Harm-reduction

Harm reduction, or harm minimization, is a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction policies are used to manage behaviors such as recreational drug use and sexual activity in numerous settings that range from services through to geographical regions. Critics of harm reduction typically believe that tolerating risky or illegal behaviour sends a message to the community that such behaviours are acceptable and that some of the actions proposed by proponents of harm reduction do not reduce harm over the long term.

Needle-exchange programmes reduce the likelihood of users of heroin and other drugs sharing the syringes and using them more than once. Syringe-sharing can lead to infections such as HIV or hepatitis C, which can spread from user to user through the reuse of syringes contaminated with infected blood. Needle and syringe programme (NSP) and Opioid Substitution Therapy (OST) outlets in some settings offer basic primary health care. Supervised injection sites are legally sanctioned, medically supervised facilities designed to address public nuisance associated with drug use and provide a hygienic and stress-free environment for drug consumers. The facilities provide sterile injection equipment, information about drugs and basic health care, treatment referrals, and access to medical staff.

Opioid replacement therapy (ORT), or opioid substitution therapy (OST), is the medical procedure of replacing an illegal opioid, such as heroin, with a longer acting but less euphoric opioid; methadone or buprenorphine are typically used and the drug is taken under medical supervision. Another approach is Heroin assisted treatment, in which medical prescriptions for pharmaceutical heroin (diacetylmorphine) are provided to heroin-dependent people. Toronto's Seaton House became the first homeless shelter in Canada to operate a "wet shelter" on a "managed alcohol" principle in which clients are served a glass of wine once an hour unless staff determine that they are too inebriated to continue. Previously, homeless alcoholics opted to stay on the streets often seeking alcohol from unsafe sources such as mouthwash, rubbing alcohol or industrial products which, in turn, resulted in frequent use of emergency medical facilities.

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