Nursing Harm Reduction Network (NHRN)

fins · Jul 18, 2007

I'm not a big supporter of the idea of having nurses help addicts shoot up. It just doesn't seem like the sort of thing that nurses should be doing.

What really gets me though is how hard you have to dig to uncover the fact that this is what is being adovcated by the Nursing Harm Reduction Network. I have an intense dislike of soothing euphemisms that obscure what people stand for.

If you think that there's a case to be made for having nurses shoot up addicts, then make it. I don't think that I'll agree with you, but at least we'll both know what we're talking about.

But to use a euphemism like "harm reduction" isn't just vague, it's manipulative. It paints people who disagree with you as being in favor of increasing harm - which is no doubt part of the intent. Plus, it certainly sounds better than the Association of Nurses Enabling Addicts.

Debra ACRN · Jul 18, 2007

In my understanding of harm reduction, it isn't about shooting up patients, it's about helping the patient to see small steps to reach goals.

For example, you have a diabetic patient that needs to lose weight, in harm reduction you wouldn't say, lose weight, here's a diet. You may say, there are many steps to get to the big goal of losing say 30#s, can you think of a step that may get you to that bigger goal. Could you drink your coffee without sugar, or could you stop eating after nine at night, or could you order grilled instead of fried. Lots of options and smaller steps rather then large steps. A step where harm is reduced is seen as a victory.

As an AIDS nurse, I would definitely want my IV drug using patients to stop, but I'll settle for not sharing needles, cleaning needles with bleach, using needle exchange, developing relationship with health care professionals that are non-judgemental, smoking instead of shooting. All small steps to get to big goals.

It feels more respectful to the patient, It feels to me, like it acknowledges that they are in control and we just offer advice.

sibadeben · Jul 19, 2007

I will start to thank Debra for her comments. Very helpful!

In the second part of this post, I am very sorry that Fins has such a simplistic way in what Harm Reduction means. I do not know whether to say thank you for calling US (NHRN) manipulatives which I found offensive or whether this is due to a lack of understanding of what the goals and objectives of Harm Reduction are.

In essence, harm reduction refers to policies and programmes that aim to reduce the harms associated with the use of drugs. A defining feature is their focus on the prevention of drug-related harm rather than the prevention of drug use per se. One widely-cited conception of harm reduction distinguishes harm at different levels - individual, community and societal - and of different types - health, social and economic (Newcombe 1992). These distinctions give a good indication of the breadth of focus and concern within harm reduction.

Primary prevention efforts to discourage the use of drugs by young people have remained a feature of the drug policy of countries that have been most strongly associated with the harm reduction approach such as The Netherlands, Australia, Canada, Germany, Switzerland and the United Kingdom. Conversely, treatments such as methadone maintenance that are firmly located within a harm reduction framework are widely available within the USA.

Historically, the main stimulus to the development of harm reduction policies and programmes was the identification of the role of injecting drug use and the sharing of needles and syringes in the transmission of HIV/AIDS. More or less in parallel, a number of countries re-examined the tension between policies that prioritised the reduction of drug use and those primarily concerned with reducing harm, drawing conclusions similar to that of the Advisory Council on the Misuse of Drugs (1988), which advised the British government that the:

...threat to individual and public health posed by HIV and AIDS was much greater than the threat posed by drug misuse...

and led to the conclusion that a hierarchy of goals should be pursued as follows:

1. Reduce the incidence of sharing injecting equipment

2. Reduce the incidence of injecting

3. Reduce the use of street drugs

4. Reduce the use of prescribed drugs

5. Increase abstinence from all drug use.

As the quotation above suggests, it is an approach that is grounded within public health and around this time, a number of countries introduced needle exchange schemes and developed or extended their methadone treatment programmes, subsequently leading to claims that these policies have been successful in averting or reversing the epidemic spread of HIV/AIDS (Stimson 1996; Des Jarlais 1998; Des Jarlais 1999; Commonwealth Department of Health and Ageing 2002)

The Canadian Centre on Substance Abuse (CCSA 1996) offers the following:

1. Pragmatism: Harm reduction accepts that some use of mind-altering substances is a common feature of human experience. It acknowledges that, while carrying risks, drug use also provides the user with benefits that must be taken into account if drug using behaviour is to be understood. From a community perspective, containment and amelioration of drug-related harms may be a more pragmatic or feasible option than efforts to eliminate drug use entirely.

2. Humanistic Values: The drug user's decision to use drugs is accepted as fact. This doesn't mean that one approves of drug use. No moralistic judgment is made either to condemn or to support use of drugs, regardless of level of use or mode of intake. The dignity and rights of the drug user are respected.

3. Focus on Harms: The fact or extent of a person's drug use per se is of secondary importance to the risk of harms consequent to use. The harms addressed can be related to health, social, economic or a multitude of other factors, affecting the individual, the community and society as a whole. Therefore, the first priority is to decrease the negative consequences of drug use to the user and to others, as opposed to focusing on decreasing the drug use itself. Harm reduction neither exclualteration to the mode of use may be more effective.

4. Balancing Costs and Benefits: Some pragmatic process of identifying, measuring, and assessing the relative importance of drug-related problems, their associated harms, and costs/benefits of intervention is carried out in order to focus resources on priority issues. The framework of analysis extends beyond the immediate interests of users to include broader community and societal interests.

Because of this rational approach, harm reduction approaches theoretically lend themselves to evaluation of impacts in comparison to some other, or no, intervention.des nor presumes the long-term treatment goal of abstinence. In some cases, reduction of level of use may be one of the most effective forms of harm reduction. In others,

5. Priority of Immediate Goals: Most harm-reduction programs have a hierarchy of goals, with the immediate focus on proactively engaging individuals, target groups, and communities to address their most pressing needs. Achieving the most immediate and realistic goals is usually viewed as first steps toward risk-free use, or, if appropriate, abstinence.

Harm reduction principles such as pragmatism, with its focus on immediate, achievable goals are routinely applied to many causes of harm. In this sense the harm reduction approach is no different to the way that risks are routinely managed in many different realms of human activity.

Despite the injuries, environmental impact, pollution and death toll associated with motoring, its elimination is not seen as realistic because people depend on their vehicles and, realistically, will not relinquish them. Speed limits, emission controls, seat belt and crash helmet laws can all be understood as harm reduction strategies to reduce the risks and harms of motoring.

Same concepts can be applied to diabetics, hypertension, and other diciplines in health care... Are we going to expelled from treatment a diabetic patient for indulging itself to a nice piece of cake?

The key concept here is respect and dignity.