their dignity.

"This is where we learn to stop seeing ourselves as just a bunch of drug users," said Cindy G., 52, who spent decades sharing needles with others, sharpening dull ones on emery boards and taking them from diabetic friends. She now participates in the exchange program run by VOCAL-New York, where she helped start a woman's support group. "What's insane is that there are so many people that can't or won't be able to use them."

Indeed, many current and former drug users say that the saddest element of the funding ban is the lost opportunity for people to create new, productive lives. Take Owens: She was once "just a body walking around," sleeping in Washington Square Park, shooting up in apartments that reeked of dried blood and burning metal, watching one friend after another die of AIDS and overdose. Now, she's a peer educator with a New York City-based non-profit, and for a $100 weekly stipend she traverses the city, convincing drug users to seek help.

"I found a job that I can do that I know is helping the community," she said. "Imagine how many people who are out there that want to change, but don't know where to start."

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The War on Drug Users: Are Syringe Exchanges Immoral?

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In short: Politics. Despite the data, some still struggle with the idea of helping drug users inject, arguing that these programs hurt society by encouraging addiction and promoting a no-work, dependent-on-the system lifestyle. Congressman Hal Rogers (R-KY) is chair of the House appropriations committee and played a key role in the decision to reinstate the ban.

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Dignity and Worth: Embodying Social Work's Core Values

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Dignity and Worth: Embodying Social Work's Core Values

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Allan Clear, Executive Director of the Harm Reduction Coalition, writes:

"There are many angles by which to look at the war on drugs; one angle is that it has been a massive and successful propaganda exercise to demonize drug users. Drug users are first criminalized for using outlawed substances. Then, along with their criminal use of drugs, they are continually suspect for crimes they may be about to commit to obtain drugs. Thus, a 'drug user' becomes a deviant - a transgressor who is incompetent and selfish, destined for jails, institutions or death. The message is that drug users do not care about their own health, the health of their friends or colleagues and certainly not the greater public health."

How can we reconcile the view of drug users described above with the NASW Code of Ethics, which calls on us to recognize the "dignity and worth" of every person? This is one of the many places where, as social workers, it is our duty to critically examine our own biases, whether they come from within us or from the society we live in.

What do we see when we look at an addict? Do we see dignity and worth?

One of the aspects of harm reduction that I most admire is that it demands that we recognize these qualities, even (especially) in people who tend to be deemed unworthy and undignified by much of the rest of society.

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Okay, that's all very warm and fuzzy ... but does it WORK?

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Okay, that's all very warm and fuzzy ... but does it WORK?

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Yes! The awesome thing (beyond how compassionate it is) is that harm reduction has been proven, over and over, to curb infection, save money, and improve public safety.

From The Atlantic (2012):

Eight federally-funded research reports have concluded that [needle exchange] programs reduce HIV transmission without increasing the use of illicit drugs. In New York City, the rate of new HIV infections among drug users fell 80 percent after the city implemented syringe exchanges.

From the Center for Disease Control (2005):

Syringe exchange programs [SEPs] have been shown to be an effective way to link some hard-to-reach intravenous drug users [IDUs] with important public health services, including TB and STD screening and treatment. Through their referrals to substance abuse treatment, SEPs can help IDUs stop using drugs.

From the ACLU (2015):

In 2002, needle exchange programs reported removing nearly 25 million used syringes from communities.

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This documentary, from the Lower East Side Harm Reduction Center in New York City, helps put a human face on the statistics.

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This documentary, from the Lower East Side Harm Reduction Center in New York City, helps put a human face on the statistics.

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Lower East Side Harm Reduction Center Harm Reduction & Me

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Addiction Specialist Explains Harm Reduction Approach

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Lower East Side Harm Reduction Center Clean Needles Save Lives

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Marijuana Maintenance as Addiction Treatment

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Transformation: the Alchemy of Harm Reduction

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Harm reduction in action! In this hour long documentary the Lower East Side Harm Reduction Center shows how harm reduction services such as needle exchange programs not only reduce drug related harms for communities and for individual drug users, but also how these programs can be a gateway to connect drug users with mental health services, substance use treatment services, and much more.

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Despite clear evidence of its effectiveness, harm reduction continues to face opposition and stigma. In 2009, President Obama overturned the ban on federal funding for needle exchange programs ... but just a few months later, social conservatives in Congress reinstated it. As of today, needle exchange programs cannot receive federal funding, despite ample proof that they curb the spread of serious diseases, increase public safety, and save taxpayers money.

Think this is crazy? Get involved by writing to your local congressperson!

http://www.house.gov/representatives/find/

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Needle exchange may be the poster child of harm reduction, but the movement's principles can be seen all over. One example that's often used to explain harm reduction is seat belts: a practical way of making a dangerous activity safer. The same can be said of many everyday things, from e-cigarettes to condoms.

One interesting recent application of harm reduction in social services is the "housing first" model. Housing first is an approach to alleviating homelessness that lowers traditional requirements for individuals seeking shelter. Check out the article at the link to learn more.

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In 2005, Utah set out to fix a problem that's often thought of as unfixable: chronic homelessness. The state had almost two thousand chronically homeless people. Most of them had mental-health or substance-abuse issues, or both. At the time, the standard approach was to try to make homeless people "housing ready": first, you got people into shelters or halfway houses and put them into treatment; only when they made progress could they get a chance at permanent housing. Utah, though, embraced a different strategy, called Housing First: it started by just giving the homeless homes.

Handing mentally ill substance abusers the keys to a new place may sound like an example of wasteful government spending. But it turned out to be the opposite: over time, Housing First has saved the government money. Homeless people are not cheap to take care of. The cost of shelters, emergency-room visits, ambulances, police, and so on quickly piles up. Lloyd Pendleton, the director of Utah's Homeless Task Force, told me of one individual whose care one year cost nearly a million dollars, and said that, with the traditional approach, the average chronically homeless person used to cost Salt Lake City more than twenty thousand dollars a year. Putting someone into permanent housing costs the state just eight thousand dollars, and that's after you include the cost of the case managers who work with the formerly homeless to help them adjust. The same is true elsewhere. A Colorado study found that the average homeless person cost the state forty-three thousand dollars a year, while housing that person would cost just seventeen thousand dollars.

Housing First isn't just cost-effective. It's more effective, period. The old model assumed that before you could put people into permanent homes you had to deal with their underlying issues-get them to stop drinking, take their medication, and so on. Otherwise, it was thought, they'd end up back on the streets. But it's ridiculously hard to get people to make such changes while they're living in a shelter or on the street. "If you move people into permanent supportive housing first, and then give them help, it seems to work better," Nan Roman, the president and C.E.O. of the National Alliance for Homelessness, told me. "It's intuitive, in a way. People do better when they have stability." Utah's first pilot program placed seventeen people in homes scattered around Salt Lake City, and after twenty-two months not one of them was back on the streets. In the years since, the number of Utah's chronically homeless has fallen by seventy-four per cent.

Of course, the chronically homeless are only a small percentage of the total homeless population. Most homeless people are victims of economic circumstances or of a troubled family environment, and are homeless for shorter stretches of time. The challenge, particularly when it comes to families with children, is insuring that people don't get trapped in the system. And here, too, the same principles have been used, in an approach called Rapid Rehousing: the approach is to quickly put families into homes of their own, rather than keep them in shelters or transitional housing while they get housing-ready. The economic benefits of keeping people from getting swallowed by the shelter system can be immense: a recent Georgia study found that a person who stayed in an emergency shelter or transitional housing was five times as likely as someone who received rapid rehousing to become homeless again.

It may seem surprising that a solidly conservative state like Utah has embraced an apparently bleeding-heart approach like giving homeless people homes. But in fact Housing First has become the rule in hundreds of cities around the country, in states both red and blue. And while the Obama Administration has put a lot of weight (and money) behind these efforts, the original impetus for them on a national scale came from the Bush Administration's homelessness czar Philip Mangano. Indeed, the fight against homelessness has genuine bipartisan support. As Pendleton says, "People are willing to pay for this, because they can look at it and see that there are actually solutions. They can say, 'Ah, it works.' " And it saves money.

The recognition that it makes sense to give money away today in order to save money later isn't confined to homeless policy. It has animated successful social initiatives around the world. For more than a decade, Mexico has been paying parents to keep their children in school, and studies suggest that the program is remarkably cost-effective, once you take into account the economic benefits of creating a more educated and healthy population. Brazil's Bolsa Familia is a similar program. The traditional justification for such initiatives has been a humanitarian or egalitarian one. But a cost-benefit analysis suggests that, in many cases, such programs are also economically rational.

Our system has a fundamental bias toward dealing with problems only after they happen, rather than spending up front to prevent their happening in the first place. We spend much more on disaster relief than on disaster preparedness. And we spend enormous sums on treating and curing disease and chronic illness, while underinvesting in primary care and prevention. This is obviously costly in human terms. But it's expensive in dollar terms, too. The success of Housing First points to a new way of thinking about social programs: what looks like a giveaway may actually be a really wise investment. ♦

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In 2005, Utah set out to fix a problem that's often thought of as unfixable: chronic homelessness. The state had almost two thousand chronically homeless people. Most of them had mental-health or substance-abuse issues, or both.

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What is your opinion of harm reduction, and why? I've obviously presented the concept from my perspective here, but would love to hear others.

What parallels, if any, do you find between the principals of harm reduction and the NASW Code of Ethics? Do you notice any places where the two diverge?

What are some examples of harm reduction that you see in your life and/or work?

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Harm Reduction Coalition: http://harmreduction.org/

Harm Reduction International: http://www.ihra.net/

Global State of Harm Reduction: http://www.ihra.net/contents/1524

Center for Disease Control: http://www.cdc.gov/idu/facts/aed_idu_syr.pdf