Jackson Blair

HLTH1050
Research Paper

The Harm Reduction coalition defines harm reduction as a set of practical strategies and ideas
aimed at reducing negative consequences associated with drug use. This definition can be expanded –
harm reduction benefits both the drug user and the general population in the direct community of the
drug users. Harm reduction programs have shown themselves to be a resounding success – although
there are countless examples of successful programs the three main programs this paper will address
are the drug policy in Israel, harm reduction programs in Mexico, and the development of harm
reduction programs in Vietnam.

Israel takes a traditional approach to drug policy – encouraging abstinence, when that fails
moving to probation and punitive measures. Each of these falls under one of the three main “pillars” of
enforcement, prevention, and treatment/rehabilitation. Israel has taken a very progressive approach to
treatment and implemented a number of harm reduction services for those who use heroin and other
intravenous drugs. Among the programs offered across the country are treatment programs using
Methadone and Buprenorphine maintenance. In addition to this they have implemented a
needle/syringe exchange program. Tel-Aviv has one of the higher rates of drug abuse in the country, and
as a result has a few more specialized programs available – they have opened health clinics, an
emergency housing accommodation for addicted sex workers, and a “first step” center to get people on
the right track. in shifting towards a public health approach towards drugs Israel has made significant
progress in the realm of harm reduction.

A large portion of the harm reduction programs in Mexico are supported both financially and
technically by the Mexican National HIV program. Harm reduction programs were implemented in the
following cities – Tijuana, Mexicali, Ciudad Juarez, Chihuahua, Delicias, Agua Prieta, Caborca, Cajeme
Guaymas, Hermosillo, Navojoa, Nogales, and San Luis Rio Colorado. These programs included needle
exchanges, provisioning prevention supplies, communication actions, and education on drug use
coupled with health care for HIV and STIs. In addition, they started performing tests for HIV, syphilis, and
other STIs while providing counseling and linking cases to health services for further support. All of this
serves to create a safer environment for at risk drug users – now they have a way to get clean needles,
get regularly tested for STDs/STIs, and have a line of support when they choose to stop using drugs. It is
a very human-centric and public health-oriented approach to something that is clearly a problem for the
whole country. Despite the amount of evidence supporting harm reduction programs worldwide there is
very little information regarding the impact of these programs in Mexico prior to the study referenced in
this paper. This study found that an estimated 869 HIV infections were prevented. Comparing the cost of
prevention vs the cost of care there is an estimated $600,000 pesos / $25,000 USD saved per prevented
infection. This means an estimated total of almost $22 million was saved in a three-year program as a
direct result of the proper implementation of harm reduction programs in Mexico.

Vietnam has history as a major exporter of opium, however that has declined by 98% between
1990 and 2001, and they are not currently major source of any black-market drugs. This was achieved
through coercing farmers to stop growing opium, although they did not provide any alternative means
of income which negatively affected farming communities. As far as current drug use goes heroin is the
most popular drug among users, closely followed by amphetamine/stimulants. Vietnam is leagues
behind on the treatment front – when a user is arrested for the first time, they are sent to a compulsory
treatment center referred to as a 06 center. There are reports that inmates in these centers are
 Jackson Blair
HLTH1050
Research Paper
regularly beaten with and electric batons. There is a higher likelihood of contracting HIV in these centers
than outside of them. These centers have been referred to as labor camps where users are forced to
work under the name of labor therapy. On subsequent arrests after going through the “treatment”
program in an 06 center, users are sent to prison for up to 2 years on their first relapse and up to 5 years
on their second relapse. This approach causes an already bad situation to become even worse. Due to
rising HIV rates Vietnam has gradually introduced harm reduction measures, it is not widespread or fully
implemented as the de facto way of handling things yet. They have introduced methadone maintenance
and needle exchanges starting in around 2008 across 80 sites in 30 cities. The government has
acknowledged that the current provisions are inadequate to handle the current situation. Interestingly,
despite the approval of the harm reduction programs from the government the police operate
independently forcing the harm reduction programs to hide needles in tea stalls or secret boxes so users
are not identified by the police who are receiving quotas on the amount of users they are required to
arrest.

This is a horse that has been beat to death and then some, over and over again. Harm reduction
programs are incredibly effective at helping both the user and the surrounding community. We can see
the amount of cost savings that come from focusing just on intravenous drugs. Expanding to other drugs
allows more individuals participating in high risk behaviors other than drug consumption (unprotected
sex, sleeping outside, not regularly checking check ups from a doctor) to receive the help and support
they need to get clean and stop the spread of other infectious diseases. Anything short of full
commitment to harm reduction services will result in users being afraid to seek help and completely
undermines the point of the services existing in the first place. My hope is that as a global community
we can come together and implement a unified and consistent approach to the epidemic sweeping the
world.
 Jackson Blair
HLTH1050
Research Paper

Works Cited

Windle, James. “A Slow March from Social Evil to Harm Reduction: Drugs and Drug Policy in Vietnam.”
Journal of Drug Policy Analysis, vol. 10, no. 2, Dec. 2017, pp. 1–22. EBSCOhost, doi:10.1515/jdpa-2015-
0011.

Hagit Bonny-Noach. “Harm Reduction Drug Policy in Israel: What Has Been Accomplished and What Still
Needs to Be Done?” Israel Journal of Health Policy Research, no. 1, 2019, p. 1. EBSCOhost,
doi:10.1186/s13584-019-0343-3.

Valenzuela-Lara, Marisol, et al. “Impact of Funding Harm Reduction Programs for People Who Inject
Drugs in Mexico.” Salud Mental, vol. 42, no. 4, July 2019, pp. 157–163. EBSCOhost,
doi:10.17711/SM.0185-3325.2019.021.