Video 4: What is the history of harm reduction?

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From the course by University of Geneva

Drugs, drug use, drug policy and health

4 ratings

University of Geneva

Drugs, drug use, drug policy and health

4 ratings

This MOOC is the first of its kind, since it addresses critical issues related to drugs from a multidisciplinary, health and human rights-based approach. Throughout the course you will cover a range of questions including what are drugs and why they controlled? What are the benefits and harms of taking drugs? How public health policies can address drug use? You will also learn about the intricacies of the international drug control framework and the negative consequences of widespread prohibitionist drug policies around the world. Finally, you will examine ways of furthering drug policy reform. The topics will be presented by over 40 speakers from scientific, academic and institutional backgrounds, spokespersons of civil society as well as people who use drugs presenting their views. By the end of the course you will have: - a strong understanding of the major health issues related to drug use and drug policy; - a clear vision of why drug policy is debated today; - and, if you so wish, you will be equipped to engage in the drug policy reform movement at your local or regional level.

From the lesson

Module 3: Addressing drug use and health: prevention, harm reduction and treatment

Welcome to Module 3 which focuses on public health, harm reduction and treatment. In this Module you will see how public health policies address drug use ; become familiar with various harm reduction concepts and tools and learn a bit about the history as well. You will learn a lot about harm reduction itself, seeing how it can fit into existing health policies and look at how policies can include prevention, harm reduction and treatment in a complementary fashion. By the end of the Module you will be able to : • Recall the concepts and list the tools of harm reduction.• Assess treatment options for dependence• and Explain how prevention, harm reduction and treatment complement each other.We hope this week will provide you with a good sense of what harm reduction is and how it fits within wider public health–oriented policies. This week also builds on what you have learnt in Module 2, with regard to certain health issues and looking at when treatment for dependence may be necessary. Don’t forget to go through the essential reading list and look at the optional additional resources. Best wishes,The Drugs, Drug Use, Drug Policy and Health team

Introduction to Module 32:41

Video 2: How public health policies address drug use8:16

Video 3: Harm reduction: concept and tools5:28

Video 4: What is the history of harm reduction?4:53

Meet the Instructors

Michel Kazatchkine
Senior Fellow
Global Health Center, Graduate Institute for International Affairs and Development, Geneva
Barbara Broers
Professor (in Addiction Medicine)
Community Health Departement, Geneva University Hospitals
Aymeric Reyre
Senior Lecturer
Faculty of Medicine, Paris 13 University
Jennifer Hasselgard-Rowe
Researcher and Lecturer
Institute of Global Health, University of Geneva

Harm reduction, in its present terminology,

first started to come on the agenda in the 1980s,

and it was seen as an alternative in drug policy to the American-inspired war on drugs.

Did harm reduction have an earlier history?

Yes, harm reduction did have an earlier history,

although it wasn't called harm reduction at the time.

In Britain, from, well,

the 1920s at least,

and earlier as well,

doctors were able to prescribe morphine and heroin to

drug users if they wouldn't otherwise be able to modify their drug use.

If they just couldn't give up.

So that had been a kind of leading principle

in British drug policy for quite a long while.

But in the 1970s,

it fell out of favor for various reasons.

Treatment moved away from general practitioners in the community into

hospital-based specialist drug dependence units and it moved

towards abstention as the primary aim of treatment.

How did the coming of HIV and AIDS lead to harm reduction in drug policy in the UK?

Well, British politicians in the 1980s had taken on

the war on drugs approach from the Americans and

there was opposition to this even before HIV/AIDS came

on the scene from other players in drug policy.

In particular, the drug voluntary sector which wanted a harm reduction approach,

and in some cities, Liverpool in particular,

harm reduction approaches were already being tried but

HIV provided a catalyst for

quite radical change and for general adoption of the harm reduction approach.

The discovery that drug users in Edinburgh were HIV positive or a

large proportion of them were HIV positive in

1985 when the HIV tests first became available,

raised fears among the government and the population at large

that drug use might be a conduit for AIDS spreading in the population as a whole.

A government expert committee,

the Advisory Council on the Misuse of Drugs,

produced a report on AIDS and drug misuse in 1988,

which was forced change and it talked about what it called a hierarchy of objectives.

So, there could be different objectives to

treatment and one of those objectives was harm reduction.

There was research done.

Research into pilot needle exchanges which

also helped to change the opinion of politicians.

So, AIDS in a sense was a catalyst

for something that a lot of people who want it to happen anyway,

but its importance was that it convinced politicians, too.

Later on, under the Labor Government in the 1990s,

harm reduction became allied

to a view that it would lead to a reduction in the prison population.

So, harm reduction in the use of methadone was seen as

an alternative to prison for drug users.

What happened in other countries?

Well, harm reduction became an international movement

through the international conferences and

the international harm reduction association but it didn't apply,

it didn't get adopted in all countries.

In the United States, for example,

there was a racial dimension to harm reduction and black politicians accused advocates of

harm reduction of potential genocide by advocating the distribution of needles.

Countries like Russia, too,

haven't adopted the harm reduction approach and also countries in the far east as well.

In recent years, too,

the terminology and the idea of recovery

has come onto the agenda as an alternative to harm reduction.

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