YOUTH AGAINST DRUGS
NORWAY
International Conference 2005
Winners of the PRIDE
International Award, 2003.
www.drugprevent.org.uk
Harm Reduction -
Where’s the Harm
in it?
Peter Stoker
Director, NDPA
Harm Reduction
How did it begin?
Harm Reduction
How does it work ?
Harm Reduction
Is Harm Reduction
any better than
Primary
Prevention?
Harm Reduction
Is there any
contradiction
between Harm
Reduction and
Primary Prevention?
The DRUG PROBLEM …
How
BIG
is it ?
Europe
Europe’s Legalisers
Have Their Eyes On You
Harm Reduction
How did it begin?
‘REAL’ HARM REDUCTION
 Used
for decades
 With known users only
 ‘1 to 1’ interface
 Part of treatment
Aim: Abstinence from use
Normalise
Glamorise
Trivialise
Sympathise
Depenalise
Decriminalise
Legalise
The Beast with
7 Eyes
‘REAL’ HARM REDUCTION
 Used
for decades
 With known users only
 ‘1 to 1’ interface
 Part of treatment
Aim: Abstinence from use
‘So-Called’ HARM REDUCTION
 invented
in 1980s
 promote to everyone
 users or non-users
 not linked to treatment
Aim: Maintenance of use
The Trojan Horse
Societal Factors
Conspicuous Consumption
 Rapid Gratification
 ‘Values Clarification’ :

‘Self’ before ‘Society’

‘Rights’ but no
Responsibilities

The ‘Right’ to be Happy
 Youth are ‘Supreme’
 Political Correctness

ALARM
REDUCTION
HARM
REDUCTION
LEGALISATION
NORM
PROMOTION
LAW
DESTRUCTION
Canada
UK
German
y
Hungary
USA
Nederlands
Switzl’d
Australi
a
Arnold Trebach
George $oro$
Who said this? ….
“ By making readily available drugs of
various kinds …
 by giving a teenager alcohol
 by praising his wildness …
 by strangling him with sex literature …


… there must be continued propaganda to
undermine the loyalty of citizens in general
and teenagers in particular.”
Josef Stalin
United Kingdom
Liverpool
Manchester
London
O’Hare
Zinberg
Parry
Schmoke
‘…Liverpool cabal … hijacked Harm
Reduction … advocate change … break
with … existing policies … unworkable
dogmas … abstinence’
‘…radical kernel … political power.’
Peter McDermott
WHAT DO THEY MEAN BY ‘HARM?’
 Harm
to user
 Physical harm
 Harm because illegal (police)
 Harm from disapproval (stress)
 Need to commit crime
WHAT HARMS DO THEY
IGNORE?
 Harm
to the users themselves
 Harm
to other people, and
 Harm
to all, in pre-addiction
stages
IT AFFECTS ALL OF US , DIRECTLY/ INDIRECTLY
•Family
•Health services
•Schools
•Religion
•Physical
•Mental
•Intellectual
•Social
•Emotional
•Spiritual
•Environmental
•Workplace
•Justice Systems
•Police
•Therapists +++
ONLY THE USER
WHO DOES
DRUG MISUSE
AFFECT?
ONLY
ONLY
THE
THE
PHYSIQUE
ADDICT
Costs start from just
day of use
Regular user greatly
Outnumber addicts and
Cost society more
IT AFFECTS ALL OF US , DIRECTLY/ INDIRECTLY
WHOLE HEALTH
Spiritual
Emotional
SOURCES:
Environmental
Physical
Mental –
Social
Intellectual
WHO
Ancient Greeks
Buddhism, Judaism…
Christianity…
COST TO SOCIETY
FROM DRUG MISUSE
COST
TO
SOCIETY
NOVICE
NO USE
REGULAR
OCCASIONAL
HABITUAL
HEAVY
ADDICTED
Harm Reduction
How does it work ?
(…. and does it ?)
NEEDLE
EXCHANGE
NEEDLE
EXCHANGE
NEEDLE
GIVE-AWAY
CONDOM
ISSUE
METHADONE
MAINTENANCE
PRESCRIPTION
HEROIN
MODERATION
SHORT BREAKS
SUBSTANCE
TESTING
Bridgeport, Connecticut - 1997
Kit to use crack “safely”
Excerpts from “Safe” Crack
Kit Brochure
“If you smoke indoors, make sure it is
ventilated. Poorly aired rooms can be
risky for tuberculosis (TB). Cover your
mouth when coughing.”
 “If you have problems breathing or are
coughing up dark stuff, slow down or
stop smoking for a while. See a doctor
is [if] it continues!”

Needle Exchange Programs
Do Not Reduce HIV and
Hepatitis C
Montreal Study:
Bruneau J. et al: “High Rates of HIV Infection Among
Injection Drug Users in Needle Exchange Programs
in Montreal: Results of a Cohort Study.”
Am. J. Epidemiology 1997; 146:904 – 1002.
Seattle Study:
Hagan H, et al. “Syringe Exchange and Risk Infection
with Hepatitis B and C Viruses.”
Am. J. Epidemiology 1999; 14-:203 – 218.
Vancouver Injection Drug Study
NEP Review - Shortcomings
of Studies
Inadequate outcome measures. Few
measure HIV incidence. Most often self
reported change of risk behaviour
 Often systematic control for covariates is
lacking
 NEP use vs. non-use often poorly defined.
Sometimes “ever used” vs. “never used”

Needle History
131 NEP programs identified
 107 reported a total of 19,397,527 handed
out with 62% returned
 i.e. 7,371,060 not returned

MMWR
CDC May 18, 2001
Chicago - Needle Sharing

39% of NEP participants shared needles
vs. 38% of non-participants

68% of participants displayed injecting
risks vs. 66% of non-participants
National Research Council/ Institute of Medicine, Preventing HIV Transmission: the Role of Sterile
Needles and Bleach, National Academy Press, Washington DC, p. 302-304, 1995.
Seattle-Conversion Risk
Conversion risk

Sporadic NEP users vs. non usersHepatitis B 2.4
Hepatitis C 2.6

Regular NEP users vs. non usersHepatitis B 1.81
Hepatitis C 1.3
Puerto Rico NEP





No significant change in injection habits
Only 9.4% entered treatment, increased in the
last month by aggressive outreach
At the low only 12.4%, at the high only 40.3% of
needles were returned
26.6% of the needles turned in were zero
positive for HIV
No prospective evaluation of NEP participants
Robles Health Policy 1998;45:209-220
NEP India
In 1996 prevalence of HIV, Hepatitis B,
and Hepatitis C were respectively 1%, 8%,
and 17%
 In February 2002, prevalence was 2%,
18%, and 66% respectively

Sarkar K, Mitra S, Bal B,
Chakraborty S, Bhattacharya SK.
Lancet 2003;361:1301-1302
Holland
Adolescent Marijuana Use Increased
142% from 1990-1995
 Organized Crime Groups 3-1988 to 931993
 Leading Exporter of Ecstasy
 73% of Dutch Feel Laws Too Lax

Australia Injecting Rooms
36 times greater overdoses in the injecting
room than rest of Kings Cross area
 Actual improvement in lives saved only
0.18 life vs. claim of 6-13 lives

England
Decriminalizing marijuana (in effect)
 From 1999-2001 the use of cannabis in
14-15 year olds has increased by 53%
from 19% to 29%
 In girls use has increased by 38% from
18% to 25%

BMJ 2003;326:942-943
England
FDAP Conference 2005
Norway
“Plata” - Oslo
So-called Harm Reduction
How does it
really work?
the
Gentle
Slope
down …
The Gentle Slope down …
Prevention
****************
‘Real’ HR
***************
>> Abstinence
The Gentle Slope down …
Prevention
****************
So-Called HR
***************
>> Abstinence
The Gentle Slope down …
Kill Prevention
****************
So-Called HR
***************
Kill Abstinence
The Gentle Slope down …
No Prevention
****************
So-Called HR
***************
>> Maintenance
The Gentle Slope down …
No Prevention
****************
So-Called HR
***************
Maintain + legal fixes
The Gentle Slope down …
Legal for all
****************
So-Called HR
***************
Maintenance
… destination
achieved ?
So – called
Harm Reduction
Is Harm Reduction
any better than
Primary
Prevention?
So – called
Harm Reduction
Is there any
contradiction
between Harm
Reduction and
Primary Prevention?
Alternatives to
so-called ‘harm reduction’ ?
Real harm reduction
 Constructive Intervention, including
Workplace, Schools etc – random testing,
and Abstinence-focused Treatment;
all these supporting:
 Abstinence-focused Education,
 Effective, community-wide Prevention,

Health Promotion across the nation.

Good foundations:


Create Positive Culture.
Prevention-oriented strategy, across
whole community, evidence-based.


Early intervention with users, with
abstinence focus.
Balance of Rights:
Individual v Society.
“All that is
Necessary for
The triumph of
Evil is that
Good men
Do nothing.”
Edmund Burke
1729 - 1797
www.drugprevent.org.uk
ndpa@drugprevent.org.uk