5 really important questions

Is it just me, or is there a lot of opposition and misconceptions regarding harm reduction?

When people ask me what I do for a living I often end up spending an inordinate amount of time explaining what harm reduction is, and being challenged regarding  it’s validity.  My experience is I can often talk until I’m blue in the face with no real effect.   I wonder maybe if I asked some questions of my own, whether I might have a greater impact upon people’s consideration of harm reduction as a valid approach to drug use within our community.

It was with this in mind I decided to develop five really important questions to ask people when faced with opposition to harm reduction.

1.  So saving lives is important right?

Pure and simple, harm reduction saves lives.  Want the proof?  Here is a little sample:

  • Independent evaluation of the Sydney Medically Supervised Injecting Centre (MSIC) has found that since the facility’s opening in May 2001 until the time of the evaluation report in April 2010, 3, 426 overdoses had been managed by MSIC staff with no fatalities (KPMG 2010).
  • Between  2000 and 2009 it has been estimated that 32, 050 new HIV infections and 96, 667 new Hepatitis C infections were averted in Australia solely due the operation of needle syringe programs (Sydney National Centre in HIV Epidemiology and Clinical Research 2009).
  • Between 1996 and June 2010 there have been 10, 171 opioid overdose reversals due to community based naloxone distribution programs in the U.S. (Centre for Disease Control 2012)

I could list many, many more but I want you to hang around to hear my second question

2. Is what you’re saying your opinion or a fact?

The spectrum of moral and ethical opinion regarding drug use covers a lot of ground.  Beliefs range from a moral and ethical opposition to any kind of drug use, through to a belief that the taking of substances is a basic human right that should not be impeded by law.  Given the diverse range of often opposing moral viewpoints regarding the use of drugs, structuring a model to reduce drug issues within our communities is highly problematic. The beauty of harm reduction is that it does not involve itself in questions of right and wrong in regards to drug use.  While often described as being value neutral, harm reduction in fact enshrines the concept of humanitarianism.  We can all agree after all that regardless of our moral stance that injury and death associated with the use of drugs is not a good thing.   By removing ourselves from the moral arguments of whether drug use is a good or bad thing, we can focus solely on the harms experienced by individuals and the communities they reside within, addressing their needs rather than their beliefs.

3. So would you prefer drug programs that actually work?

Despite the fact that harm reduction has been demonstrated to save lives in a non judgemental manner, it continues to be opposed by many quarters.

It could be argued that one of the consequences of this continuing resistance to harm reduction strategies and programmes is that such strategies have come under far greater scrutiny than other forms of alcohol and other drug intervention.  Needle and syringe programs in Australia have undergone two major economic evaluations nationally in the past decade, testing their economic viability, methadone as an opiate substitution therapy is one of the most well researched and evidenced pharmacotherapies utilised in drug treatment and the medically supervised injecting centre in Sydney has operated under a trial status for over a decade.

In fact it could be argued that harm reduction has one of the most comprehensive evidence bases comparative to other approaches to alcohol and other drug issues in our society.  When considering how we want to approach alcohol and other drug issues in our society, do we want interventions that align with a particular set of moral beliefs, or do we want interventions that work?  I will go with interventions that work every time.

4. Would you like to pay more or less taxes?

The treatment of blood borne viruses (BBV) and sexually transmitted infections (STI) are expensive.  Paramedic responses to overdose are expensive.  Coronial inquiries after the advent of a fatal overdose are expensive.  Cost effective measures therefore that reduce the incidence of overdose, or that reduce the transmission rates of BBV and STI’s reduce expensive outlays of taxpayer dollars.

Perhaps the most compelling demonstration of the financial advantages of harm reduction is the two national evaluations of Australian needle and syringe programs (National Centre in HIV Epidemiology and Clinical Research 2002 and 2009) measuring the economic viability of Needle Syringe Programs.  Spanning nearly two decades of provision of needle syringe programs in Australia, the findings of both reports demonstrated an overwhelming cost saving in regards to both health and social costs saved due to the prevention of transmission of blood borne viruses.

In the latter of the two reports it was found that:

“For every one dollar invested in NSPs, more than four dollars were returned  (additional to the investment) in healthcare cost-savings in the short-term (ten years)  if only direct costs are included; greater returns are expected over longer time  horizons.”


Harm reduction then does not only reduce drug related harm to the individual but significantly reduces the economic costs associated with drug use.

5. Can you describe another approach that does all that?

I don’t know about you but I can’t think of another model of addressing drug problems in our communities that combines the abilities to:

a)      Significantly reduce drug related harms, AND

b)      Meet people where they are at regardless of what they believe about drug use, AND

c)       Is well evidenced to actually work, AND

d)      Saves you money


Centre for Disease Control ‘Community-Based Opioid Overdose Prevention Programs Providing Naloxone — United States, 2010’, in Morbidity and Mortality Weekly Report  February 17, 2012 / Vol. 61 / No. 6 pgs 101-105 http://www.cdc.gov/mmwr/pdf/wk/mm6106.pdf accessed 26th May 2012

KPMG (2010) ‘Further evaluation of the Medically Supervised Injecting  Centre during its extended Trial Period (2007-2011)’. Final report http://www.health.nsw.gov.au/resources/mhdao/msic_kpmg_pdf.asp

National Centre in HIV Epidemiology and Clinical Research (2002) ‘Return on investment : Evaluating the cost-effectiveness of needle and syringe programs in Australia’,  University of New South Wales,

Sydney National Centre in HIV Epidemiology and Clinical Research (2009) ‘Return on investment 2: Evaluating the cost-effectiveness of needle and syringe programs in Australia’.  University of New South Wales, Sydney

4 Responses to “5 really important questions”
  1. David Woods says:

    Reblogged this on ThinnerBlueLine and commented:
    Thanks for this interesting article on thoughts behind harm reduction work… an area often misunderstood by other professionals

  2. Warren says:

    Nice work Matthew, great points and i agree its a tough role to talk about. Guess we still have lots of the older style models and political attitudes present.

    • stonetreeaus says:

      Cheers Warren. My experience is that harm reduction often (but not always) gets a good reception in AOD circles. This is as it should be when you consider that harm reduction is one of three strategy types that constitute Australian drug policy. Harm reduction does seem some what counter intuitive for many members of the public however who have little or no association with the sector – this is where I most often have these kinds of conversations.

      Thanks for the comment Warren.



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