Harm
Minimisation
Harm Minimisation
Basic Principles of
Harm Minimisation
• Do no harm!
• Focus on drug related harms, not the drug itself
• Maximise the range of options for intervention
• Choose appropriate treatment outcome goals –
give priority to those that are practical and
achievable
• Respect the rights of the person with drug
related problems.
Harm Minimisation
National Drug Strategy
“To improve the health, social and
economic outcomes by preventing the
uptake of harmful drug use and
reducing the harmful effects of licit and
illicit drugs in Australian society”
NDS Mission Statement 2004-2009
Harm Minimisation
Harm Minimisation
The National Drug Strategy is built upon three
pillars:
• harm reduction
• supply reduction
• demand reduction
Harm Minimisation
Harm Minimisation
Supply
Reduction
Demand
Harm
Reduction Reduction
Education and
Information
Controls and
Enforcement
Treatment and
Rehabilitation
Research and Evaluation
Harm Minimisation
Harm Minimisation in Action
1. Supply Reduction
3. Harm Reduction
Legislation
Law Enforcement
(incl. Customs, Criminal Justice
System)
Community Attitudes
Education
Information e.g.
• cigarette packet labelling
• Needle & Syringe Programs
Treatment e.g.
Information e.g.
• controlled drinking
• substitution therapy
(nicotine patches, MMT)
• ‘Drinkwise’
Community Intervention e.g.
2. Demand Reduction
Education
Treatment
Rehabilitation
Drug Substitution
Community Interventions e.g.
• promotion of low alcohol drinks
• RBT
• unleaded petrol.
Harm Minimisation
Harm Minimisation (HM)
“… 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 abstinenceoriented strategies.”
National Drug Strategy 2004-2009
Harm Minimisation
Applying HM Principles
Consider:
• whose needs (clinician’s vs. patient’s)
influence decisions
• rationale behind practice policies
• options, supports, resources available to
patients and the practice
• risks to the patient by intervening (or not!)
• risks to others (e.g. drink driving, violence,
safety & welfare of children/partner)
• that the type of intervention may vary (e.g.
safety issues, readiness to change).
Harm Minimisation
HM in General Practice
When patients are not interested in ‘giving up’:
• identify the health, social, and behavioural
impact of drug use
• develop awareness of links between AOD use
and related harms (where evident)
• attempt to reduce harms associated with AOD
use generally (or where they are related to
specific drugs)
• encourage patients to return when they are
contemplating a need to address specific AOD
issues.
Harm Minimisation
HM Examples in General Practice
Eric, aged 54, presented with sleeping difficulties to his GP.
The GP’s AOD assessment revealed:
• 6 stubbies of full strength beer most nights.
Brief intervention offered:
• GP discussed and provided information about standard drinks
and low-risk drinking
• acknowledged importance of alcohol in Eric’s life
• linked sleep issues and Eric’s current health problems to alcohol
• arranged a long appointment in a week to discuss further.
To the GP’s surprise, Eric presented 10 days later stating he
had one of the new low alcohol beers ‘which didn’t taste too bad’
and were ‘cheaper’. He had only had alcohol on three days of
the week, and ‘felt better for it’.
Harm Minimisation
Cycle of AOD-related Harms
Administration
Drug affected
behaviour
Acquisition
Recovering from
drug use
Withdrawal
Harm Minimisation
What is ‘Drug-Related Harm’?
Drug-related harm:
• directly or indirectly affects the health, safety, security,
social functioning and productivity of all Australians.
Drug-related harms cause or contribute to:
•
•
•
•
•
illness and disease
accident and injury
violence and crime
family and social disruption
economic costs and workplace concerns.
Illicit drug-related harms include:
• prosecution and conviction
• involvement in production and distribution of
illicit drugs.
Harm Minimisation
Hierarchy of Risk
Injecting
Smoking
Hierarchy of
Drug
Administration
Risk
Snorting
Swallowing
Harm Minimisation
Preventing Drug-related Harm
Primary prevention:
• targets individuals at ‘no-use’ and ‘low-use’ end of continuum
• prevents harm occurring; prevents, delays or reduces uptake
• involves health promotion activities e.g. education, legislation, policy,
enforcement, promoting alternatives to drug use.
Secondary prevention:
• aims to moderate use patterns and  awareness of risk
• targets those already using, and ‘at risk’
• e.g. early detection, referral, information (incl. media), developing
skills for safer using.
Tertiary prevention:
• aimed at individuals already experiencing problems
• includes provision, development and improvement of specialised
services for those with established dependence
• e.g. withdrawal services, pharmacotherapies, counselling, diversion.
Harm Minimisation
Harm Reduction Strategies
• Establish and maintain an empathic relationship
• Retain contact with patient
• Maximise physical and mental health
• Enhance motivation via education about dependence
• Involve patient + significant others in harm reduction
• Emphasise personal responsibility
• Other forms of support may include:
– family or vocational counselling
– establishing non-drug using relationships
– time management
– problem solving
– skill and hobby building.
Harm Minimisation
Harm Reduction Steps for GPs
• Be familiar with patterns of AOD use and related harms
• Routinely assess patients’ AOD use and related harms
• Provide information and feedback re drug use activity
and related harms
• Assist patient to identify drug use goals
• Collaborate with patient to develop harm reduction
strategies
• Monitor patient behaviour
– reinforce positive changes
– address patient difficulties.
Harm Minimisation
GPs Can...
• Identify drug use and intervene early
• Provide information about safer or lower risk use
strategies
• Advise about associated risks and harms (e.g.
infections)
• Advise about treatment options
• Encourage less risky forms of administration e.g. give
advice about:
– safe injecting
– high-risk drinking.
Harm Minimisation
Harm Minimisation (HM)
• Doesn’t promote or condone drug use
• Involves a range of approaches to prevent / reduce
harms including prevention, early intervention, specialist
treatment, supply control, and safer
(though not risk free) use
• Includes abstinence
• Encourages existing or intending drug users to use in
less risky ways
• HM recognises that:
–
–
–
–
–
there is no completely drug free society
the spectrum of use ranges from acute  chronic
drug use is a risk factor for both physical and social harms
most drugs can be used in low risk ways
‘realistic’ approaches to reducing harms are necessary.
Harm Minimisation
Benefits of HM Approach
Builds rapport:
• shows that GP is interested and prepared to assist
• suggests that GP is not simply ‘telling the patient what
to do’ (i.e. not telling the patient to ‘say NO to drugs’).
Engages the patient:
• trust-building increases potential to influence behaviour
and decrease AOD-related harms
• increases likelihood of return.
Empowers the patient:
• responsibility for change is given to the patient.
Harm Minimisation