Talk:Harm reduction

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This piece could use some mention of the Netherlands and about differing attitudes towards harm reduction around the world. Europe and, to some extent, Canada, seem more open to the concept but it is politically unacceptable where government policies are strongly influenced by religion or ideology (e.g. USA). --LeeHunter 18:12, 16 Aug 2004 (UTC)

Contents 1 Criticism (again) 2 Female Circumcision 3 "Soft bigotry" quote 4 Methadone NPOV 5 Arguments 6 use / abuse 7 Criticism section 8 Restrictive harm reduction? 9 Response to removal of section 10 Methadone NPOV redux 11 Pseudo-Relevant Link? 12 Focus too narrow(?) 13 opening paragraph 14 "Soft bigotry" quote 15 Harm Minimisation 16 Addition of weasel tag

[edit] Criticism (again)

I've replaced this section, with some editing. I don't understand why we can have, say, an article like Pollution that points out that the major source of emissions is motor vehicle exhaust, but we can't have a few words as to some potential harm that can, ironically, be caused by harm reduction.

Almost nothing is a universal good or evil. Just about everything has a benefit, and a cost. Why pointing that simple fact out on this issue is such a controversial point, frankly, completely escapes me.

--Hrodulf 03:07, 17 July 2006 (UTC)

This section looks like original research to me. There are no citations. Loverevolutionary 20:07, 10 August 2006 (UTC)

[edit] Female Circumcision

I removed the bit about female circumsision as being a form of harm reduction, as female circumcision is widely considered to be an act of violence against someone else, and therefore doesn't fall within the realm of "harm reduction." Serotrance 23:03, 16 May 2006 (UTC)

[edit] "Soft bigotry" quote

Is there anearlier source than this? http://www.ed.gov/news/pressreleases/2003/03/03122003.html(March 2003) ? === Vernon White (talk) 12:56, 28 December 2006 (UTC)

[edit] Methadone NPOV

I think at least half of the Methadone section (starting with: "There is an international literature") is in serious need of an NPOV cleanup, but I'm not sure if it would be appropriate to delete those parts.. so I'll leave it at this. The section goes from presenting factual and logical evidence to a large, rampant tirade on why Harm reduction is good/bad. If someone could help out, that would be great. Rhodekyll 01:17, 1 March 2006 (UTC)

[edit] Arguments

I don't quite understand some of the arguments and criticisms under the premise that this article is about harm reduction. Consider the heroin/methadone point. "Critics of methadone treatment claim that this is merely a substitution of one addiction for another, or that methadone treatment does not work". In this case, would not someone who intends to reduce the harm done agree with the critics, if it was true? Given that, the critics are also harm reductionists, aren't they?

As a harm reductionist, I would argue that the prohibitionists see all addiction as bad, therefore what appears to be simply stating the obvious becomes some kind of argument. I'm not saying it's sensical, just that that's their thing. Pope Guilty 05:06, 1 January 2006 (UTC)

[edit] use / abuse

As always, 'abuse' is a judgement made about a particular use. Definitions vary depending on whether you are a doctor, a lawyer, and American or a European. Let's stick to the facts. Guttlekraw 19:05, 21 Apr 2005 (UTC)

Everything is a "judgement" about some kind of use. The question is, is it an accurate description? The drug abuse article is in the process of being expanded to include this type of information. You've been asked to stick to the "facts" for about a week now, but you refuse to cite sources for your edits. --Viriditas | Talk 22:25, 21 Apr 2005 (UTC)

On the contrary. You seem intent on pushing your pov to the exclusion of all others. Are you really saying that drug use in and of itself cannot cause harm, and that only 'drug abuse' can cause harm? If so that is a ridiculous proposition. Even the most ardently pro-drug agree that even responsible, moderate drug use can have negative effects. Guttlekraw 23:54, 21 Apr 2005 (UTC)

In reality, the complete opposite is true. You've been asked to cite sources and stop changing cited text. Yesterday, you claimed you didn't have to, and you were corrected. The irony of course, is that by editing articles and cited quotes to say what you want them to say, instead of citing sources for your edits, it is you in fact, who is pushing a POV. Please read the policy pages and stop making Wikipedia a difficult place. You are starting to sound like a troll. --Viriditas | Talk 23:59, 21 Apr 2005 (UTC)

Cut the abuse and stick to the facts. It is simply not true that all drug use that leads to harm is abuse. It's simply not true. All tobacco use causes some harm, and yet we do not call all smoking drug abuse. What more do you want than that? Please read what you are reverting. Guttlekraw 01:08, 22 Apr 2005 (UTC)

You are comparing apples and oranges. Tobacco smoking is specifically not categorized as drug abuse since cigarettes are nicotine-delivery devices. One can, however, abuse nicotine, and I've provided a specific definition of such abuse to you on Talk:Sex education. Again, you continue to blame me for your own errors. --Viriditas | Talk 03:16, 22 Apr 2005 (UTC)

Please try to read what you are reverting. The sentence talks about using harm reduction methodologies for drug USE. Only you want to use the term ABUSE. Take out you pov pushing and the sentence makes perfect sense. Low tar cigarettes are a harm reduction methodology applied to drug USE. Guttlekraw 04:31, 22 Apr 2005 (UTC)

Alright guys, what's the context? I'm all about helping you guys in making a decision on this factor but I will not do so blindly; I need context first. Rhodekyll 06:28, 1 March 2006 (UTC)

The use of the word "abuse" anywhere in this article is inappropriate. Harm Reduction is based on value neutral language because it has nothing to do with either ideology, religion, values or morality. Harm Reduction uses ONLY value neutral language and "abuse" is a value judgement. Harm Reduction only recognises substance USE (not abuse)as it is inappropriate to project one's morals or values upon someone else. Harm Reduction is based on pragmatism and not ideology. The occurences of the word 'abuse' in this article (and in their context) should be changed to 'use'. 28 May 2006 Jeshmir.

The person who could settle this disagreemnt is Dr. Alan Marlatt, the psychologist who brought harm reduction to this country from the Netherlands. Simply ask him and post his reply here on the talk page. His contact information is at [1].Harmon Johnson 17:43, 29 May 2006 (UTC)

[edit] Criticism section

A criticism section is needed. --Viriditas | Talk 12:57, 26 May 2005 (UTC)

[edit] Restrictive harm reduction?

The section on "restrictive harm reduction" seems somewhat misguided, and I suspect original research. Harm reduction is an alternative to prohibition. The template for harm reduction is "Let's stop trying to prohibit _______ and make it safer for people who choose to ______". Seat belt laws don't really fit this, as there is no serious campaign to prohibit these behaviors. Underage drinking laws don't really fit this, because they seek to prohibit behavior. I'm going to remove it unless someone can provide a link that it isn't original research. The Hokkaido Crow 21:13, 4 November 2005 (UTC)

Harm reduction is not an alternative to prohibition. In fact prohibition is surely just an extreme form of it. It is possible to prohibit activity -- which presumably stops some people doing it even if not very many -- and still provide harm reduction services to those too stupid to get the message in order to reduce the amount us poor taxpayers have to spend on Medicare treating people with Hep-C or alcoholism. Prohibition doesn't "magically" stop the activity any more than Harm Reduction "magically" makes the activity harmless. So why we would we want to limit ourselves to using one or the other to fight the problem ? We should be using both barrels to hit this problem as hard as we can. -- Derek Ross | Talk 03:19, 18 September 2006 (UTC)

Though I respect your perspective, it does not belong in a discussion about how to explain what harm reduction is, but in a discussion about the merits of harm reduction. To say that some people are too "stupid" to "get the message" is clearly nothing more than a value judgment about people who use harmful substances. This kind of value judgement is not only counter to the very prinicples of harm reduction, it is counterproductive to solving the problems associated with harmful substances. Why? Because value judgments do not encourage people to stop behavior or minimize its harmful effects. They only allow the judger to feel superior. Clearly, you are missing a lot of understanding about harm reduction if you do not understand it to be an alternative to prohibition. Indeed, harm reduction programs can coexist with prohibition. However, prohibition runs counter to harm reduction principles in the same way your value judgements do. Prohibition inherently claims the use of harmful substance against the social contract, judging it to be an anti-social activity. Anti-sociality is one of the harms harm reductionists hope to reduce. Therefore, if we are to have a coherent policy on harmful substances, we should choose one or the other. Also, since they have different cost-effectivities, we really should choose the more cost-effective policy choice. The metaphor of both barrels is nice, but only valid given unlimited resources. However, as you mentioned, we want to spend as little money as possible to have the maximum effect. This is not accomplished by maintaining an incoherent policy, but by choosing the one that is most cost-effective. Most studies indicate that this is harm reduction (there is also an ethical argument for harm reduction for another time and place). Just because it is possible for a government to have an incoherent policy does not mean that different alternative policy choices are not in fact alternatives.

Also, moving away from your perspective and onto your methodology, you should do your homework before you go trying to improve Wikipedia. Medicare is the government-managed healthcare fund for people in retirement, who very seldom have Hep-C and alcoholism. I believe you meant to denegrate the humanity of people who rely on Medicaid for their healthcare. I say that your intention was to denegrate their humanity, because if you were truly concerned with the cost to the taxpayer of dealing with harmful substances you would probably have done some research and learned that it costs a hell of a lot more to keep someone in jail for a year than getting him or her onto a maintenance program. Given that you claim to be a "poor taxpayer," I would suggest you look at cost-effectiveness studies of harm reduction programs and begin to advocate for their implementation. Harm Reduction is not only a way to reduce the social, psychological and physical harm associated with the use of harmful substances (all of which taxes the economy), but it actually saves us money!! -- Dwinetsk 16:42, 23 October 2006 (UTC)

It seems to me that a lot of the critcisms from the proponents of prohibiting "victimless crimes" are just not true or dont really make sense. They usually say that by makign somethign legal more people will do i, or that legalizing it will encourage people to do it. I have taken numerous psychology classes and so I beleive this to be true; making something illegal only encouages people to do it more. If they made sour-patch kids illegal, I'm sure thier would be a huge surge in crimes relating to sour-patch kids and people would also do it a-lot more than they currently do.

I also don't believe that making something illegal deters anyone from doing it. The only time that it actually deters someone is when the person blindly follows the laws. The best example of this is speed limits that are overly cautious. I'm sure most intelligent people would agree with me on this.

I guess what I'm tryign to say in all of this is that I feel that the criticsms are not sound-minded and are not very intelligent even though they may sound logical at first. I find this a huge problem in many articles. But my biggest problem is that these initelligent arguements for things are being given equal weight as the arguements that not only make sense but have been proven.

Actually, to understand the argument for prohibition you have to look at economics not psychology. While prohibition does make it slightly more tempting for people to use prohibited substances (especially among adolescents), thus contributing a slight increase in demand for the substances, prohibition much more significantly increases the cost of the substance, thus lowering the quantity demanded. So it does lead to some decrease in use of the substance. However, one of the main problems with this which we can derive from economics is that a black market will arrise (does arrise) for the substance, with high profitibality. Given that the highly profitable industry requires very little education, the black markets will arrise especially where education and alternative economic options are scarce. Hence we have the tragedy of drug infestations of low income neighborhoods, adding insult to injury (note it is a tragedy not because drug use in itself is a tragedy, but because the combination of drug dependency and poverty cause enormous social problems not adequately addressed by harm reduction efforts). Furthermore, that prohibition then takes the participants in these markets and removes their labor from the local economy, we are adding injury upon insult upon injury to our fellow citizens who live in low-income neighborhoods. Oh, but now I'm preaching. Dwinetsk 16:42, 23 October 2006 (UTC)

[edit] Response to removal of section

I posted the 'restrictive harm reduction' section.

I'm still unclear on what "original research" entails. The only thing I can identify as original research from the removed section was the part about the store that only allowed two people under 20 in at a time; I actually saw such a store at one point. Everything else was just a response to the request for a criticism section by Viriditas.

I'm unsure of the bounds of OR. If I were to start saying things like "harm reduction has caused an X percentage change in such and such effect" obviously that is OR, because it is stating objective facts with no citation to an authority. But just to acknolwedge that in some situations there may be a cost to certain forms of harm reduction in terms of loss of freedom, this is original research? It's not stating a fact, it's analyzing existing facts. I don't see why the necessary restriction on original research that produces new facts must also restrict anyone on wikipedia from analysizing facts that does not require any actual research. As I've mentioned before when discussing this issue, there's no accuracy problem with an analysis of existing facts, if no new facts are claimed to exist.

In the past I've recommended changing the no original research rule to a 'no original thoughts' rule if this is in fact the intent of the rule, but nobody has ever commented, either positively or negatively, on this idea.

As for whether or not these restrictions meet the definition of harm reduction, if the material is in the incorrect place or needs to be on a new page it seems that it should be reclassified, rather than deleted. Maybe harm avoidance rather than harm reduction?

RudolfRadna 5:27 29 December 2005 (UTC)

Read WP:NOR for guidelines on original research. :) - FrancisTyers 11:35, 29 December 2005 (UTC)

I did look at it and it said "idea," so that is covered, but I don't think having an idea counts as research. I think the rule would work better if it was "no original ideas or research" rather than "no original research."

That all being said, I'm unclear on where the line is drawn. For example, if I had written something like that in the libertarianism article, I doubt it would have been flagged, because that was an article *about* libertarianism. Is this really about OR, or is it really a matter of POV?

RudolfRadna 20:39 29 December 2005 (UTC)

I tried to redo the criticism section. I couldn't find any good sources but based it on some common-sense ideas that I hardly think are new. If I can identify a good source I'll add it to the section, as anyone else may. Is it ok now? If it gets pulled down again, I'll put it on the talk page and maybe people can work on it there.

RudolfRadna 21:12 29 December 2005 (UTC)

Part of my issue with the restrictive harm reduction section with relation to OR is that OR also deals with novel interpretations of facts, meaning ideas or novel interpretations that you came up with your own. The "research" part of OR is misleading, in spirit it's really opposed to generating original information in general.

Specifically I took issue with the idea that seat belt laws are somehow harm reduction. Seat belt enforcement as an alternative to what... banning collisions? Banning driving? In the loosest possible sense, restrictions on liberties can reduce harm by prohibiting all risky behavior, but that isn't really what harm reduction is about. And since I know you did not demonstrate a citation supporting your assertion, I remove it under WP:OR. If on the other hand you find a primary source that agrees with you, then we compare sources and decide who wins. Hope that makes sense. The Crow 02:53, 25 October 2006 (UTC)

In my research and publications on harm reduction in public health, I almost always cite seatbelts as the most common example of the application. See, e.g., http://www.harmreductionjournal.com/content/3/1/15 or http://tobaccoharmreduction.org/index.htm . If you type ["harm reduction" seatbelts] into a search engine, you get a lot more examples by other people. This is clearly not original research/conceptualization/whatever. And to clarify the point, harm reduction is not alternatives to banning things, it is about making an exposure safer, rather than the more typical approach of trying to reduce the prevalence of the exposure. The point about seatbelts is that instead of telling people they should drive less (which would be better for their health, but is not practical public health policy), we make it safer to drive. Risk still exists (so it is not harm elimination) but it is less (reduction). Note that I am not making any changes to the content, because I have not been following what is going on, but if something was eliminated because of a belief that seatbelts are not considered harm reduction, I think it was pretty clearly a mistake. Carlvphillips 00:35, 26 October 2006 (UTC)

I wish I had the time to go to the library and do research and put citations here to show what this article needs, a real neutral point of view, which means acknowledging that harm reduction is controversial and *gasp* not everyone in the world supports it, but the reality is I don't. In the meantime, people should feel free to continue deleting text from wikipedia that doesn't reflect their worldview, under the guise of enforcing WP:OR or WP:NPOV. Maybe someday I'll manage to figure out a practical way to make this sort of editing work out, but at the moment it's sadly not a practical reality. --Hrodulf 23:09, 26 October 2006 (UTC)

[edit] Methadone NPOV redux

Hi Wiki readers -

I think this methadone article remains pro - biased. There is much evidence that methadone treatment does not produce less harm to the patients or society than the prior addiction modes. In my country (NZ) it kills addicts at 10x the rate of sole illicit opiate users. Users also experience higher rates of car crashes, more difficulty kicking the habit than with illicit use if they try. And on balance international studies show meth treatment mainly just reduces drug seeking stress and marginaly lower property crime. By increasing supply it increases the total pool of addicts.

I guess it creates employment for health pros and keeps afghanistan from profitting off heroin production. But as a health pro I'd say the treatment puts countries in breach of UN conventions which require psychoactives to only be used if they have proven scientific of medical benefits.

Meth is a dirty drug compared to heroin as it has lots of processing. It causes brain damage too and high car crash rates are reported in countries where legislation is less tthan ideal. And health insurers refuse to pay on it as it was long past disproven as a beneficial medical treatment. For some it may be an antidepressant but better less adictive options exist. It tends to reduces purposive living and general motivation.

The medical benefit of aids prevention for a limited number of not too bright clients has been argued as justification. Needle exchanges cater to this need nowadays. The greatet advocats of methdone are stakeholding professionals who are relics from the 60s and not up with research and IMO have clearly lost sight of the patients interests.

A truly informed patient with a clear head would think twice re consent to take methadone but few when they present are clearheaded or get informed or told the options eg naltroxen, antidepressants, full rehabilitation / abstinence, due to professionals being radical pro treatment advocats.

Methadone treatment can be a nightmare, a pessimistic (often final) solution going on the OD numbers in poorly run services - specially if you are misinformed that you have any chance really of getting "a cure" by it.

- A Kiwi Nurse who has Uk mental health reg!

It seems to me a lot of this article is POV. I'm not sure what to do with it though. --Galaxiaad 13:22, 4 July 2006 (UTC)

Could you site some of this research you talk about? I would be really interested to see it, as someone who is trying to advocate for the legalization of substitution therapy in Russia, where it is unavailable. Also, what about Buprenorphene? I'm assuming you are talking about the death rate from patients who use heroin on top of meth and overdose. This does not happen with Bup, so do you still believe it not to work? --Dwinetsk 17:02, 23 October 2006 (UTC)

Our Kiwi nurse knows not of what she speaks. The UK's National Institute for Clinical Excellence has just completed a technology appraisal that looks at all the research on methadone and assesses it's value as a clinical intervention. On the grounds of cost and clinical efficacy, methadone is recommended as a treatment for opiate dependence. You simply don't get evidence more objective and scientifically rigorous than a NICE Technology Appraisal.

See the guidance here:

http://www.nice.org.uk/guidance/TA114

This article is exalent and i am so glad that itis here. It should also say the bad sides to methadone prescription especially the fact that many with a methadone dependancy say that methadone is harder to come off. plus methadone takes longer to come out of the system taking 5-7 rather than the 2/3-5 of heroin. i personaly advocate the prescribing of diamorphine as many with a heroin dependancy find it so difficult to swop. Methadone and the presribing of injectable methadone are definatly harm reduction though. I would really like to see the figures about more heroin dependant people over dosing caused by methadone it is possible that they have a very large, well established long term up take of methadone programmes. Getting people moved through the system is some thing we have a problem with in the UK as there are so few detox centres and so few rehab places (and no money to send them to rehab). I think after detox care would be serious harm reduction. We r campaining for it as i type!!!

Great article. Not sure the biasy banner is in the right place. Delighted eyes 23:13, 24 July 2007 (UTC)

[edit] Pseudo-Relevant Link?

"How to Inject Crystal Meth More Safely A guide on injecting crystal meth more safely written in easy to understand terms." Seems pseudo-relevant, and if we're going to list such links, then we might as well list how to "safetly" use all other drugs as well. I'm going to remove it. --Anthonysenn 06:34, 17 May 2006 (UTC)

[edit] Focus too narrow(?)

I wonder whether the focus of the article is too narrow. Conceptually, I don't think harm reduction is just restricted to (illegal) drugs and sexual behaviour (as the leadin suggests). I think it could just as well be smoking less cigarettes, eating less high calorie food (for someone that is overweight) or using protective gear to minimize injury. Nephron  T|C 09:28, 19 August 2006 (UTC)

Reply:

I agree that the exclusion of tobacco is too narrow. Tobacco harm reduction is one of the hottest areas in harm reduction research today, and is emerging into the harm reduction mainstream (if that is not an oxymoron). I added a bit about smokeless-tobacco-based harm reduction to the page and a link to our website on the topic to the external links. I would be interested in adding a more complete section on tobacco as part of the harm reduction page, and editing the introductory material accordingly, if this seems like a good idea.

Note that this was my first contribution to Wikipedia, and this is my first Discussion post, so I apologize if I did not do it according to standards. Carlvphillips 20:48, 18 September 2006 (UTC)

[edit] opening paragraph

I found the 1st section to be a bit of a clunky read, so I'm trying to reword it a bit. I'm trying to avoid changing the substance of what's there, instead just trying to make it read better. I'll keep at it for a couple days. Mike McGregor (Can) 03:42, 8 September 2006 (UTC)

Ok, I think I improved the first section a bit. as I mentioned above, I was trying not to change the substance of the section, but where i read "Among other arguments, they point out that health risks of cannabis use and also of most other illegalized drugs are relatively low", I couldn't help but say "what the hell?", because although that my be true for pot, in my understanding of IV drug use, the health risks are huge. Was the intention of this to say that the effect on the individual user was minor? or that the effect on health care resources and law and order was minor? Anyway, I reworded it to reflect the latter. on an unrelated note, I noticed that there is little or no information on initiatives regarding education on vein care, safe(er) injection and inhalation kits, and programs to enhance the safety of prostitutes (sharing "bad date" info, distributing condoms, police outreach to 'at risk women', etc.). Would anyone be interested in leading or helping to develop sections on those? If anyone is interested on collaberating in those areas, or can point me towards some good sources on the net/in the libraries/ etc. feel free to drop me a line on my talk page! Mike McGregor (Can) 22:49, 10 September 2006 (UTC)

[edit] "Soft bigotry" quote

Is there anearlier source than this? http://www.ed.gov/news/pressreleases/2003/03/03122003.html(March 2003) ? === Vernon White (talk) 12:56, 28 December 2006 (UTC)

Or this? http://www.newsmax.com/archives/articles/2004/1/9/110923.shtml(Jan 2004), or is there an earlier statement? ===Vernon White (talk) 13:01, 28 December 2006 (UTC)

[edit] Harm Minimisation

Sources that I've read in the past, especially on Bluelight, proposed the idea that Harm Reduction and Harm Minimisation are different ideologies with the same goals. I've read that Harm Minimisation should be considered to minimise harm by focusing on the reduction of use rather than safer use and thus employs tactics such as supply line reduction, strengthened law enforcement etc etc. Harm Reduction being more like the philosophy explained in the wiki article. Within this article the terms Harm Minimisation and Harm Reduction seem to be interchangeable. Is there a generally accepted standard or has any one else heard of an alternate meaning for the term Harm Minimisation? --Spuzzdawg (talk) 14:41, 18 November 2007 (UTC)

Yeah, the terms do cross over in their use. The National Drug Strategy of Australia has this to say on the matter:

Harm minimisation does not condone drug use, rather it refers to policies and programs aimed at reducing drug-related harm. It aims to improve health, social and economic outcomes for both the community and the individual, and encompasses a wide range of approaches, including abstinence-oriented strategies. Australia’s harm-minimisation strategy focuses on both licit and illicit drugs and includes preventing anticipated harm and reducing actual harm.

Harm reduction strategies to reduce drug-related harm to individuals and communities.

Here in Australia, Harm Minimisation is the oerall policy that involves supply reduction (stopping drugs reaching users), demand reduction (reducing the number of people using drugs) and harm reduction (minimising the damage caused by what the other two don't stop).

We coined the idea in 1985 with the national campaign against drug abuse, which was the first in the world to use this three way approach. Do people think that is an authoritative source? rakkar (talk) 01:55, 26 May 2008 (UTC)

[edit] Addition of weasel tag

Harm reductionists contend that ...

Critics of harm reduction contend that ...

These are classic weasel terms, so I am adding the weasel tag. perhaps someone can cite a "harm reducionist"? —Preceding unsigned comment added by 164.97.245.84 (talk) 00:15, 4 January 2008 (UTC)