Harm reduction is based on the protection of human rights. People who use drugs have the right to life, the right to privacy, to health care, to social assistance, to freedom from torture and degrading treatment. Taking drugs does not mean losing these rights. PWUD, especially those from vulnerable groups, are at particular risk of rights violations as a result of criminalization of drug use and possession, stigmatization, and systemic discrimination.
Drug use is a public health problem and should never be the domain of law enforcement and the justice system. Repressive laws that criminalize people who use drugs not only fail to increase public safety, but cause individual and social harms. Criminalization increases vulnerability and negatively impacts access to medical services and support, fuels the HIV and HCV epidemic among people who use drugs. Harm reduction achieves public health goals (improving health, social well-being, and quality of life) by integrating people who use drugs into the health care systems.
- A world without drugs is an unrealistic vision. The use of psychoactive substances has been with humanity since the dawn of time and is part of the human nature.
- Drug use can be beneficial and have a positive impact on lives.
- Drug use can cause health and social harms.
- Drug laws that criminalize people who use drugs cause health and social harms.
- Psychoactive substance use is a multifaceted phenomenon. Substance users may change their patterns of use many times during their lifetime, moving along a continuum from abstinence (the only fully effective method of harm elimination), through low-risk use to problem use.
- Most people who use drugs will not become addicted and will not suffer the harms associated with substance use.
- Use of psychoactive substances is often a form of self-medication – coping with mental illness and disorders, experience of trauma and violence.
- Some substances carry more risk than others and have a higher addictive potential. Some forms of use are more harmful than others.
- The realities of poverty, class, social isolation, traumatic experiences, and gender discrimination affect both people’s vulnerability to drug-related harms and their ability to cope effectively. People belonging to vulnerable groups in society require the most support and care.
- Abstinence should not be a condition for support. Abstinence is not the best option for everyone. Criteria for effective interventions should relate to quality of life and well-being and not assume abstinence as the starting point for interventions.
- People who use drugs should be actively involved in planning strategies, developing practices and policies that affect them.
Harm reduction dates back to the 1980s and the HIV epidemic. The first efforts to reduce infections among people who inject drugs were initiated by users themselves in Western Europe. The phenomenon of injecting drug use and the resulting health harms was particularly present in urban areas, and they played a key role in introducing new interventions and expanding the range of services aimed at PWUD (needle and syringe exchange programs, substitution treatment). The 1990s saw the development of harm reduction programs, growing acceptance of this approach, recognition of the effectiveness of interventions and cost-effectiveness of programs, and consequently integration of activities into health care systems, as well as into drug policy guidelines of the European Union and other countries of the Western world (United States, Australia). Harm reduction is an integral part of official policy in the United Nations (WHO, UNAIDS) and global public health institutions. Nevertheless, in many countries in the world, people who use drugs are denied access to basic health services, sentenced to draconian penalties (including the death penalty), and denied the right to life and health simply by using drugs. In most countries with harm reduction programs, their scope and quality is insufficient.
Poland was the first country in the region to introduce harm reduction interventions (needle and syringe exchange, opioid substitution treatment). The programs developed in the 1990s. The amendment to the Act on Counteracting Drug Addiction in 2000 was a turning point in terms of access to services. The introduction of criminalization of possession of substances for personal use resulted in a gradual outflow of clients and a decrease in the number of services. Restrictive drug laws, the dominant abstinence model of drug treatment, and the stigmatization of people who use drugs prevent the development of this approach and the reform of the treatment system.
The coverage and access to harm reduction is very low in the country. Only about 15% (in the group of problem opioid users) of those in urgent need of support can receive it. Legal regulations prevent the implementation of interventions that are key to protecting the health and lives of people who use drugs, such as safe injection sites and naloxone programs. Harm reduction is included in the National Program on Counteracting Drug Addiction, an agenda of the Ministry of Health – the National Centre on Counteracting Addictions finances and actively supports harm reduction programs. However, they function on the periphery of the aid system and the harm reduction philosophy still arouses controversies among people working in the field of addictions.
Currently there are five harm reduction programs in Poland – in Warsaw (Prekursor Foundation, Jump 93), Krakow (Drop-in Krakowska 19), Wroclaw (Salida Foundation) and Gdansk (Prekursor Foundation).
Harm reduction aims to reduce the health and social harms associated with drug use. It makes the rational and pragmatic assumption that there will always be people using drugs and everything should be done to minimize the negative consequences of drug use. It also aims to create a safe space for PWUD who experience discrimination and violence. Harm reduction programs are most often the only places where people who use drugs are treated with acceptance, respect and kindness.
Harm reduction also aims to reduce the negative health, social and legal consequences that result from drug laws and policies. Restrictive laws that criminalize drug users sometimes cause more harm than the substance itself.
In the abstinence model, working with people who use drugs is aimed at stopping their substance use. In the support system (health care, social services), abstinence is very often condition of help and as long as someone continues to use they cannot be supported. However, abstinence for most people with addiction is an unattainable and unrealistic goal. People don’t want to, can’t, or aren’t ready to stop using. And even if they are ready, access to treatment is limited, the offer of help is narrow, and it does not meet their needs.
The essence of harm reduction is respect for people who use drugs and acceptance of their choices. Without judging, putting conditions and requirements that they have to meet in order to get help. People who use drugs have the right to make their own decisions, they have the right to protect their lives and health, and they are the ones who identify the problems they want to address. Harm reduction is about building a respectful and trusting relationship through which PWUD can make changes in their lives. Every change, however small, is important. It is connecting with the people where they are and addressing the areas of their life that are most important to them at that moment.
Harm reduction is strategies and interventions designed to reduce the health and social harms associated with psychoactive substance use. It is also practices and services designed to minimize the social and legal harms that result from repressive, criminalizing laws.
- Needle and syringe exchange programs
- Opioid substitution treatment
- Drug consumption rooms
- Naloxone programs
- Drug testing
- Education on safer ways to use drugs
- Prevention and treatment of HIV, HCV, HBV, tuberculosis
- Psychosocial support
- Legal counseling
- Alternatives to punishment
- Social services
- Housing initiatives
- Employment initiatives