Harm Minimisation

The International Harm Reduction Association (IHRA) defines harm minimisation as the policies, programmes and practices that aim to reduce the harms associated with the use of psychoactive drugs in people unable or unwilling to stop. This focuses on the prevention of harm, rather than on the prevention of drug use itself and focusses on people who continue to use drugs (Stone & Shirley-Beavan, 2018)

A harm minimisation policy approach recognises that drug use may carry substantial risks, and that people who use alcohol and other drugs require a range of supports to progressively reduce drug-related harm to themselves and the general community, including families. This policy approach does not condone drug use.

Since 1985, harm minimisation has been adopted by Australian Governments as the national framework for addressing the range of issues related to alcohol and other drugs in Australia. The National Drug Strategy 2017-26 (NDS) adopts a harm minimisation approach to the use of illicit drugs and the misuse of licit drugs. The aim of the NDS is:

To build safe, healthy and resilient Australian communities through preventing and minimising alcohol, tobacco and other drug-related health, social, cultural and economic harms among individuals, families and communities (Department of Health, 2017).

Australia’s long-standing commitment to harm minimisation considers the health, social and economic consequences of drug use on individuals, families and communities as a whole and is based on the following considerations:

Drug use occurs across a continuum, from occasional use to dependent use
A range of harms are associated with different types and patterns of drug use
The response to these harms requires a multifaceted response.

Australia seeks to adopt a balanced approach across the three pillars of harm minimisation, namely.

Reducing the demand for drugs: Preventing the uptake and/or delaying the onset of use of alcohol, tobacco and other drugs; reducing the misuse of alcohol, tobacco and other drugs in the community; and supporting people to recover from dependence through evidence-informed treatment
Reducing the supply of drugs: Preventing, stopping, disrupting, or otherwise reducing the production and supply of illegal drugs; and controlling, managing and/or regulating the availability of legal drugs
Harm reduction: Reducing the adverse health, social and economic consequences of the use of drugs, for the user, their families and the wider community (Department of Health, 2017).

Australia’s approach to harm minimisation aims to minimise a range of harms including:

Health harms such as:
- injury
- chronic conditions and preventable diseases (including lung and other cancers, cardiovascular disease and liver cirrhosis)
- Mental health problems
- Road trauma.

Social Harms including:
- violence and other crime
- engagement with the criminal justice system more broadly
- unhealthy childhood development and trauma
- intergenerational trauma
- contribution to domestic and family violence
- child protection issues
- child/family wellbeing.

Economic Harms associated with:
- healthcare and law enforcement costs
- decreased productivity
- associated criminal activity
- reinforcement of marginalisation and disadvantage.

Alcohol, tobacco and other drug problems are also associated with social and health determinants, such as discrimination, unemployment, homelessness, poverty and family breakdown (Department of Health, 2017).

As of 2018, at least 84 countries worldwide had an explicit supportive reference to harm reduction in their national policy documents. Even among countries which did not have such a supportive reference, many had harm reduction measures in place, such as needle and syringe programs, opioid substitution programs or drug consumption rooms (Stone & Shirley-Beavan, 2018).

Examples of Harm Reduction Programs

Needle and syringe programs

Needle and Syringe Programs are an example of a harm reduction approach. These programs have been implemented effectively in Australia for over 35 years and provide sterile injecting equipment to injecting drug users to reduce the sharing of needles and prevent the spread of HIV, Hepatitis C and other blood borne viruses. Evaluations of these programs have also shown them to be very cost effective (Kwon et al., 2012).

Medication-Assisted Treatment for Opioid Dependence

Medication-Assisted Treatment for Opioid Dependence (MATOD) is another widely used harm reduction measure. This treatment has been available in Australia since the mid-1960s. Initially, it was available in the form of methadone treatment, and later, buprenorphine preparations were added. A substantial amount of research has established that MATOD is associated with a range of positive health and social outcomes for both the individual on treatment and the broader community (Harm Reduction Australia and ScriptWise, 2018).

On a snapshot day in 2019, nearly 51,000 clients across Australia received pharmacotherapy treatment for their opioid dependence at 2,940 dosing points across Australia. At that time, there were 3,395 authorised prescribers of opioid pharmacotherapy drugs. Although MATOD has traditionally been associated with illicit opioid use, predominantly heroin, recent data show that people also access MATOD for dependency issues related to pharmaceutical opioid use (Australian Institute of Health and Welfare, 2020).

Diversion programs

One of the harms that can stem from illicit drug use is getting a criminal record if apprehended by the police for possession offences. Drug diversion programs offer drug education or treatment to people who commit less serious drug offences. This type of program helps people to avoid a criminal record and gives them the opportunity for early intervention into drug problems.

Sobering up services

Sobering up services provide a safe environment in which intoxicated people receive care and can sober up until the effects of the substance consumed have subsided. They are also an alternative to police cells for people who are apprehended by the police for being intoxicated. The primary aim of these services is to keep people safe while they are sobering up, but they can also offer brief/early intervention services and referrals to other agencies.

Other Resources

A range of documents relating to harm reduction may be found on the The International Harm Reduction Association website.
For a global perspective on illicit drug harm minimisation see the publication The Global State of Harm Reduction 2018
For more information on harm minimisation see the Australian Drug Foundation.

References

Australian Institute of Health and Welfare. (2020). National Opioid Pharmacotherapy Statistics Annual Data Collection (NOPSAD) 2019. Canberra: AIHW.

Department of Health. (2017). National Drug Strategy, 2017-2026. Canberra: Department of Health.

Harm Reduction Australia and ScriptWise. (2018). National MATOD Summit Report. Sydney: HRA & SW.

Kwon, J., Anderson, J., Kerr, C., Thein, H., Zhang, L., Iversen, J., . . . Maher, L. (2012). Estimating the cost-effectiveness of needle-syringe programs in Australia. Aids, 26 (17), 2201-2210.

Stone, K., & Shirley-Beavan, S. (2018). The Global State of Harm Reduction 2018. London: International Harm Reduction Association