Newcombe says that it is too late to apply 'primary prevention' - education
to prevent people taking drugs - to the present generation of drug users.
In general terms, primary prevention has failed. However, it has been shown
that education can slow the development of the more problematic forms of
drug use, while leading to an increase in safer forms of drug use. This
suggests that it would be prudent to divert some resources towards
'secondary prevention' or 'harm reduction' - preventing overdosing,
accidents and infections which result from ignorance.
Policy makers should be giving serious consideration to the question:
"Would it be preferable to reduce the incidence of illicit drug use while
not promoting safer forms of drug use, or would it be more realistic to
give greater priority to the reduction of harm from drug use?"
According to Newcombe, the four main components of a harm reduction
strategy should be: (1) rationale, (2) content, (3) implementation and (4)
evaluation.
1. It should be acknowledged that people like to get high, and that this is
not likely to change. Drug use may be rational, not deviant, Newcombe says.
It should be acknowledged that many psychoactive drugs are no more harmful
than prescribed drugs. "The message that drugs are unhealthy is akin to
warning soldiers in battle that chewing gum can cause indigestion," he
says. Harm reduction policies are based on a caring rather than a
judgemental approach, and are therefore less likely to drive drug users
underground.
2. The strategy must be based on knowledge. The focus should be on
controlling use rather than seeking complete abstinence, which is out of
character with modern life. Instructions should be given on suitable
quantities, effects, safest methods of administration, obtaining help when
needed, avoiding hazards and methods of controlling mental states.
3. The implementation strategy should draw on knowledge of how to maximise
the probability of success. Drug use tends to follow on from heavy smoking
and drinking, so smokers and pub goers are a suitable target, although
there may be a risk of arousing an interest in drug use, and there may be
objections from parents.
4. It will be necessary to do 'before and after studies' and long-term
follow-ups using control groups to evaluate the effectiveness of harm
reduction strategies.
