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Saturday, May 8, 1999 Published at 13:47 GMT 14:47 UK


Drug war focuses on 'harm reduction'

Intravenous drug abuse is reaching "epidemic proportions" in some regions

A controversial approach to reducing the spread of intravenous drug abuse is still on trial. Corinne Podger, of BBC Science, reports on the progress of the 'harm reduction' programme.

Anti-drug campaigns are being run all over the world, but the message is not getting through.

The abuse of intravenous drugs is spreading from the US, western Europe and Australia to just about every other region of the world.

Countries now report that the number of injecting drug addicts and the spread of Aids through sharing needles is reaching epidemic proportions in Asia and parts of Eastern Europe.

At a conference in Geneva last month scientists, politicians and drug users met to discuss the project.

The idea behind 'harm reduction' is to prevent drug addicts from harming themselves and society. It is about prescribing drugs to addicts so they do not have to buy from drug dealers, as well as providing clean needles for addicts to prevent the spread of HIV.

Quality of life

Conference president Dominic Oiser says society has a moral duty to support the policy.

"My moral question or my ethical point of view is that as public health people, as medical doctors, as social workers, we have to find ways to maintain and improve quality of health, quality of life, of individuals and of the society where we are living in and that there is no reason to not choose a method that is effective," he said.

Studies show that harm reduction does save lives, as well as improving addicts' quality of life.

But critics say that governments should be encouraging them to kick their habit completely, instead of supplying clean needles and methadone.

The Director of the International Harm Reduction Association, Pat O'Hare, disagrees.

"Giving methadone to drug users - what it does is it stabilises their life," he said.

"The evidence is very clear about methadone, it stops people injecting, although some people do inject methadone. It stops them using street heroin, it reduces the amount of sharing of needles and it reduces the amount of crime that those people commit. Now, that sounds to me like a pretty good deal."

Needle exchange

The HIV epidemic has added weight to arguments in support of harm reduction. Provision of clean needles for drug-injecting addicts is seen as vital to curb the spread of the disease.

Brazilian politician Paolo Tishera says for poor, developing world countries it is the most cost-effective way of preventing Aids.

"It's easy for us to make programme like that, because it's too expensive to treat people living with Aids," he said.

"And when you have a needle exchange programme, the number of people living with Aids also decreases. So treating people once they have Aids is more expensive than making a prevention programme like needle exchange programmes available to addicts."

But the costs of needle exchange programmes are still too high for many developing countries.

Remains controversial

Non-governmental organisations are having to step in to fund schemes in central and eastern Europe, where HIV rates have soared, mainly because of unsafe drug injecting.

Glen Baksis, Director of the Open Society's harm reduction programme, said: "We're working in central and eastern Europe and in particularly the former Soviet Union - Russia, Moldova, Belarus and Ukraine - because they are the new centre of HIV in the northern hemisphere.

"The number of cases that happened in Russia and Ukraine alone last year surpassed all of north American infections and all of European infections last year."

Ten years after the "harm reduction" approach was first tried, it still remains controversial.

Offering clean needles to addicts is becoming more acceptable - but supplying them with substitute drugs is still too radical for many to accept.

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