Harm Reduction

Question 1

Drug use and society?

Answer 1

Most of us have used drugs
Both legal and illegal drugs can be beneficial or harmful
A small fraction of users will develop an addiction
Drug use is not inherently good or bad

Question 2

What are the 3 categories of psychoactive drugs?

Answer 2

Legal
Prescription
Illegal

Question 3

What types of psychoactive drugs are legal?

Answer 3

Alcohol
Tobacco
Cannabis

Question 4

What types of psychoactive drugs are prescribed?

Answer 4

Morphine
Benzodiazepines

Question 5

What types of drugs are illegal?

Answer 5

Cocaine
Heroin
LSD

Question 6

What is harm reduction?

Answer 6

Refers to policies, programs, and practices that aim to minimize the negative health, social, and legal impacts associated with drug use, drug policies, and drug laws

Question 7

What does harm reduction include?

Answer 7

Laws
Resources
Treatments

Question 8

What is harm reduction not?

Answer 8

Does not assume drug abstinence is the optimal outcome for everyone
Does not require participation in treatment programs
Does not require a commitment to abstain from illegal drugs

Question 9

What are the goals of harm reduction?

Answer 9

Keep people alive
Minimize the harms associated with illegal drug use

Improve drug laws, policies, and law enforcement so that they are not detrimental to the health and wellbeing of people who use drugs

Offer evidence-based interventions to prevent or end drug use, if that is what the drug user desires. May also help people maximize any potential benefits that they gain from using drugs

Question 10

What were the pros of alcohol prohibition?

Answer 10

Reduced alcohol use (initially)
Less public drunkenness

Question 11

What were the cons of alcohol prohibition?

Answer 11

Overtime, alcohol use increased to higher than pre-prohibition driver by crime cartels

Iron law of prohibition

Disproportionate adverse impacts on minorities, immigrants, and the poor

Question 12

What was the iron law of prohibition?

Answer 12

As law enforcement becomes more intense, the potency of prohibited substances increases

Question 13

What was the war on drugs?

Answer 13

A global campaign of drug prohibition with the aim of reducing drug abuse and illegal drug trade

Question 14

What did the initial war on drugs focus on?

Answer 14

Law enforcement, education, and drug addiction treatments
Emphasis on law enforcement
Significant increase in drug-related incarcerations

Question 15

What were the unintended impacts of the war on drugs?

Answer 15

Though cocaine and crack are nearly identical chemically, the punishment for crack possession compared to cocaine is 100 to 1

Black people are more likely to be convicted of crack cocaine offenses (even tho most crack users are white) and white people are more likely to be convicted of powder cocaine offenses

Question 16

What is the fair sentencing act?

Answer 16

Reduced the sentencing disparity from 100:1 to 18:1

Question 17

How can the war on drugs be summarized?

Answer 17

Has little effect on overall drug use
Incarceration of drug users is expensive
Does not treat the underlying addiction
Exacerbates illegal drug supply by encouraging stronger and more potent drugs
Drug laws disproportionately impact poor and racial minorities independent of actual drug use

Question 18

What is decriminalization?

Answer 18

A harm reduction strategy in which non-criminal penalties are available for designated activities, such as possession of small quantities of a controlled substance

Criminal sanctions replaced with interventions that promote access to education and to harm reduction and treatment services

Question 19

What is legalization?

Answer 19

Removes all penalties for possession and personal use of a drug. Regulations to manage how the drug can be produced, sold, and consumed

Question 20

What are the pros of drug legalization?

Answer 20

Drugs can be regulated, tax revenues, restrict access, avoids harms of drug criminalization

Question 21

What are the cons of legalization?

Answer 21

Negative effects of drug use may be amplified if more people use drugs

Question 22

Did the legalization of cannabis in Canada change its use?

Answer 22

Less minors used
18-24 stayed the same
Greatest increase was seen in 65+
Only a 3% increase in overall cannabis use

Question 23

What are the risks of legalization?

Answer 23

Legalization and commercialization of the drug trade can lead to unintended consequences like profit seeking

Historic and contemporary example of tobacco marketing to youth

Population risks of drug use are amplified following legalization

Question 24

What is the challenge with legalization?

Answer 24

To find a balance between legalization and unregulated market to minimize the harms of drug use

Question 25

What is drug education?

Answer 25

Provides information on the risks and harms associated with drug use
Targeted to youth
Historically, drug education was focused on abstinence only

Question 26

What does abstinence-only education ignore?

Answer 26

That people always have and always will use drugs and does not give them the information they need to stay safe

Question 27

What is refer madness?

Answer 27

A propaganda film to teach people about the dangers of cannabis use
The extreme risk of cannabis use did not coincide with people’s lived experiences

Question 28

Can you overdose on fentanyl by touching it in trace amounts?

Answer 28

No, this is a biological implausibility
This is just mass hysteria

Question 29

What does ineffective drug education do?

Answer 29

Abstinence-only education which is unrealistic and ineffective
Exaggerate the harms of drug use which delegitimatizes the educator
Stoking fear which can distract from legitimately dangerous issues

Question 30

What does effective drug education do?

Answer 30

Presents evidence-based information on the risks of drug use and ways to mitigate those risks

Question 31

What are supervised consumption sites?

Answer 31

Provide a safe place to take drugs to reduce harm or poisonings
Clients bring their own drugs and are provided clean needles and medical supervision in the case of overdose
Any one can access and can remain anonymous

Question 32

What is safe supply?

Answer 32

Refers to a legal and regulated supply of drugs that have traditionally been accessible through the illicit drug market
Can include programs that check illicit drugs for contaminants to prescribing drugs usually obtained through the illicit market

Question 33

What is injectable opioid therapy?

Answer 33

Clients must be referred to program by health care practitioner and must have failed all other addiction treatment
Clients are prescribed specific doses of injectable opioids and are expected to self-administer at the iOAT clinic
Clients are closely monitored for averse reactions

Question 34

What are the pros of safe consumption sites and injectable opioid therapy?

Answer 34

Strong evidence that these interventions reduce morbidity and mortality associated with opioid use
Provide access to information and resources for additional treatment

Question 35

What are the cons of safe consumption sites and injectable opioid therapy?

Answer 35

Risk of drug diversion
Normalizes risky drug use
Runs counter to the Hippocratic oath
The moral argument for providing drugs to people with addiction

Question 36

What is naloxone?

Answer 36

Non-selective competitive opioid receptor antagonist
Available to the public and an intramuscular or nasal spray
Works within minutes and lasts about half an hour

Question 37

What were the three waves of the opioid overdose crisis?

Answer 37

Early 2000s = prescription opioid drugs
Early 2010s = cheap heroin from Mexico
2020s = fentanyl-tainted illicit drugs

Question 38

What are the trends found with fentanyl?

Answer 38

Fentanyl toxicity is driving an alarming rise in drug-overdose deaths since 2015
Fentanyl has been found in other street drugs like cocaine, MDMA, and methamphetamine
It is a dangerous time to use illicit drugs