Harm Reduction—From a Conceptual Framework to Practical Experience: The Example of Germany

Abstract

Drug demand reduction programs must be integrated into a comprehensive strategy aiming at preventing drug misuse, facilitating access to counseling, to treatment of dependence, and to rehabilitation; and establishing effective measures to reduce the adverse health and social consequences of drug misuse. The continuous and even rising spread of HIV/AIDS and other infectious diseases (e.g., hepatitis B and C) among injecting drug users is alarming. Although, in many countries the prevalence of HIV infections is decreasing due to the implementation of effective harm reduction measures, such as syringe exchange and opiate substitution treatment (OST), in other countries infections are on the rise. The lessons learnt indicate that only a comprehensive, evidence-based approach in prevention, treatment, care, and support is promising in combating the devastating effects of drug dependence.

Keywords :

• dependence
• needle/syringe exchange programs
• supervised injecting facilities (sif)
• opiate substitution treatment
• harm reduction measures
• risk competence

THE AUTHORS

Ingo Ilja Michels, Ph.D., is sociologist and advisor for treatment of drug dependence. Since 2010, he is Project Leader of the EU Central Asia Drug Action Programme (CADAP) (www.cadap.eu), conducted by the Deutsche Gesellschaft für Internationale Zusamenarbeit (GIZ) with Regional Office in Bishkek, Kyrgyzstan. He worked in psychiatric clinic with drug-dependent heroin user, as Head of the Drugs and Prison projects department of the German AIDS-Hilfe in Berlin, as Drug Commissioner of the Federal State of Bremen in northern Germany, and as Head of the Office of the Federal Drug Commissioner within the Federal Ministry of Health in Berlin. He is freelance advisor for drug services in PR China in Beijing and Shanghai and Guest Professor at the Department of Sociology/Social Work of the East China University of Science and Technology (ECUST), Shanghai. He is author of several articles on prevention and treatment of drug dependents and on drug policy in International Journals on Substance Use.

Heino Stöver, Ph.D., is social scientist and Professor of Social Scientific Addiction Research, Faculty of Health and Social Work at the University of Applied Sciences in Frankfurt, Germany. Since 1987, he is director of the Archive and Documentation Centre for Drug Literature and Research at the University of Bremen (www.archido.de), the Bremen Institute for Drug Research (BISDRO), and the “Institute of Addiction Research of the University of Applied Sciences in Frankfurt am Main” (www.isff.de). Main fields of his research and project development expertise are health promotion for vulnerable groups, drug services, prisons, and related health issues (especially HIV/AIDS, Hepatitis C, and drug dependence).Consultant for the European Commission, United Nations Office on Drugs and Crime (UNODC), WHO, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), International Committee of the Red Cross (ICRC), and Open Society Institute (OSI) in various contexts. He has published several articles in international journals and books on preventing and treating infectious diseases adequately (HIV/AIDS, hepatitis, STIs, and TB), opioid substitution programs.

Notes

3 See http://www.sddcare.eu/

4 Treatment can be briefly and usefully defined as a planned, goal directed, temporally structured change process, of necessary quality, appropriateness and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which are not also used with nonsubstance users. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) treatment-driven model, there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Treatment is implemented in a range of environments; out-patient or residential.

⁵ The term “substitution treatment” does no longer fit into international terminology; the US NIDA “Treatment Improvement Protocols” (TIPs) named this treatment option “Medication Assisted Treatment.” Other UN experts are talking about “Long-Acting Opiod-Agonists” in the Treatment of Heroin Addiction. Why Should We Call them “Substitution”? See Gerra, G., et al. (2009). Substance Use & Misuse, 44, 5, 663–671: “L-AOs such as methadone and buprenorphine should not be considered as being replacements (substitution) for the rewarding effects of heroin but instead as medications for heroin addiction, particularly because of their ability to reduce craving and control addictive behaviour” (p. 666).

6 See overall results: heroinstudie.de