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Introduction
For the past two decades, Australia has been at the forefront of a unique approach to drug policy and practice, known as 'harm minimisation'. This fact sheet provides an explanation of the principles of harm minimisation, and examples of how community drug initiatives fit within its framework.
What is harm minimisation?
A harm-minimisation approach considers the actual harms associated with the use of a particular drug (rather than just the drug use itself), and how these harms can be minimised or reduced. It recognises that drugs are, and will continue to be, a part of our society.
A change in our thinking and attitudes toward drug use
Harm minimisation encourages a change in our attitudes towards people who use drugs, including those who are physically and psychologically dependent upon illegal drugs such as heroin. This approach moves away from the unhelpful stereotypes of drug users as homeless alcoholics drinking in parks or 'junkies' shooting up in alleyways. Instead, we are encouraged to think about the relationships between the person, the drug and the environment and circumstances in which they are using it. Rather than seeking to 'treat' or 'cure' alcoholics or 'drug addicts' as people who have a disease, this holistic approach considers other problems associated with the person's harmful drug use, such as the availability of the drug in the community, the prevalence of its use, and how much is known about the drug and its effects and harms in the community. Importantly, harm minimisation does not seek to make moral judgments by which people are considered to be 'good' or 'bad' according to their drug of choice or frequency of use.
All drugs can cause harm
Harm minimisation highlights that all drugs have the potential to cause harm, not just the illegal ones. This is especially important when we consider that the legal drugs tobacco and alcohol are responsible for the greatest social and economic harms in our society. Estimates of the economic costs to Australia of harmful drug use in 1999 was a staggering $34.4 billion, with $6 billion due to illegal drug use, $7.6 billion due to alcohol use and $21 billion due to tobacco use.
A public health approach
Another important aspect of harm minimisation is its focus on public health, which has improved co-operation between the health, social, justice and law enforcement sectors and services. For example, one important initiative in harm minimisation has been needle syringe programs which provide sterile equip-ment, information and other services to people who usually are using illegal drugs. Extensive consultation and collaboration between these services and police have been important in their success in reducing the spread of blood-borne viruses in the community.
Better outcomes for clients
A harm minimisation approach includes supporting abstinence as a valid choice or treatment. However, it does not insist on abstinence as the objective of treatment or community prevention initiatives. In other words, people are empowered to make their own choices about their drug use.
This means that health workers can offer their clients a range of options for their desired treatment outcomes, which encourages more people to participate in treatment and prevention programs. The harms associated with a client's drug use can be reduced or minimised simply by their participation.
How does it work?
Using a variety of strategies, harm minimisation works to reduce the harmful consequences of drug use, by reducing:
- demand for drugs
- supply of drugs
- drug harms—assistance for people who choose to use drugs to do so in the safest possible way.
Demand-reduction strategies work to discourage people from starting to use drugs, and encourage those who do use drugs to use less or to stop. A mixture of information and education, along with regulatory controls and financial penalties, help to make drug use less attractive. A good example of a demand-reduction strategy was the graphic health information advertisements that 'Every cigarette is doing you damage'. Treatment is another example; it works to reduce a drug user's need to use drugs.
Supply control strategies involve legislation, regulatory controls and law enforcement. An example of a supply control strategy is liquor licensing laws restricting the sale of alcohol to persons aged 18 and over.
Harm-reduction strategies have been controversial, because they work to reduce the risks of harm, but not necessarily to reduce drug use. For example, introducing low-alcohol beer means that people can still drink beer, but the long-term health risks can be reduced. Another example is providing injecting drug users with access to clean equipment through needle syringe programs. By reducing the risk of blood-borne infections such as hepatitis C and HIV being transferred, the risks are reduced for both the individual and the community as a whole.
Is it effective?
Australia has the lowest rate of HIV infection among injecting drug users in the world, evidence that the harm minimisation approach can be highly effective in reducing harms in our community. Harm-reduction strategies such as needle syringe programs are also effective in attracting drug users who never have contact with other drug services into treatment, medical, legal and social services.
Harm minimisation can best be viewed in the context of community safety. We all want ourselves and those whom we love to be safe from ill health, injury, violence, crime and discrimination. A harm minimisation approach to drug use can help to keep people safe when they choose to use drugs.