2. Jacqui Brown
Harm Reduction 101

3. Harm Reduction 101!
Or, “Why the war on drugs is a war against
people and why I think we should be using
another approach …”!
Jacqui Brown BA BPsych (Hons) MPsych (Clinical)!
Harm Reduction & Program Management Advisor!
Salvation Centre Cambodia, Siem Reap!

4. Why is Harm Reduction
interesting to me?!
The 1990s (a snapshot for those too young to remember) …!

5. Okay … so what does it mean?
! " Fairly self-explanatory:!
! " Aims to reduce the harms associated with the use of
psychoactive substances.!
! " Maintains a judgment neutral stance on drug use!
! " Acknowledges that psychoactive substances are a part of
human culture!

6. But aren’t drugs bad and shouldn’t we
“just say no”?!
! " No, we shouldn’t “just say no” – Why? Because there is
significant evidence it doesn’t work and makes things worse.!
! " “Just say no” can create a sense of failure and self-
stigmatization when the individual does not stop using!
! " “Just say no” doesn’t take into account the broader
environment and individual psychology!
! " “Just Say No” doesn’t really give you anywhere else to go
if it doesn’t work.!

7. But drugs are bad for you!!!!!
! " Yes … in some circumstances, drugs (legal and illegal)
can be bad for you, however …!
! " Just because something is bad for you, doesn’t mean we
shouldn’t do it. Health is a means to achieving our goals,
not necessarily a goal of its own.!
! " If we lived our lives trying to avoid anything that is bad for
us, we would have to compromise many things we like, and
our lives would be incredibly constrained.!

8. Background to Harm Reduction
! " Term “war on drugs” introduced by Richard Nixon in
1971, however history goes back to alcohol prohibition.!
! " Prior to the “war on drugs” the US had slowly pressured
other countries into criminalizing the use of certain
substances despite objections – “zero tolerance”!
! " The use of certain substances deemed illegal became
stigmatized and punishable by imprisonment in most
countries.!

9. History of Harm Reduction
! " Early to mid 1980s, HIV changes everything. !
! " Once established that HIV was blood borne, people realised that
sharing injecting equipment was a high risk!

10. History of Harm Reduction
! " First informal Needle and Syringe Programs (NSPs) set up by
drug user activists !
! " In an act of “civil disobedience” an Australian medical
practitioner (with the support of drug user activists) started
supplying sterile injecting equipment in Darlinghurst, Sydney.!
! " First NSP in world was in Amsterdam, then shortly after in
England (1984)!
!

11. History of Harm Reduction cont …
! " By late 1980s, governments in Australia, Canada, UK and
some parts of Western Europe had some harm reduction
programs to prevent the spread of HIV amongst people
who injected drugs.!
! " Reports have found that for every $1 spent by the
government on Harm Reduction programs in Australia,
between $4 and $16 is saved.!

12. Harm Reduction Definition
‘Harm Reduction’ refers to policies, programmes and
practices that aim primarily to reduce the adverse health,
social and economic consequences of the use of legal and
illegal psychoactive drugs without necessarily reducing
drug consumption. Harm reduction benefits people who use
drugs, their families and the community. !

13. Type of Harm Reduction interventions
! " Needle & Syringe Programs (NSPs)!
! " The US government has a ban on using any federal funds
for NSPs!
! " Cities that introduce NSPs, have a mean annual decrease in
HIV of 18%, compared to a mean increase of 8% for cities
that don’t introduce NSPs.!
! " There is no evidence to suggest that making syringes more
available makes people more likely to inject, in fact evidence
suggests the opposite.!

14. Type of Harm Reduction interventions
! Medically Supervised Injecting Rooms (MSICs)!
! " Exist in 7 countries!
! " Sydney MSIC !
! " has around 170 injections per day!
! " mostly street based people with nowhere else to go or who
can’t wait until they get home.!
! " has responded to 4,400 overdoses, with none being fatal!
! " made over 9,500 referrals to drug treatment, health and
other services.!
! " generally has the support of the local community because of
less public injecting and less needles left laying around!

15. Type of Harm Reduction interventions
! Drug Law Reform!
! " Refers to range of options, including controlled
decriminalization to legalization!
! " Gaining momentum, especially due to “drug war” in Mexico!
! " Recent high profile supporters!
! " US government spends $500 a second on their war on
drugs.!
! " Health issue, not law and order issue!
! " Portugal experiment – reduced use!

16. Type of Harm Reduction interventions
! Prescription diacetylemorphine (Heroin)!
! " Switzerland, Germany, Holland & Denmark, with other
countries considering.!
! " Swiss evidence shows significant benefits (less crime, less
health problems, and interestingly, less use in general)!
! " Can reduce people off slowly!
! " The drug is manufactured under strict conditions, not in a
caravan in Burma or Afghanistan.!

17. Type of Harm Reduction interventions
! Drug User Groups!
! " Common in many countries and often government funded.
In Asia, Asian Network of People who Use Drugs (ANPUD)!
! " No such thing exists in Cambodia, however currently
trying!!
! " Groups of people who openly acknowledge they are drug
users and advocate for user rights!

18. Type of Harm Reduction interventions
! Peer Workers!
! " Employed in health and other services because of their
personal experience.!
! " Clients often trust them more!
! " Have a unique set of skills. In Australia, we trained “peers”
to provide some clinical interventions (taking blood,
responding to overdose with oxygen)!

19. So … if Harm Reduction is so great and
evidenced based, why do so many people
hate it?"
! " Fear from politicians to take the first step (it might not be
popular)!
! " Drug Users aren’t seen as a high priority politically because
they are so stigmatized!
! " Highly emotional issue!
! " Naïve belief that drug use can be stopped !
! " Some conspiracy theories exist (some more realistic than
others)!

20. Something to think about when we consider
the “war on drugs” and “just say no”"
The definition of stupidity is doing the same thing
over and over again and expecting a different
result!
Albert Einstein!
!
!

21. Something to think about when we consider
Harm Reduction."
! " It is based on solid scientific evidence.!
!
! " It treats people with respect no matter what they decide
to put in their bodies! !
! " Almost 40% of Australians and about the same amount
of Americans admit to illicit drug use!
! " The last three Presidents of the US have used drugs, two
of them cocaine.!

22. Thank you!
! " Thanks to Andy Sinclair, who none of you will know
!
because he works in Melbourne, but he sent me some
information for this.!
!
! " Thank you for listening!
! " Som Aw Kun!
! " Questions?!

23. Thank You!
Jacqui Brown