Harm Minimisation Basic Principles of Harm Minimisation Do

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 Education and Information Controls and Enforcement Treatment and Rehabilitation Research and Evaluation

Harm Minimisation in Action 1. Supply Reduction 3. Harm Reduction Legislation Law Enforcement (incl. Customs, Criminal Justice System) Community Attitudes Education Information e. g. 2. Demand Reduction Information e. g. • ‘Drinkwise’ Education Treatment Rehabilitation Drug Substitution Community Interventions e. g. • promotion of low alcohol drinks • cigarette packet labelling • Needle & Syringe Programs Treatment e. g. • controlled drinking • substitution therapy (nicotine patches, MMT) Community Intervention e. g. • 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 RI SK M OS LE AS T T Injectin g Smokin Hierarchy of Drug Administration Risk g Snorting Swallowi ng 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