Qatar University College of Arts and Science

Department of International Affairs

Capstone

Spring 2015

Harm Reduction program as a tool to Prevent People who Use Drugs from Health issues

Dana Ali AlQahtani

201005563

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Index

Introduction

Definition of Concepts

Harm Reduction Program

Human Rights of Addicts

Harm Effects of Drug Addiction

Substance Use Disorder

Deaths

Infections of HIV and HCV

Literature Review

Methodology

Harm Reduction Program

Drugs Addicts

Research Problem

Research Objectives

Research Questions

The importance of the research

Hypothesis

Type of the Research

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Discussion

Reduce the HIV and HCV Infections.

Reduce the Poison of the Drug by Early Warning System

Qatar and Harm Reduction

Conclusion

Recommendations

References

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Introduction

Drugs users are members of any community; they are population that could not be

ignored in the societies. They work and live in the community. Many years before, communities

could not accept the addicts and feel they are criminals in the community. They faced many

social and health problems that cause them diseases and deaths. Health and safety is such a

concern for people who use drugs as it is for the general population (Working with People who

use Drugs, 2007). Communities should seriously take a policy to help and prevent drugs users

from the harm consumptions of the drugs. Substance Abuse Treatment (2002) viewed that it does

not matter how or why the individual starts using drugs over time, repeated drug use causes

significant changes in brain and function that lead to addiction, and drug’s users could not stop

even they know the terrible consequences of the addiction. The solution is to find a program that

prevents them from harm.

Harm Reduction Program:-

Harm reduction is the policies, programs, and practices that aim to reduce the adverse

health, social and economic consequences of the use of the legal and illegal substances without

reducing the drug consumptions. Harm reduction program can benefit the individuals, families,

and communities (Harm reduction: Questions and Answers, 2014).

The program has been applied to many countries such as Canada and United States.

Some researchers found the program will benefit the individuals, families and the communities,

but the other refused the program describing it as a program that will increase the addicts in the

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community, which will cause disadvantages to the individuals by increasing the number of the

addicts, and it will be harmful to the families and the communities.

Human Rights for Drugs Addicts:-

Drug Policy and Human rights (2015) viewed that many countries around the world

practice abuse, torture and ill-treatment for addicts’ individuals. But the United Nation drug

control agencies have paid attention to whether international drug control efforts are consistent

with human rights protection, or to the effect of drug control policies on fundamental Human

Rights. The UN believed that drug control should respect human rights. Jensema (2013)

mentioned that UN favor the decriminalization of use and advocate for harm reduction

approaches for addicts, because every individual has the right to live a life in dignity.

Harm Effects of Drug Addiction

Substance Use Disorder

Substance use disorder occurs when a person has a dependence on drugs that is

accompanied by intense and sometimes uncontrollable craving and compulsive behavior to

obtain the substance. In the substance use disorder multiple brain circuits are altered creating

changes in brain function. These changes interfere with the ability to think clearly and use good

judgment; they affect learning and memory as well as the ability to control behavior. Substance

Use Disorder (2014) mentioned that the substance use has a harm effect on the part pf the brain

that allows for good judgment. The problem is that drug users did not think their troubles are

from the drug addiction. This phenomenon called denial of the problem, which is a symptom of

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disorder. Tolerance and withdrawal are other symptoms of drug addiction. They are two

symptoms that a result of the biological changes in the brain and nervous system from continual

use of a substance. Substance Use Disorder (2014) mentioned that Tolerance is the increasing

need by the body for larger doses of substance to maintain the desired effect. The other symptom

is the withdrawal, which means that when the substance stopped, the drug users will face

shakiness and extreme anxiety.

Death

Global State (2014) viewed that overdose of the substance is the major cause of death to

the drug users. Overdose mortality is increasing in the countries that did not apply the Harm

Reduction Program in their policy. For example, it has estimated in Global State (2014) that

around 100,000 people die from the overdose in Russia. In 2012 the United Nation made a report

about the global number of deaths from the drug addiction. The report mentioned that drug abuse

kills about 200,000 people around the world each year (Drug Abuse, 2014).

Virus HIV and Hepatitis C:

Viruses HIV and HCV are two symptoms to drug addiction. Global State (2008)

mentioned that 10% of all HIV infections in the countries occur through injecting drug use and in

some countries such as, Russia and Ukraine 80% of people living with HIV are likely to have

acquired the virus through unsafe injecting.

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Figure (1)

HIV prevalence among people who inject drug

HIV Percentage

Britain

India

Figure (1) shows that the HIV virus from unsafe injecting in Britain is 5%, India 68%,

and Indonesia 47% (Global State, 2008).

HCV also is a common infectious disease among people who inject drugs. The virus is

more infectious than HIV and can be transmitted through sharing not only the sharing of needles

and syringes, but also of injecting- related equipment such as cotton. Global State (2008) viewed

that most HCV infections around the world occur through unsafe injecting drug use.

Figure (2)

HCV Prevalence among People who Inject Drugs

HCV Prevelence among People who Inject DrugsBritain

IndiaIndonesiaBahrainSaudi Arabia

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The figure shows the percentage of the HCV among people who inject drugs. The results

show that the percentage in Britain is (41%), India (92%), Indonesia (98%), Bahrain (81%), and

Saudi Arabia is (69%).

The aim of the research

The research will show the advantages and the disadvantages of the Harm Reduction

Program by analyzing the previous studies about the program, and show data from previous

studies to show the percentage of samples who use the program and benefit from it. In the end of

the research, the researcher will show if the program could be applied in Qatar society, and give

some implications about the problem.

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Literature Review

Harm reduction program is a public health strategy that was directed towards individuals

and groups that aims to reduce the harm that was associated with certain behaviors. Hunt (2003)

mentioned that the program is concerned with reducing the harms that can accompany drug use,

and is sometimes with approaches priorities prevention of drug use, and a rigid zero tolerance

enforcement of drug prohibition. When the programs were applied to substance abuse, harm

reduction accepts that a continuing level of drug use in society is inescapable and defines

objectives as reducing adverse consequences (Harm reduction, 2008). The programs emphasize

the measurement of health, social and economic outcomes, as opposed to the measurement of

drug consumptions.

There are many services available to prevent harms from substance use. Substitution

therapy is one of the services. Its goal is to substitute illegal heroine with legal one, which is

taken with non-injection methadone. The other service is educating drug users to encourage safer

behavior. The last service is the needle distribution program that distributes clean needles and

educate on their safe disposal. Programs for needle and syringe exchange were more readily

associated with the harm reduction approach than other type of interventions, because needles

and syringes were the most dangerous on health and increase mortality and morbidity. Hunt

(2003) mentioned that the main motivation to the development of harm reduction strategy was

the identification of the role of injecting drug use and the sharing of needles and syringes in the

transmission of HIV/ AIDS.

There are many principles for harm reduction. Humanistic values are one of the

principles, which mean that the drug user’s decision to use drugs is accepted as fact, and the

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dignity and rights of the drug users are respected. Focus on harm is another principle of harm

reduction, which means the fact of a person’s drug user per se is a secondary importance to the

risk of harm consequent to use. The harms addressed could be related to health, social or

economic factors, affecting the individual and the community. Therefore, decreasing the negative

consequences of drug use to the user and the other is the first priority.

The programs’ initial identification was in the 1980s, as an alternative to abstinence only

focused interventions for adults with substance abuse disorder. Persuasive evidence from the

adult literature that harm reduction approaches reduce morbidity and mortality associated with

the risky health behaviors (Harm reduction, 2008). Areas in Canada that use needle exchange

have shown annual decreases in HIV compared with those areas that have not use the needle

exchange program. In addition, using the methadone maintenance programs is strongly related to

decrease mortality from diseases and overdoses (Harm reduction, 2008).

Ruefli and Rogers (2004) argued that harm reduction programs operate with the

assumption that some people who engage in high- risk behaviors are unwilling or unable to

abstain. Using the programs do not require that clients abstain from drug use in order to gain

access to service, rather than having abstinence goals set for them. Clients in such programs take

part in a goal setting process to success. Providers help clients to make connecting among their

complex attitudes, behaviors, and the change. They are trying to pursue as a result of interactive

process. Behavior change is regarded as incremental and based on the premise that people are

likely to initiate and maintain behavior changes if they have the power to shape behavioral goals

and enact them.

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A study was done by Rogers and Ruefli (2004) on 120 clients using nominal group

technique to develop culturally relevant outcomes to measure progress. The researchers argued

that the results showed that program participants made positive improvement across most

outcomes with the most substantial progress made in how clients dealt with drugs use problems.

For example, comparing the 120 clients who involved in the program and stayed for one year

and the clients who involved in traditional therapy; the clients who were involved in the harm

reduction program were strongly related to their progress in the outcomes of housing and

income. They success to abstinence or controlled, having low- level drug use, because they want

to qualify for subsidized housing or to maintain an income producing job.

On the other hand, criticism mentioned that the program will not be benefit to individuals

or communities. Hunt (2003) argued that using the harm reduction program encourages drug use;

by assisting people who are already using drugs remain healthier and stay alive. The other

problem that could be caused from the program that people who do not use drugs will see drugs

as safe and decide to start using drugs themselves. In addition, Loughlin (2010) argued that the

harm reduction program is a process that facilitates the continued of toxic, which is harmful for

the individuals, and it will damage the society by escalating the crime.

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Methodology

Harm Reduction Program:

Understanding Harm Reduction (2013) viewed that Harm Reduction is a program that

aims to keep substance users safe and minimize death, disease, and injury from high risk

behavior. It involves a range of support services and strategies to help individuals, families and

communities safer and healthier. There are some services use to prevent harm from drug use.

Such as:

1. Needle distribution. It is a recovery program that distributes sterile needles and other

harm suppliers, and provides information about their safe disposal.

2. Supervised consumption facilities to prevent the drug users from overdose deaths and

harms by providing a supervised environment for drug’s users.

3. Therapies that substitute illegal heroine with legal and no injection methadone.

4. Education services that make contact with people who use drugs to encourage safer

behavior.

5. Driving prevention campaigns that create awareness of the risks of driving under the

influence of legal and illegal substances.

Drugs Abuse and Addiction:

The Science of Addiction (2007) mentioned that people of all ages suffer the harmful

consequences of drugs abuse and addiction even if they adolescents or adults. Adolescents

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who abuse drugs often do poorly academically, they are at risk of violence and infectious

diseases. In addition, adults who abuse drugs often have brain problems, such as problem

thinking clearly, and remembering. They often developed poor social behaviors as a result of

their drug abuse. Drug addiction is a chronic, relapsing brain disease that characterized by

compulsive drug seeking and uses, despite the harm consequences that drug’s users feel.

These people have the right to live in high standards of living, and get services from the

community and the state, such as health care, mental health and social services (Substance

Abuse Treatment, 2002).

Research Problem

Drugs users are a kind of people that face many health and social problems in their lives.

They are poorly educated and have a less chance in work. They face many health problems

such as HIV and Hepatitis B and C from using the injections. In addition, they are at a risk of

violence and community abuse. These people could not stop the addiction even they know

the harm consumptions that they face. The research focuses on the treatment that benefits the

substances users to reduce the harm of the addiction without stop the use of these substances.

The research aims to:

1) To show the advantages of Harm Reduction Program on the individuals.

2) To show the disadvantages of the Harm Reduction Program on the individuals.

3) To show if the program could be applied in Qatar society.

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Research Questions

Main Question:

Could the Harm Reduction Program be benefit for the drug users?

Sub- Questions:

1) What are the advantages of the Harm Reduction Program?

2) What are the disadvantages of the program on the individuals and the community?

3) Could the program be applied in Qatar society?

The Importance of the Research:

The research is an exploratory study to see the advantages and the disadvantages

of the Harm Reduction Program as a new perspective in the community, especially the

Arabic societies who refuse the concept of addiction. The Arabic societies as Qatar prefer

to use the traditional treatment for the addicts. Even Qatar has opened a center for the

addicts, but the main objective is to rehabilitate the addicts and not to prevent them from

the harm consumptions of the drugs (Scott, 2014). They isolate the addicts from the

community and treat them to stop taking drugs. The state did not adopt the Harm

Reduction program to prevent the addicts from the harm consumption that they could

face, which means that Qatar is using the traditional treatment for Drug’s Users. After

analyzing the advantages and disadvantages of the program, the researcher will show if

the program could be applied in Qatar society.

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Hypothesis

1) The program has benefits to prevent drug’s users from the harm

consumptions.

2) The program will increase the addicts.

3) The program could not be applied in Qatar society.

Type of the Research

The research is a Qualitative study. It is primary exploratory research to give

understanding of underlying reasons, and opinions for using the Harm Reduction

Program for the Drugs addicts. It gives insights into the Harm Reduction Program to

see the advantages and the disadvantages of the program and how it could help the

individuals. The research gives deeper into the program to see if it is benefit to the

drugs addict, then it shows if the program could be applied in Arabic countries such

as Qatar.

Discussion

Reduce the HIV and HCV Infections:

Hedrick and Rhodes (2010) mentioned that Harm Reduction Program coincided with the

emergence of human immunodeficiency virus HIV and HCV epidemics in many countries. The

aim of the program is to reduce the harm effects of the HIV and HCV. Harm Reduction (2005)

mentioned that the program has a positive impact on public health by reducing the prevalence of

blood borne viruses such as HIV and HCV. Needle exchange programs recover more needles

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than they distribute. The program supervised the needles that the drug users inject themselves,

and by supervising injection facilities the number of public injecting will reduce. The program

will provide the drug users a safe and alternative drug use. Harm Reduction (2005) viewed that

by using the program the risk of contracting HIV could decrease as much as 50- 80%.

On the other hand, there are some countries applied the program by providing sterile

injecting equipment. Hedrick & Rhodes (2010) mentioned that in 2002 (77) countries in the

European Union made the syringe sales are legal. After six years of the adaptation of the Harm

Reduction in these countries, the European Commission concluded that among of the EU States

there are signs of higher level of risks taking among new, younger generation, in particular

heroine injectors who have not been reached the harm reduction messages. The new young drugs

users feel that helping drug users stay alive, reducing their exposure to risk and became healthier

feel that the drug user safe and start using drugs (Harm Reduction, 2005). These results show

that Harm Reduction Program sent out wrong messages and signals and undermined primary

prevention efforts. In addition, Global State (2012), which means after 10 years of applying the

program in the EU, mentioned that people living with HCV in European Union have increased.

The percentage in Britain was 41%, and it became 62% by year 2012.

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Figure (3)

The Percentage of HCV in EU between 2002 and 2012

HCV in EU

Figure (3) showed that the HCV in the Europe did not decrease, and the program did not

succeed in the countries that applied the Harm Reduction Program.

Reduce the Poison of the Drug by Early Warning System:

Before using the Harm Reduction Program in the European Union Policy, the illegal

drugs were not subject to the government control for safe manufacture, storage and distribution,

which make the illicit markets associated with harms arising from poor product safety. For

example, factories were uncertain about the strengths or purity of the drug, which has made it

difficult to calculate doses, resulting overdoses and deaths. After applying the program in EU,

the governments control responses to the danger and poisons of the drugs by testing and early

warning systems, which change the product and alert for the health.

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Qatar and Harm Reduction

The researcher searched for applying Harm reduction Program in Qatar from 2008-2014.

No data was found that Qatar adopted the program. Global State (2012) viewed that Qatar did

not respond to the program, and there is no data about the number who use drugs, or what is the

way in dealing with drug users. Moreover, Overcoming addiction (2013) mentioned that little is

known about substance abuse in Qatar, except it is exists. Qatar opened the Treatment and

Rehabilitation Center (TRC). The center offers a comprehensive service, including treatment and

support for people who suffer from addiction. But the aim of the center is to return drug users so

they can return to normal, Productive lives and education to prevent addiction in the first place.

The Harm Reduction Programs has many criticisms about its effectiveness. The program

did not prohibit drugs for drugs users, which is not allowed in Qatar’s culture. If the program

shows more effectiveness in reducing HIV, HCV, and the overdoses deaths, Qatar will look

seriously to the program, because the HIV rates in Qatar continue to increase. Qatar is one of the

countries that care about its people health. It could follow some countries that adopted the

program such as, Oman, Iran, and Bahrain. Walker (2014) gave a data to show the numbers of

HIV number in Qatar:

The year HIV infections in Qatar

2009 5 infected

2010 11 infected

2011 11infected

2012 15 infected

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References:

Drug Policy and Human Rights (2015). Human Rights Watch. Retrieved from

http://www.hrw.org/node/82339

Drug Abuse Kills 200,000 People Each Year: UN Report (2012). Drug- Free Kids. Retrieved

From http://www.drugfree.org/join-together/drug-abuse-kills-200000-people.

Global State of Harm Reduction: Mapping the Response to Drug Related HIV and Hepatitis C

Epidemics (2008). Ihra. Retrieved from www.ihra.net.

Global State of Harm Reduction (2012). Count the Costs. Retrieved from www.countthecost.org.

Global State of Harm Reduction (2014). Ihra. Retrieved from www.ihra.net.

Harm reduction: An approach to reducing risky health behaviors in adolescents (2008). Pediatric

Child health.13 (1). 53-56.

Harm Reduction: Questions and Answers (2014). Waterloo: Public Health.

Harm Reduction (2005). Britain: A British Columbia Community Guide.

Hedrick, Dagmar& Rhodes, Tim (2010). Harm Reduction: Evidence, Impact and Challenges.

Britain: European Monitoring Center for Drugs and Drugs Addiction.

Hunt, N (2003). A review of evidence- base for harm reduction approaches to drug use.

Retrieved from http://www.forward-thinking-on-drugs.org/review2-print.html.

Jensema, Ernestien (2013). Human Rights and Drugs Policy. TNI. Retrieved from

http://www.tni.org/briefing/human-rights-and-drug-policy

Loughlin, Peter (2010). Is It Harm Reduction or Harm Continuation? USA: The Journal of

Global Drug Policy.

Overcoming Addiction (2013). Qatar: Supreme Council of Health.

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Ruefli, Terry& Rogers, Susan (2004). How do drugs users define their progress in harm

reduction Programs? Qualitative research to develop user- generated outcomes. USA:

National Institute of health.

Rogers, Susan& Ruefli, Terry (2004). Does harm reduction programming make a

difference in the lives of highly marginalized, at-risk drug users? USA: Harm Reduction

Journal.

Scott, Victoria (2014). Expanded Treatment Center for Addicts to Formally open Next Month.

Qatar: Qatar News.

Substance Use Disorder (2014). USA: Alta Bates Summit Medical Center.

Substance Abuse Treatment For Injection Drug Users: A Strategy with Many Benefits (2002).

USA: Department of Health and Human Services.

The Science of Addiction (2007). USA: department of Health and Human Services.

Understanding Harm Reduction Substance Use (2013). HealthlinkBC. Retrieved from

http://www.healthlinkbc.ca/healthfiles/hfile102a.stm.

Walker, Lesley (2014). SCH: Qatar residents diagnosed with HIV increases to 10- year high.

Qatar: Qatar News.

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