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World: Harm Reduction Of Drugs Elicits Passionate Debate

Geneva, 9 April 1999 (RFE/RL) -- More than 1,500 people from around the globe spent the better part of last week in Geneva, discussing best methods and worst-case scenarios in the global fight against drug-related harm.

Researchers, public health workers, politicians and drug abusers took part in the annual debate, the tenth of its kind since the First International Harm Reduction Conference took place in Liverpool, England in 1989.

A lot has changed since then. Most important, participants said, is the "explosive" situation in the newly independent states of the former Soviet Union, where drug use and abuse, and concurrently AIDS, are on the rise.

But what is harm reduction and how can it help combat these problems that have challenged the best of both developed and developing nations?

To answer those questions our correspondent spoke to researcher Jean Paul Grund of the Netherlands. He is the winner of this year's annual award given by conference organizers for international work on reducing drug-related harm.

"We do not try to limit the activity or to repress the activity, but we try to change the activity in a way that it becomes less harmful."

According to Grund, this approach is a central component of harm reduction, the roots of which, as a unified theory, originated in Amsterdam. Grund says harm reduction is a public-based health intervention which accepts that drug use exists. He says the challenge is how to minimize harm for the individual and the community, the end point being not whether a person stops using drugs, but whether they use them more responsibly and with a reduced capacity for harm.

Acceptance that drug use exists, Grund argues, leads to better treatment.

"If you only think in terms of the only goal being abstinence or cessation of use, or even that people will never start, your range of action is very limited. But from a harm-reduction standpoint, all ranges are available, of which abstinence is definitely a goal. But reality teaches us that not everyone -- at any given time -- is ready to give up alcohol or drugs." Grund says the abstinence mandate keeps people away. He said ambivalence is such a strong factor in drug abuse that when the abstinence mandate is made, many people just avoid addiction services altogether. He said this means people with drug or alcohol problems continue to use drugs and alcohol, and to use them in a way that presents a high risk of health problems to the individual user and those in contact with them, whether it be a sexual partner or someone with whom they share an injection needle. As Grund put it, small reductions of harm are better than no reduction of harm.

Grund, like most participants at the conference, expressed the hope that harm reduction -- well thought out and widely practiced -- would also help return a sense of control to the individual, something severely lacking in the newly emerging independent states of the former Soviet Union. Grund says that with access to methadone treatment, clean syringes and condoms, for example, people have control over the environment in which they are living and responsibility over their own lives.

But harm reduction is a method and theory that elicits passionate debate. It has at times met strong resistance in the United States and Europe -- especially as regards needle exchange or methadone treatment -- depending upon the political climate of the time. Grund says that same resistance can also be seen in Russia today.

"Last year, [Russia] passed new drug legislation which is totally repressive if you look carefully at it and in some aspects goes back to a totalitarian system, if only for this group. It talks about compulsory treatment [and] it specifically excludes a number of treatments which we know work, such as methadone. It is the most studied treatment and, according to studies, the most effective treatment for opiate addiction. And Russian legislation, simply based on moralistic arguments, forbids the use of this medication."

In contrast, Grund says the government of Ukraine has adopted a more open, or liberal approach to the problem by introducing new legislation to fight the country's growing epidemic of the HIV virus, which causes AIDS. Grund says Kyiv officially endorses the use of needle exchange to stem the spread of infection and has adopted several harm reduction programs in the past year to better inform its drug-using public. Grund says the difference in approach is producing a difference in public health as well.

In Ukraine, he says there are some initial positive signs, despite the breadth and depth of the problem there. Grund says Russia, on the other hand, continues to spiral downward in a lethal mix of drugs and disease.

(This is the first in a series of five pieces on drug-related harm and harm-reduction efforts. In the second in the series our correspondent will take a closer look at the situation of drug use and HIV/AIDS infection in Russia and Ukraine.)