Seven things we can do to reduce the health impacts of drug use
According to a recent report, 12 million people inject drugs globally, but they are often simply judged, looked down on, condemned or ignored. This has serious health and social consequences for them, their families and their communities – not least in terms of their risk of acquiring or passing on HIV and hepatitis C.
So what can we do to reduce the impact of drug use? Here we look at seven known, evidence-based ways to reduce the health dangers of drug use – collectively known as ‘harm reduction’.
1. Provide needle and syringe programmes (NSPs) to ensure people who use drugs can access clean injecting equipment.
This isn’t about ‘encouraging’ or ‘condoning’ drug use; it’s simply an effective and proven way to reduce the spread of HIV and hepatitis among people who use drugs and their networks.
As well as permanent NSP services, pharmacies, mobile facilities and 24-hour vending machines are all being used to help increase availability of clean needles and syringes.
2. Reduce the number of people lost to drug addiction by providing opioid substitution therapy (OST) and other programmes that give them more control over their drug use and more stability in their lives.
Substitute drugs such as mephedrone and buprenorphine are very effective at giving people who use drugs more control over their addiction, which in turn helps them to access health services and adhere to antiretroviral treatment if they are HIV-positive.
3. Set up safer injecting facilities to support users and bring them back to the healthcare system rather than isolating and stigmatising them.
People who know how to handle and dispose of injecting equipment safely are much less likely to acquire and pass on infections.
Injection centres, with professionals on hand, can also improve the safety of the surrounding community. The first supervised injection facility opened in Switzerland in 1986. More recently, other countries have followed suit.
4. Provide non-judgemental testing, counselling and treatment services for STIs, HIV, and hepatitis C in locations that won’t drive away or stigmatise people who use drugs.
People who use drugs need the right diagnosis and care – the earlier the better. People who start treatment earlier stand a much better chance of living a full life.
The location, hours of operation and attitudes of staff are all important in tackling fears about discrimination and social stigma.
5. Provide antiretroviral treatment to people who inject drugs who are living with HIV; this not only improves their health and reduces the effects of hepatitis co-infection, but also reduces the risk of onward transmission.
Substitute drugs such as OST (see number 2) can help people who inject drugs gain more control in their lives and dramatically increases adherence to treatment programmes.
Drug users in many parts of the world are disadvantaged and marginalised, making their access to antiretroviral treatment all the more urgent.
6. Set up outreach teams to connect with people who inject drugs and, where appropriate, their sexual partners and families, giving them information and prevention supplies in a respectful, non-judgemental way.
In reality, people who inject drugs are often consumed by finding drugs and money to pay for their supply. They also may not have a permanent home.
Outreach teams seek to connect with them to provide information and access to supplies of new needles and syringes, alcohol swabs, and condoms.
Peer education, in which users or former injectors work with people, can also have a powerful impact.
7. Decriminalise drug use; this would reduce the harms drugs cause both to people and society.
Punitive drug policy limits access to vital harm reduction services and HIV and STI testing and treatment services. It also limits access to broader healthcare and leads to routine violations of drug users’ human rights. As a result, punitive drug policies have exacerbated HIV and hepatitis C epidemics in many places around the globe.
In Portugal, where possession for personal use was decriminalised in 2001, new cases of HIV and hepatitis B and C among people who inject drugs has decreased dramatically. Users have more freedom to access safe facilities and equipment, gain professional help and be open about their situation with their friends, family and sexual partners. It also keeps users out of prisons, which are a high-risk environment for infection transmission.
We’ve got lots more information on harm reduction and injecting drug use across AVERT.org.