From a historical perspective, the treatment of people of their substance abuse characters has been focusing on the elimination of the usage of drugs, which means that it has neglected the prevention of the harmful effects of the usage of the drugs. However, in the recent past, the minimization of harm from the usage of drugs has developed rapidly. The interventions that focus on the reduction of the adverse effects associated with the usage of illicit drugs to both the people who use them and their communities, harm reduction, has emerged as one of the most controversial topics in the modern world, especially in the US. While strategies of harm reduction have been increasingly acknowledged and adopted into the strategies of drug treatment polices in some European nations and other nations, they have not been popular around the US (Council of the European Union, 2004; Hilton et al., 2000). On one side of the debate, proponents of the strategy consider that it is a useful way of helping people who cannot quite their addictive lifestyles. However, contrarily, those against the approach suggest that it does not teach people on the importance of avoiding drug dependency, but encourages them to abuse them even further (Toumbourou et al., 2007). Therefore, the objective of this paper is to analyze both sides of the controversial issue through considering the positives and negatives of the harm control approaches.
An Overview of Harm Reduction Strategies
Harm reduction denotes the practices, programs, and policies that purpose to reduce the harms related to the usage of psychoactive drugs among individuals that have been unable or those who are reluctant to stop (Harm Reduction International, 2017). The defining features of this program are its focus on the prevention of harm as opposed to the hindrance of the usage of the drugs themselves as well as its attention on the individuals who sustain their drug usage tendencies. A discussion on harm reduction started to be prominent following a recognition of the threat of the spread of HIV from and among the drug users who inject the substances into their bodies (Leslie, 2008). However, it is worthwhile noting that similar interventions have been utilized for a long time in many additional contexts for an array of drugs.
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Harm reduction supports the efforts that seek to reduce or prevent the overall levels of drug consumption among society members. This approach is founded in the realization that most individuals around the globe continue to use the psychoactive drugs even in the wake of the most powerful efforts to curb the initiation or sustenance of the use of drugs (Leslie, 2008). Therefore, harm reduction concedes that most individuals who abuse the drugs are not able or show relative levels of unwillingness to stop the consumption of such substances at any point in time. The accessibility of proper treatment for their problem turns out to be the most fundamental aspect for the individuals who have the problems of drugs. The only problem, nevertheless, is the fact that most of the people with such problems are unwilling to be treated for their issues. Additionally, most of the people who abuse drugs do not need treatment. For such reasons, it is imperative to offer individuals who have these problems with options, which will aid in the minimization of the risks of continued drug usage as well as that of harming themselves and the people around them (Tilson et al., 2009).
The abuse of drugs is a common problem of the West, and it became too common among society members in the 19 th century when doctors started overprescribing opiate medications (Tilson et al., 2009). It is notable that strategies of harm reduction remained alien to the US until the AIDs pandemic of the 1980s. By then, the Heath Omnibus Program Extension Act of 1988 had illegalized the distribution of syringes (Erickson, Butters, and Walko, 2003). However, AIDs and harm reduction activists fought hard against this decision while contesting that the exchange of needles reduced the rates of HIV infection while it did not increase the overall levels of drug usage. Today, the topic remains a controversial issue because while proponents consider that it reduces the rates of infection of blood diseases such as hepatitis C and HIV, opponents contend that it encourages drug usage.
Synthesis of the Arguments
Arguments for Harm Reduction
The primary argument in support of the harm reduction strategies of substance abuse is a consideration that reduces the rates of Hepatitis C and HIV infection. Tis argument is draw from the fact that most of substance abusers who inject the drugs into their blood systems share the syringes and needles for the fact that they do not have sufficient access to fresh needles (Ti and Kerr, 2014; Amundsen, 2006). Despite the growing efforts by governments to deal with the AIDs epidemic, HIV, as well as other infectious diseases continues to afflict the populations of people around the world, especially among those who abuse drugs through injecting themselves. It is notable that the numbers of people who live with HIV and those who have been dying of AIDS has continued to rise. In fact, by 2006, 39.5 million individuals were living with HIV and an approximated 4.3 million children and adults were infected by the same virus in the same year (UNAIDS, 2006). For such reasons, international agencies dealing with health management, including WHO (The World Health Organization) have been on the forefront in the recommendation of programs of harm reduction as the best approaches and critical for the management and reduction of the rates of infection of HIV among injecting drug users (United Nations Office on Drugs and Crime, 2008). There is already evidence in support of this argument. For example, the Canadian Press reports that harm reduction strategies are effective in the reduction of the rates of infection among the injection drug users. Specifically, the findings concerned a fifteen-year study that had been conducted in Vancouver starting from 1996 to 2011. The research found that by 2011, the numbers of users that had been sharing needles fell to 1.7 percent to forty percent (de Moya, 2014).
The programs of harm reduction have also been targeting to make the environments in which people who abuse drugs live safe for their relatives and friends. As opposed to the fact that some of the drug addictions have been facing stigmas because of their conditions, the new approach aims to make society understand the role they have to play in supporting them. The first notion of stigmatization that this approach holds is that considering the drug users as addicts is a form of stigmatization (O'Loughlin, 2007). For this reason, dependency has been adopted because it is thought to be a lesser and less pejorative term, which is also less stigmatizing. It is of special interest noting that dependency was a term that the American Psychiatric Association suggested even while it did not give enough clinical or scientific justifications for its adoption (O'Loughlin, 2007). However, it is now plausible to argue that the suggestion was motivated by socially correct attitudes of the American society towards stigmatization. In this consideration, addiction is considered as a disease as opposed to it being termed as a stigma for the fact that it increases an awareness of the society concerning the real dangers of drug addiction.
Five constructs have been adopted for this explanation, and they all target to make society safer for those who do not use drugs as well as those who do. The first construct is that addiction is a type of disease that affects the spirit, body, and brain of individuals (O'Loughlin, 2007). Additionally, it is thought and argued that no one sets out to be addicted to drugs, and that they do so unconsciously. The third construct is that any individual that includes toxic and mind-altering substances such as alcohol in to their lifestyles can easily develop Substance Abuse Disorder. The forth hypothesis is that some of the people are more vulnerable to being addicted than others while the last one is that there exists a fine line between Substance Abuse Disorder and addiction (Beirness et al., 2008).
The five constructs described in the preceding paragraphs suggest that people who become addicted to drugs need the support of their communities. According to this argument, it is suggested that such people need treatment in the same manner people could be treated for their problems that could not necessarily be caused by addiction. In this approach, the effects of stigmatization of the people who depend on drugs is reduced a great deal, which makes them to live in safe and stable environments. In addition, the fact that this intervention hopes to teach society on the safest methods of drug usage, including the need to move away from the cheap and more destructive forms of drugs means that they learn how to be responsible in their behavior (Beirness et al., 2008). In extrapolation, the drug users will have an opportunity of establishing effective relationships with members of their immediate societies, which creates a co-existence between them and the rest of the community.
The proponents of the harm reduction strategies have also contested that this approach helps drug addicts to get into sustainable employment. This argument is founded on the fact that most of the people whose lives have been ruined by drugs have not received the necessary support to get into meaningful employment (O'Loughlin, 2007). For such reasons, the drug addicts have been left to struggle economically, which has caused them to resort to crime. In fact, crime is the most frequent deviant activity that is associated with the usage of drugs (O'Loughlin, 2007). Some of such addicts engage in crime because they want to obtain money to sustain their lifestyles. On the contrary, others do so because of the psychological effects of the drugs that they consume. Because the harm reduction strategies hope to support people who cannot quit their drug-filled lifestyles, it is only rational that they receive support to sustain themselves economically.
Arguments against Harm Reduction
The most widely debated issue with harm reduction strategies is a consideration that it does not encourage people to stop their addictive ways; instead, it motivates them to keep abusing drugs. Criticism of this program draws from the fact that one of the strategies of dealing with addiction that harm reduction adopts is the provision of drugs to people who would like to have them (de Moya, 2014). For example, the main concern of the proponents of the program has been that substance dependent individuals only harm themselves when they cannot gain access to better quality drugs. Therefore, the program has consistently advocated the provision of drugs such as opioids. The Opioid Replacement Therapies, for example, are among the most recognized forms of drug harm reduction therapies, which help the addicts to maintain their methadone levels (Stockard, 2014).
While this therapy could be useful in dealing with the negative effects of sudden withdrawal from drugs, it encourages them to continue using the drugs. The drugs that they are offered are used as trap to lure and wean them from those offered from the streets. The cause of disagreement in this approach is the fact that even while the program helps the addicts to get off street drugs, it only does so for the heroin and cocaine addicts, but still exposes them to other forms of psychoactive drugs. In this case, therefore, instead of letting the drug addicts feel the consequences of their actions, the harm reduction efforts have encouraged them to continue with their behavior regardless of whether they would be harmful to their health or not (Stockard, 2014). In this line of thought, therefore, opponents contest that harm reduction pushes society into more drug abuse instead of dealing with the issue of treatment of addicts.
Another strong argument against the use of harm reduction strategies in dealing with addiction is the fact that the programs have not been consistent for all the affected people. First, it is needful to acknowledge that the rates of enrolment in such activities have been considerably significant (O'Loughlin, 2007). However, the policy makers in this sector have not been serious in their tracking of the levels of progress of their clients. For example, the numbers of people who present for care under them has accessed the levels of success of the programs. In this case, the recruitment of more people into such programs has been used as the sole statistic measuring their levels of success. Specifically, the higher the numbers of individuals who enroll for the programs, the more successful the programs have been (Beck, 1998). So far, proponents of the same strategies have been arguing that they have been successful since they have recruited relatively high numbers of participants. However, the proponents have not realized the discrepancies in the data that they report. For instance, some of their clients enroll for the programs but drop out soon, yet they are considered to have graduated (O'Loughlin, 2007). Therefore, these programs have not been effective in dealing with the issue of cheap drug use, especially with crack cocaine and heroin since other reports suggest that drug addiction has continued to afflict the American society, especially among the youths (Amundsen, 2006).
Another argument in opposition of the adoption of harm reduction programs in dealing with substance abuse is the fact that it does not better the economic lives of the individuals involved. It may well have been argued by proponents that the intervention helps addicts to get to meaningful employment. Nevertheless, it should be known that drug addiction has ruined the economic lives of individuals in the US and elsewhere. The reasons given for this argument are the facts that an over-reliance on drugs makes the affected people to consider that they cannot work without using them (Rogers and Ruefli, 2004). This reason resonates with the fact that employers have not been easy on any people who habitually use drugs, there have been no employment opportunities reserved for people who are habitual substance abusers (Rogers and Ruefli, 2004). If anything, employers have always been desiring to employ sober people because of their constant preference for people who can benefit their businesses. Sobriety, therefore, has constantly kept drug addicts out of meaningful employment, which means that the proponents have not been effective in measuring the economic effects of their programs on their clients.
Summary and Individual Synthesis
The controversies surrounding the issue of harm reduction programs in the US concern the need for society and medical practitioners to care for people who cannot quite their drug dependent modes of life on one side and that of eradicating addiction on the other. For this reason, proponents of the program have argued that drug addicts do not do consciously, and that their condition should be considered as a disease. The addiction should be considered as a disease since society should not stigmatize people who find themselves in such situations. In this school of thought, addicted people should be assisted to get off street drugs and be taught the best methods of using their drugs, which will reduce the rates of infection and transmission of blood diseases such as HIV and Hepatitis C. In addition, such people need to be supported to live in sustainable and safe environments for themselves and their relatives, and be encouraged to get to meaningful employment.
On the contrary, opponents suggest that the duty of society should not be to encourage addiction, but to eradicate it. Considering this argument, people who find themselves in their trap of addiction should be treated for their problems, and that does not mean that they should be supported to continue with their behavior. This argument, therefore, suggests that drug treatment thru harm reduction have not been useful in supporting people into productive employment since employers seek potentially productive individuals as opposed to habitual drug users. Therefore, more people will likely enter into drugs because of the leniency of society in dealing with the dangers associated with it. As per now, the opponents argue that the exact figures of those who have benefited from the harm reduction interventions remain hypothetical for the fact that such data has not been captured properly.
Practicing APNs have a role to play in the improvement of public health as do the rest of the medical health practitioners. In their role of ensuring proper public health, APNs should discharge their duties with compassion and dignity for all people (Fowler, 2008). The ethical frameworks that underpin the practice of nursing, therefore, require that all the patients be accorded equal treatment. It suggests, therefore, that addicted substance abusers should be treated for their problem. Unfortunately, it should be understood that addiction is not easy to deal with because of the adverse effects associated with withdrawal. Harm reduction strategies could be an effective way in which nurses, especially the PMHNPs would deal with the psychoactive drugs. Specifically, the fact that addiction happens unconsciously and is difficult to cure means that victims of the problems should not be neglected. Instead, they should be encouraged to move away from their lifestyles. In addition, because a sudden cessation of their practices could be harmful, they should be supported to do so through regulating the manner in which they use their drugs. Therefore, the harm reduction programs would be an excellent way of attaining this objective. However, there is a need that the policy makers expand this program to follow up the people that enroll in them and teach society against the dangers of addiction. This way, the rates of drug abuse would go low and make the harm reduction interventions more successful.
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