STAGE 4. Selecting the theoretical approach

What steps should be completed?

Step 1: Select the theoretical approach or approaches on which the intervention will be based

THEORETICAL APPROACHES TO HARM REDUCTION

What are their bases?

Harm reduction is defined as a series of individual and collective strategies aimed at minimising the harm associated with drug use in people who are unable or unwilling to stop. It is an alternative, proposed by the field of public health, to punitive and sanctioning drug use policies. It raises a humanist and neutral proposal, both with regard to drug use and to the people who use drugs, and does not raise abstinence as the main treatment goal. Objectives include increasing users’ quality of life, preventing overdoses and adverse reactions, reducing infectious disease transmission, increasing awareness of the risks and harm associated with drug use, and reducing drug-related crime, delinquency and degradation of neighbourhoods and communities.

Practical implications

It proposes a multisectoral and multidisciplinary approach characterised by prioritising people’s wellbeing, promoting personal abilities, developing measures to reach people in a situation of harm wherever they are, providing services suited to users’ needs, offering low-demand services (as opposed to traditional ones) and offering preventive options based on a hierarchy of risks.

There is evidence that application of this model (approach) can significantly reduce rates of preventable mortality and transmission of diseases that have a considerable impact in terms of public health. There is also evidence that disseminating knowledge about the risks associated with certain behaviours, along with training in specific skills, can help change population and personal attitudes in favour of health protection and preservation.

This model (approach) originated in Europe to reduce the negative effects of the use of injecting drugs and has subsequently been used to address drug-related problems in recreational and leisure settings. Most of the programmes that have been based on this model (approach) and are detailed below are basically intended for heroin users, although other populations, such as crack users or people who inject cocaine, can also access them.

• Opiate Substitutes maintenance programmes (OSMP). +
• Syringe exchange programmes (SEP). +
• Supervised drug consumption rooms. +
• Overdose prevention and naloxone prescription  programmes. +
• Heroin prescription programmes. +
• Controlled alcohol consumption programmes. +
• Smoking-related harm reduction programmes. +
• Harm reduction programmes for abuse or dependence on illicit drugs other than opiates. +