Harm reduction strategies: Reducing the adverse health consequences of drug abuse

Transcription

1 Harm reduction strategies: Reducing the adverse health consequences of drug abuse 2 ND NATIONAL CONFERENCE ON ALCOHOL AND DRUG ABUSE 10 TH 13 TH JUNE 2013 Moi Sports Centre Kasarani Gymnasium The and Drugs: A Call for Action Dr Richard Gakunju M Pharm, MPH, NCAC 1,KCAC 11

2 Rationale Alcohol and drug abuse (ADA) is a global phenomenon ADA may include abuse of: alcohol, tobacco, cannabis, inhalants, prescription medicines, Khat, heroin, cocaine, other licit and illicit substances and new emerging drugs ADA affects individuals, families, communities, and whole nations alike

3 Definition of Harm Reduction Harm reduction is an approach that aims to reduce drug-related harm experienced by individuals and communities, without necessarily reducing the consumption of drugs

4 Harm Reduction is anything that reduces the risk of injury whether or not the individual is able to abstain from the risky behavior Inherently, it is a staged form of behavioral change, which is consistent with all the prevalent models of sexual and drug use behavior change and all the models of behavior change in these areas that have been shown to have some benefit --- David Ostrow, MD, PhD

5 Basic Definition of a Drug A common definition of the word drug is any substance that in small amounts produces significant changes in the body, mind or both -- Andrew Weil, MD

6 Definition of a Psychoactive Drug Psychoactive drugs affect mood, perception and/or thought, producing changes in both mind and body

7 Alcohol, Tobacco, Khat, Cannabis Rapid Situation Assessment of Drug and Substance Abuse in Kenya, 2012: Youth aged 15-24; 117% are current users of alcohol, 62% tobacco, 47% Khat and 15% cannabis

8 Cont d ADA is a major cause of physical illness, accidents, fatal injuries, disease, disability and death

9 HEALTH AND SOCIAL ECONOMIC IMPACT Chronic illnesses leading to premature deaths Associated replacement costs Risky sexual behavior, associated STI s Absenteeism and increased sick offs Preoccupation with obtaining and using drugs and substances while at work or school, interfering with attention and concentration After effects of drugs and substance use (hangover, withdrawal) affecting performance

10 Drug, Set and Setting Drug: pharmacology Set: individual drug user Setting: contexts of drug use

11 Percent Context of usage of alcohol Percent distribution of respondents by situations when they drink most often When in party with friends When in party with parents When alone and bored 87 When we have a party at home 11 during school outings other No response 11

12 The Continuum of Drug Use No use Experimental Occasional Regular Heavy Chaotic

13 The Continuum of Risk Low risk? High risk

14 What Harms? Harm reduction focuses on reducing or minimizing the harm associated with higher-risk behaviour In this case, the higher-risk behaviors are related to: Substance use Injection drug use

15 Alcohol and Drug Abuse Consequences of alcohol and drug and abuse by Staff at institutional level Got injured such that they did not work the next day 0% Got Hospitalised 5% Practiced risky sexual behavior 6% Committed a crime 7% Lost memory of the events of previous day 29% 0% 5% 10% 15% 20% 25% 30% 35%

16 Structural Factors and Harm age Class Gender Sexuality

17 Levels of Harm Individual Family Community

18 Types of Harm Physical Psychological Social Economic Legal Political,

19 Contexts for Harm Reduction Universal health care Political pragmatism Activism and inclusion Non punitive approach to treatment

20 Principles of Harm Reduction Recognition that non-medical use of psycho-active substances is inevitable in our society Acknowledgement that such use will inevitably produce social and individual harm Understanding that drug policies are pragmatic They must be assessed on their actual consequences, not symbolic import

21 Principles of Harm Reduction Accepting the fact that protecting the health of the larger community requires we protect the individual drug users A wide range of interventions is required to address these harms User s decision to use is accepted User is treated with dignity User expected to take responsibility for own behavior

22 Step-by-Step Guide to Harm Reduction in Practice 1 Making contact 2 Meeting survival needs 3 Engaging 4 Holistic needs assessment

23 Step-by-Step Guide to Harm Reduction in Practice 5 Focus on consumer s own needs and goals 6 Meeting needs to reduce harm 7 Maximizing health and potential

24 Harm Reduction Options One Shot, One Sterile Syringe Safest injection is making sure everything is clean, freshly washed Overdose Prevention-Respect What You Inject Know and Trust Your Source New Supply - Give It Only a Small Try Shoot With A Friend - It Might Save You In The End Use Your Own - Needles, Cookers, Cotton, Water

25 Reduce amounts of alcohol taken in one sitting Reduce frequency of alcohol or drug episodes Do not take alcohol with water or energy drinks, take water only between episodes Avoid adulterated (fortified?) alcohol or drugs Drink enough water to piss clear - Clear Piss is Healthy Piss Learn about and consider the utility of nutritional counseling (including vitamin supplements) for lessening or eliminating drug use

26 What way forward for Harm Reduction Programs? User involvement Embrace positive change Supportive agency policy Collaborations with other providers

27 The Collaborative Model Harm R Program Institution Govt or Civil employee Consumer Or client

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