Harm Reduction Flashcards
Drug use and society?
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
What are the 3 categories of psychoactive drugs?
Legal
Prescription
Illegal
What types of psychoactive drugs are legal?
Alcohol
Tobacco
Cannabis
What types of psychoactive drugs are prescribed?
Morphine
Benzodiazepines
What types of drugs are illegal?
Cocaine
Heroin
LSD
What is harm reduction?
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
What does harm reduction include?
Laws
Resources
Treatments
What is harm reduction not?
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
What are the goals of harm reduction?
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
What were the pros of alcohol prohibition?
Reduced alcohol use (initially)
Less public drunkenness
What were the cons of alcohol prohibition?
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
What was the iron law of prohibition?
As law enforcement becomes more intense, the potency of prohibited substances increases
What was the war on drugs?
A global campaign of drug prohibition with the aim of reducing drug abuse and illegal drug trade
What did the initial war on drugs focus on?
Law enforcement, education, and drug addiction treatments
Emphasis on law enforcement
Significant increase in drug-related incarcerations
What were the unintended impacts of the war on drugs?
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
What is the fair sentencing act?
Reduced the sentencing disparity from 100:1 to 18:1
How can the war on drugs be summarized?
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
What is decriminalization?
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
What is legalization?
Removes all penalties for possession and personal use of a drug. Regulations to manage how the drug can be produced, sold, and consumed
What are the pros of drug legalization?
Drugs can be regulated, tax revenues, restrict access, avoids harms of drug criminalization
What are the cons of legalization?
Negative effects of drug use may be amplified if more people use drugs
Did the legalization of cannabis in Canada change its use?
Less minors used
18-24 stayed the same
Greatest increase was seen in 65+
Only a 3% increase in overall cannabis use
What are the risks of legalization?
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
What is the challenge with legalization?
To find a balance between legalization and unregulated market to minimize the harms of drug use
What is drug education?
Provides information on the risks and harms associated with drug use
Targeted to youth
Historically, drug education was focused on abstinence only
What does abstinence-only education ignore?
That people always have and always will use drugs and does not give them the information they need to stay safe
What is refer madness?
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
Can you overdose on fentanyl by touching it in trace amounts?
No, this is a biological implausibility
This is just mass hysteria
What does ineffective drug education do?
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
What does effective drug education do?
Presents evidence-based information on the risks of drug use and ways to mitigate those risks
What are supervised consumption sites?
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
What is safe supply?
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
What is injectable opioid therapy?
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
What are the pros of safe consumption sites and injectable opioid therapy?
Strong evidence that these interventions reduce morbidity and mortality associated with opioid use
Provide access to information and resources for additional treatment
What are the cons of safe consumption sites and injectable opioid therapy?
Risk of drug diversion
Normalizes risky drug use
Runs counter to the Hippocratic oath
The moral argument for providing drugs to people with addiction
What is naloxone?
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
What were the three waves of the opioid overdose crisis?
Early 2000s = prescription opioid drugs
Early 2010s = cheap heroin from Mexico
2020s = fentanyl-tainted illicit drugs
What are the trends found with fentanyl?
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
