Harm reduction programs and policy in Australia: barriers and enablers to effective implementation

2020 ◽  
Vol 66 (1) ◽  
pp. 33-43
Author(s):  
Daniel O’Keefe ◽  
Alison Ritter ◽  
Mark Stoove ◽  
Chad Hughes ◽  
Paul Dietze
Keyword(s):  
Harm Reduction ◽  
Treatment Programs ◽  
Policy And Practice ◽  
Public Health Response ◽  
Effective Implementation ◽  
National Drug ◽  
Health Response ◽  
National Drug Policy ◽  
Australian Experience ◽  
Disease Epidemics

Abstract. Background: Harm reduction is an integral component of Australia’s overall national drug policy. Harm reduction policy and interventions can be applied to any legal or illegal drug to mitigate harm without necessarily reducing use, but harm reduction is traditionally conceptualised in relation to injecting drug use. Early and comprehensive adoption of many innovative harm reduction interventions has meant that Australia has had significant success in reducing a number of drug related harms, avoided disease epidemics experienced in other countries, and established programs and practices that are of international renown. However, these gains were not easily established, nor necessarily permanent. Aim: In this paper we explore the past and present harm reduction policy and practice contexts that normalised and facilitated harm reduction as a public health response, as well as those converse contexts currently creating opposition to additional or expanded interventions. Importantly, this paper discusses the intersection between various interventions, such as needle and syringe distribution and drug treatment programs. Finally, we detail some of the practical lessons that have been learned via the Australian experience, with the hope that these lessons will assist to inform and improve international harm reduction implementation.

A Public Health Response to Opioid Use in Pregnancy

2018 ◽  
pp. 71-77
Author(s):  
Stephen W. Patrick ◽  
Davida M. Schiff
Keyword(s):  
Public Health ◽  
Substance Use ◽  
Social Services ◽  
Drug Testing ◽  
Treatment Programs ◽  
State Governments ◽  
Opioid Use ◽  
Public Health Response ◽  
Unintended Pregnancies ◽  
Health Response

The use of opioids during pregnancy has grown rapidly in the past decade. As opioid use during pregnancy increased, so did complications from their use, including neonatal abstinence syndrome. Several state governments responded to this increase by prosecuting and incarcerating pregnant women with substance use disorders; however, this approach has no proven benefits for maternal or infant health and may lead to avoidance of prenatal care and a decreased willingness to engage in substance use disorder treatment programs. A public health response, rather than a punitive approach to the opioid epidemic and substance use during pregnancy, is critical, including the following: a focus on preventing unintended pregnancies and improving access to contraception; universal screening for alcohol and other drug use in women of childbearing age; knowledge and informed consent of maternal drug testing and reporting practices; improved access to comprehensive obstetric care, including opioid-replacement therapy; gender-specific substance use treatment programs; and improved funding for social services and child welfare systems. The American College of Obstetricians and Gynecologists supports the value of this clinical document as an educational tool (December 2016).

A tale of two epidemics: drugs harm reduction and tobacco harm reduction in the United Kingdom

2016 ◽  
Vol 16 (3) ◽  
pp. 203-211 ◽  
Author(s):  
Gerry V. Stimson
Keyword(s):  
Public Health ◽  
Harm Reduction ◽  
Tobacco Harm Reduction ◽  
Public Health Response ◽  
Content Type ◽  
Drug Of Choice ◽  
The United Kingdom ◽  
Health Response ◽  
Wide Range ◽  
Hiv Aids

Purpose The purpose of this paper is to compare the response to HIV/AIDS and drug use (drugs harm reduction) with tobacco harm reduction. Design/methodology/approach Analysis of historical and contemporary sources, combined with personal knowledge of key stakeholders in the history and development of both fields. Findings Both drugs harm reduction and tobacco harm reduction share a similar objective – to reduce health risks for people who are unwilling or unable to stop using their drug of choice. Both also share a broader public health aim of helping people to make healthier decisions. Drugs harm reduction – as a response to HIV/AIDS – included the adoption of a wide range of radical harm reduction interventions and was a public health success. It became an established part of the professional Public Health agenda. In contrast the Public Health response to e-cigarettes and tobacco harm reduction has ranged from the negative to the cautious. A recent Public Health England report is exceptional for its endorsement of e-cigarettes. Originality/value Highlights contradictions in Public Health responses to drugs and tobacco; and that public health interventions can be implemented without and despite the contribution of professional Public Health.

scholarly journals Looking Beyond the Provision of Injecting Equipment to People Who Use Anabolic Androgenic Steroids: Harm Reduction and Behavior Change Goals for UK Policy

2021 ◽  
pp. 009145092199870
Author(s):  
Geoff Bates ◽  
Jim McVeigh ◽  
Conan Leavey
Keyword(s):  
Public Health ◽  
Harm Reduction ◽  
Public Health Intervention ◽  
Anabolic Androgenic Steroids ◽  
Public Health Response ◽  
Health Response ◽  
Wide Range ◽  
Reduction Strategies ◽  
The Uk ◽  
Androgenic Steroids

Understanding of the choices and motivations of people who use anabolic androgenic steroids (AAS) for muscular enhancement has increased greatly in the past thirty years, along with understanding of a wide range of health harms associated with this form of drug use in the community. During this period the predominant public health intervention for this population in the UK has consistently remained the provision of injecting equipment to prevent blood borne virus (BBV) transmission. The study explored the health professionals’ and other stakeholders’ perceptions on: whether the current UK public health response is sufficient to address the needs of people who use AAS, and if not, what other needs they might have. This included an exploration of whether there were gaps in harm reduction strategies or other behavioral outcomes and interventions that were needed. Interviews with 27 stakeholders who provide support to people who use AAS in a variety of roles established consensus on the need for a range of interventions to reduce harm and risk in those that choose to use AAS, to prevent initiation, to motivate and support cessation, and to prevent relapse. Study findings indicate that while providing sterile injecting equipment remains essential, it should be considered a bare minimum. The challenge is to develop and deliver a range of harm reduction interventions that look beyond BBV prevention to provide appropriate support to who choose to use AAS at all points in their cycles of use and ultimately for those choosing the temporary or permanent cessation of use.

Using Surveillance With Near–Real-Time Alerts During a Cluster of Overdoses From Fentanyl-Contaminated Crack Cocaine, Connecticut, June 2019

2021 ◽  
Vol 136 (1_suppl) ◽  
pp. 18S-23S
Author(s):  
Peter Canning ◽  
Suzanne Doyon ◽  
Sarah Ali ◽  
Susan B. Logan ◽  
Aliese Alter ◽  
...  
Keyword(s):  
Public Health ◽  
Harm Reduction ◽  
Real Time ◽  
Crack Cocaine ◽  
State Department ◽  
Poison Control ◽  
Opioid Overdose ◽  
Public Health Response ◽  
Mapping Tool ◽  
Health Response

In 2019, Connecticut launched an opioid overdose–monitoring program to provide rapid intervention and limit opioid overdose–related harms. The Connecticut Statewide Opioid Response Directive (SWORD)—a collaboration among the Connecticut State Department of Public Health, Connecticut Poison Control Center (CPCC), emergency medical services (EMS), New England High Intensity Drug Trafficking Area (HIDTA), and local harm reduction groups—required EMS providers to call in all suspected opioid overdoses to the CPCC. A centralized data collection system and the HIDTA overdose mapping tool were used to identify outbreaks and direct interventions. We describe the successful identification of a cluster of fentanyl-contaminated crack cocaine overdoses leading to a rapid public health response. On June 1, 2019, paramedics called in to the CPCC 2 people with suspected opioid overdose who reported exclusive use of crack cocaine after being resuscitated with naloxone. When CPCC specialists in poison information followed up on the patients’ status with the emergency department, they learned of 2 similar cases, raising suspicion that a batch of crack cocaine was mixed with an opioid, possibly fentanyl. The overdose mapping tool pinpointed the overdose nexus to a neighborhood in Hartford, Connecticut; the CPCC supervisor alerted the Connecticut State Department of Public Health, which in turn notified local health departments, public safety officials, and harm reduction groups. Harm reduction groups distributed fentanyl test strips and naloxone to crack cocaine users and warned them of the dangers of using alone. The outbreak lasted 5 days and tallied at least 22 overdoses, including 6 deaths. SWORD’s near–real-time EMS reporting combined with the overdose mapping tool enabled rapid recognition of this overdose cluster, and the public health response likely prevented additional overdoses and loss of life.

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