Harm reduction (addiction syndrome)

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Harm reduction , -reduction or depreciation (ger .: harm minimization or -Reduction ) is a concept that the decrease of a drug or pathological games has risks and health hazards related to the goal. The term damage minimization includes measures that reduce these risks without having to contribute directly or absolutely to the absence of substance or impulse.

Harm reduction stands for the concept of offering drug addicts assistance via low-threshold access to treatment facilities without any special preconditions. The aim is to improve the physical and mental condition as well as the social situation, which can include an increased crime rate as well as unemployment and homelessness up to impoverishment . It is increasingly recognized that harm reduction cannot be limited to the problems of the individual consumer, but also requires political solutions for the good of society.

Compared to the normal population, life in the drug scene (with neglect , social marginalization , distress , delinquency , homelessness ), indirect damage to health and the frequently detectable concomitant diseases lead to a 10-63-fold increase in mortality . Here are overdoses , violence and injuries , cirrhosis of the liver (by hepatitis B , C and alcohol ), AIDS and endocarditis and other bacterial infections for most of the excess mortality to blame. The suicide rate is 14 times higher than that of the normal population of the same age.

The concept of damage minimization is not limited to damage that has already occurred, but also tries not to add any further problems to the existing problems in order to prevent damage. This is done through advice on the effects and side effects of the substances consumed, occasionally also testing the (illegal) substances in circulation (such as by ChEck iT! ), Information on " safer sex " and the issue of condoms , provision of sterile needles ( syringe exchange ) for the intravenous substance consumption in treatment centers or via syringe and needle machines , vaccination programs, offers for medical examinations and care, food distribution and more.

Damage minimization is  diametrically opposed to the principle of “zero tolerance” - in Australia above all with the demand for rapid withdrawal by means of rapid detoxification with naltrexone . A direct comparison of the two approaches has not yet been scientifically investigated.

history

In 1929 the US Congress authorized the United States Public Health Service to set up two institutions (so-called narcotic farms ) “for the confinement and treatment of persons addicted to the use of habit-forming narcotic drugs” . When the Public Health Service Narcotic Hospital opened in Lexington, Kentucky on May 25, 1935, it embodied the hope that opiate addicts could be cured and regain productive roles in American society. Therapy was offered in a moderated penal system and initially convincing success rates with regard to opioid withdrawal were reported - u. a. in the less than 4% of patients who registered for voluntary withdrawal. These were mostly farmers who had become addicted to opioids for medical treatment and who returned to their families after withdrawal. However, within 20 years the institution has become a symbol of deep-rooted pessimism about the cure for a drug addiction that continues to influence politics to this day.

When Vincent Dole and Marie Nyswander published their first study on long-term treatment with methadone in 1965 , the 22 participants were long-term addicts only on heroin and no additional substance. The highly structured care program and the successes achieved were able, if not to allay, if not to allay concerns about treatment with an addictive, but hardly euphoric, drug, at least to keep them within limits. But there were and still are people who regard abstinence from all addictive substances as the primary goal and who demand appropriate therapies, even if their successes are temporary.

One of these therapies has become the substitution therapy of opioid addicts in its special form of "maintenance therapy for withdrawal" or "abstinence-oriented maintenance therapy ", even if maintenance therapy with higher doses has shown better results. In prison staff, a higher abstinence orientation and rejection of drugs is associated with a lower knowledge of the advantages and disadvantages of methadone than among treatment staff outside of prisons.

In the meantime, an increasing global supply of heroin and the rapid spread of HIV (and at that time still in the background: hepatitis B and C; the hepatitis C virus was only identified in 1988) made other approaches advisable, so that the Australian government agreed in 1985 Convened drug summit, at which the issue should not be politicized but dealt with by experts. Taking into account that drug-freeness is not the most important goal and moreover can only be achieved for a minority of addicts, the concept of harm reduction was advocated. Substitution with Methadone could now be carried out in general practice, the program was advertised among practitioners, training in history taking and physical examination, evaluation of motivation, treatment options and their meeting with the patient, obtaining the informed consent (ger .: informed consent ) and review of the The course and success of the treatment. Treatment should be based on an empathic , non-judgmental therapeutic relationship and advocated high methadone doses in long-term therapy as opposed to an abstinence-oriented basis. In 1996, however, this consensus, which was initially supported by politics, was again on the brink of breaking. When in July 1997 an article entitled I woke up cured of heroin addiction appeared in Womens Weekly , an Australian women's magazine, mass hysteria broke out. What was meant was a forced opioid withdrawal under anesthesia with subsequent treatment with naltrexone .

In many countries, harm reduction policies have become an integral part of national drug strategies. For example, in 2003 and 2004, several harm reduction laws were passed in France, Finland and England. France passed a law in August 2004 adopting the five-year health policy plan and integrating harm reduction policies for drug users into public health rules. This gave damage minimization an official definition and was included in the scope of French jurisdiction.

Prohibitionists and reformists still face each other today.

literature

Individual evidence

  1. ↑ Meinolf Bachmann, Gerhard Meyer: Gambling addiction - causes and therapy Springer, 2005, ISBN 3-540-23731-3 , p. 286.
  2. ^ Opinion on the structured hearing on the subject of "The future of gaming in Germany" . State government of Rhineland-Palatinate - State institute for preventive action, p. 6  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. (PDF)@1@ 2Template: Toter Link / mpk.rlp.de  
  3. ↑ Report and concept for combating and preventing addiction in the state capital Magdeburg 2010 to 2013. State capital Magdeburg, 2009. Harm reduction p. 19 ff.
  4. ↑ Page no longer available , search in web archives: Swiss Federal Office of Public Health, accessed on July 3, 2010@1@ 2Template: Dead Link / www.bag.admin.ch
  5. ↑ Nicholas Seivewright, assisted by Mark Parry: Community Treatment of Drug Misuse: More Than Methadone. Cambridge University Press, 2009
  6. ↑ CA Perucci, M. Davoli, E. Rapiti, DD Abeni, F. Forastiere: Mortality of intravenous drug users in Rome: a cohort study. In: Am J Public Health. 1991 October, 81 (10), pp. 1307-1310, PMC 1405314 (free full text).
  7. ↑ L. Gronbladh, LS Ohlund, LM Gunne: Mortality in heroin addiction: impact of methadone treatment . In: Acta Psychiatr Scand. , 1990, 82, pp. 223-227, PMID 2248048 .
  8. ↑ S. Darke, J. Ross: Suicide among heroin users: rates, risk factors and methods. In: Addiction , 2002 Nov, 97 (11), pp. 1383-1394, PMID 12410779 .
  9. ↑ a b c d Richard P. Mattick, et al .: Pharmacotherapies for the Treatment of Opioid Dependence: Efficacy, Cost-Effectiveness and Implementation Guidelines . Informa Healthcare, 2009, ISBN 978-1-84184-400-8 .
  10. ^ Thomas R. Costs, David A. Gorelick: The Lexington Narcotic Farm. (PDF) psychiatryonline.org
  11. ^ A b C. J. Acker: The early years of the PHS Narcotic Hospital at Lexington, Kentucky. In: Public Health Rep. 1997 May-Jun, 112 (3), pp. 245-247, PMC 1382000 (free full text).
  12. ^ J. Bell, J. Chan, A. Kuk: [ Investigating the influence of treatment philosophy on the outcome of methadone maintenance. In: Addiction. 1995 Jun; 90 (6), pp. 823-830, PMID 7633300 .
  13. ↑ JR Caplehorn, DM Hartel, L. Irwig: Measuring and comparing the attitudes and beliefs of staff working in New York methadone maintenance clinics. In: Subst Use Misuse. 1997 Mar; 32 (4), pp. 399-413, PMID 9090802 .
  14. ↑ JR Caplehorn, TS Lumley, L. Irwig: Staff attitudes and retention of patients in methadone maintenance programs. In: Drug Alcohol Depend. 1998 Sep 1, 52 (1), pp. 57-61, PMID 9788007 .
  15. ↑ JR Caplehorn, TS Lumley, L. Irwig, JB Saunders: Changing attitudes and beliefs of staff working in methadone maintenance programs. In: Aust NZJ Public Health. 1998 Jun; 22 (4), pp. 505-508, PMID 9659781 .
  16. ↑ LR Gjersing, T. Butler, JR Caplehorn, JM Belcher, R. Matthews: Attitudes and beliefs towards methadone maintenance treatment among Australian prison health staff. In: Drug Alcohol Rev. 2007 Sep; 26 (5), pp. 501-508, PMID 17701513 .
  17. ^ GV Stimson: AIDS and injecting drug use in the United Kingdom, 1987-1993: the policy response and the prevention of the epidemic. In: Soc Sci Med. 1995 Sep; 41 (5), pp. 699-716, PMID 7502102 .
  18. ^ House of representatives, Private members business, Pharmaceutical Benefits: Naltrexone: Speech. (PDF).
  19. ↑ Alex Wodak, Timothy Moore: Modernizing Australia's drug policy. UNSW Press, 2002, ISBN 0-86840-482-9 .
  20. ^ European Monitoring Center for Drugs and Drug Addiction-EMCDDA , accessed July 3, 2010.
  21. ↑ Damage minimization. EMCDDA, accessed July 3, 2010.
  22. ^ Feasibility Research into the Controlled Availability of Opioids - Background Papers . (PDF) Published by the National Center for Epidemiology and Population Health - The Australian National University; Canberra, Australia.