Abstract: Syringe-exchange programs (SEPs) in Connecticut operate with caps on the number of syringes exchanged per visit. We investigated the effects of legislation increasing the cap on drug injectors’ access to clean syringes through the SEPs in New Haven and Hartford. The mixed design of this study included longitudinal and cross-sectional data from individuals and ecological data from program operations. Five parameters-syringe return rate, syringes per visit to the SEP, syringe reuse rate, syringe human immunodeficiency virus (HIV) prevalence, and syringe sharing-were monitored through syringe tracking and testing of SEP syringes and by interviewing injectors. Two increases in the cap-from 5 to 10 and then from 10 to 30-had little effect on the five parameters that measured injectors’ access to clean syringes. In contrast, access to clean syringes increased when the New Haven SEP first began operations, when syringes first became available at pharmacies in Hartford, and when the agency running the Hartford SEP changed. Legislation providing piecemeal increases in the cap may not, by themselves, be sufficient to increase injectors’ access to clean syringes and decrease the risk of human immunodeficiency virus transmission in this population.

Abstract: Restricting availability is the major response to illicit drugs in most Western countries including Australia. Prohibition may reduce harm when the drug in question is in low demand, controls are difficult to subvert, and when similar drugs are less toxic or unavailable. However, the health, social and economic costs of supply reduction are substantial and increasing for both injecting drug users and the general community. Population adjusted mortality of heroin users has doubled in Australia in the last decade. The possible impact of supply reduction policy on the spread of HIV infection among IDUs is an important but largely neglected consideration. The effectiveness of supply restriction policy in decreasing the availability of drugs or in reducing drug-related harm is unlikely to be increased significantly by more vigorous implementation of supply reduction or adoption of new technology. Conversely, on the basis of existing data, greater availability of HIV prevention measures attractive to the target population (including especially drug treatment such as methadone maintenance) is likely to be effective and cost-effective. The costs and benefits of innovative methods of providing currently illicit drugs to those who are determined to use them requires careful evaluation and comparison with existing policies. Policy on illicit drugs in most countries including Australia is still dominated by concern about drug use rather than focused on the need to reduce drug-related problems, which is the agreed aim of national drug policy.

Abstract: With the limited exception of HIV/AIDS prevention, harm minimisation in the UK has focused on the harm that drug users may do to themselves. This article explains how harm minimisation within Hammersmith and Fulham (part of inner London ) has now begun to address wider issues. Hammersmith and Fulham has the highest estimate HIV+ rate of any local authority area in the UK, and approximately 4000 injecting drug users. Spending on HIV prevention and services for people with HIV/AIDS is the highest in the UK . Police estimate that more than half of all acquisitive crime in the area is committed to fund drug purchases. Public services in the health, criminal justice, education, housing and social fields have formed an unusually close partnership to address these problems. This is generating rapid changes in service provision, including moves away from prosecution of people in possession of any drug for their own use, and moves to attract many more users into treatment by greatly extending prescribing practice. The overall aims of harm minimisation in the area now include reduction of crime and reduction of the illicit drug market alongside minimisation of harm to drug users themselves.

Abstract: The disease model, while still the predominant conceptualization guiding U.S. treatment is now being challenged by the harm reduction model, highly developed in Britain. This paper examines both positions in light of historical/cultural differences related to Puritan zealotry and argues that with regard to illegal drugs, America’s War on Drugs actually inflicts harm. The huge government expenditure, spread of AIDS, criminalization of drug users, and treatment neglect are just several of the negative consequences.