Susan Kaplin May, 1994
 

Although the term "Harm Reduction" is applied more generally, it has its roots in and is applicable to treatment. Harm reduction has some use in treatment; hopefully while working toward the goal of stopping drug use. To attempt anything less is a disservice to individuals, families, communities, and society. Although it is said that harm reduction covers a continuum of approaches ranging from prohibition/abstinence to legalization, most harm reduction approaches focus on the "safer" uses of drugs

where drug-taking behaviors fall on a continuum with differing levels of danger.
 

Therefore, harm reduction is not appropriate for use in primary prevention, since primary prevention focuses on avoiding drug use since any use of drugs affects the body, which can lead to harm. This includes both legal and illegal drugs. It is especially important to remember that harm reduction is not appropriate with young (underage) children since it is illegal for them to get/use legal drugs (e.g. cigarettes and alcohol), in addition to illicit drugs.
 

There are four studies which have examined the effects of the "harm reduction" policy of the Netherlands on drug taking:
 

1. "The Dutch Drug Policy: A Physician's Commentary" (Karel Frederick Gunning, M.D., 1993). Conclusions: The availability and sale of cannabis in Dutch coffee shops has been associated with an increase in its social acceptability and use among adolescents as a "soft" drug. The "harm reduction" Dutch policy of containing heroin addiction through distribution of free needles and syringes and through methadone distribution

has not prevented the spread of heroin addiction, curtailed drug-related crime, nor has it proven to decrease the level of HIV infection.
 

2. "Drug Reform: The Dutch Experience" (Richard R. Schwartz, 1993). Conclusions: The Dutch policy has been associated with a progressive increase in cannabis use among 15-19 year olds (from 4% in 1984 to over 8% in 1989). Between 1984 and 1988, the use of cannabis increased by almost 100% among upper high school students in the Netherlands. The policy of "harm reduction" has not prevented a steady and significant rise in drug addiction (cannabis, cocaine and opiates) among 15-19 year olds and young adults. [These two reports are presented in "Cannabis: Physiopathology, Epidemiology, Detection" (CRC Press, London, 1993).]

3. The Dutch Institute on Alcohol and Drugs questioned 8,000 young people and also found that the percentage of students smoking cannabis has more than doubled in four years (from 3% in 1984 to 7% in 1988). (Guardian, 9 November 1993).

4. The Council of Europe, Pompidou Group Survey of 1990 showed that there was a doubling of cannabis use among 15 and 16 year olds after the laws were relaxed. The number of retail outlets or cafes, where cannabis products are sold, has risen from 30 to 1,500. (Lambton Families in Action Newsletter, Fall 1993)

After visiting Amsterdam to learn more about the Dutch drug policy, the Scottish Affairs Committee documented important problems with this policy. Drug policy guidelines have been violated in many coffee shops selling cannabis: stocking amounts over the 30 gms limit, selling alcohol and other ("harder") drugs and advertising (Scottish Affairs Committee, House of Commons "Drug Abuse in Scotland, Volume I, " 1994). It was reported that "the guidelines are clearly being flouted despite the more rigorous enforcement which was supposed to have taken place over the last year. Since May 1993, we were told by the Justice Ministry officials that 60 coffee shops had been closed down, 14 of them on the grounds that they permitted hard (sic) drugs to be sold on the premises".

The Scottish Committee also described Amsterdam as "an important centre

for the import and export drugs of all categories and along with the Crown Office, we believe that the Dutch toleration of soft (sic) drugs has had a role to play in this unwelcome development". Recently, it has been noted that a new type of cannabis ("skunk") has been developed in the Netherlands that has a much larger THC component and this has now been found in the U.K. (Home Office, 1994). Amsterdam is seeing an increase in crime and it has been written that it has one of the highest crime rates among European cities. Police are experiencing difficulty in handling this

crime and the general increase in, and visibility of, other drug use such as heroin. Citizens are also objecting to the increased visibility of heroin use, especially those people who have children who are exposed to this sight.

Other countries have had an increase in drug use and related social problems

when drug laws and policies were made more lenient. In England, drug-related crime has risen in regions adopting harm reduction strategies (including cautions for some drug offenders, registration of addicts, methadone and needle exchange programmes). For example, the cost of drug-related crime in the Metropolitan Police area is 1.85 billion each year (1992). In Wigan, England, it has been estimated that drug-related crime costs victims 7 million per year. More than half the crimes committed in the borough are thought to be carried out by drug abusers in order to fund their addictions

(1993). U.K. government sources have stated that legalizing drugs will not lower crime because those who desire drugs will still require the money for these drugs. "So those who currently resort to stealing will continue to do so. Furthermore, since the drug would be more easily available, demand would increase and so, arguably, would theft". (Kenneth Baker, "Why We Cannot Go Soft on Drugs," June 1991).

In Liverpool, England, ten years ago, a small number of people were injecting

drugs. With the uncontrolled issuing of syringes, the number of people injecting drugs increased dramatically. (South Liverpool Family Support Group). Spain's change to a lenient drug policy resulted in a tremendous increase in drug use and crime, including trafficking (cocaine, heroin and other drugs).

Places that have tried decriminalization or legalization have either rescinded

liberalized laws or are currently rethinking them based on the increase of crime and other social problems that appear to have occurred as a result of more lenient laws regarding cannabis use. Police in Alaska supported decriminalization in 1975 primarily because they believed that crime would decrease. However, by monitoring the situation over time, in 1990 it was shown that there was a major increase in cannabis use and problem use: up to twice the national average in both categories. Use of all other drugs

increased. Health and social costs also increased drastically. Most importantly, the main argument for decriminalization that is also occurring in the UK (that crime would decrease) was disproved as crime increased. Whether or not there was a direct cause and effect relationship between cannabis decriminalization and the increase in crime, decriminalization was seen to have failed. In seeing this failure, the police who had initially supported decriminalization fully supported rescinding the law. (Drug Prevention: Just Sav Now, Stoker).

In early 1992, Zurich, Switzerland ended its four year experiment with designating a park a "police-free harm reduction area". In this park, drug users were allowed to deal and use and dealers "commuted" from Turkey and Lebanon. Drug users in the park increased dramatically and came in from other parts of the world. Food and needles were distributed, as many as 12,000 needles a day. However, three to four users died each night and crime rose enormously. In one year, drug-related deaths doubled and this city has one of the highest drug abuse and AIDS rates in Europe. Swiss officials admitted that harm-reduction had failed and thus, this experiment was ended. Although ended, there were still costs to the drug users and

society that remain after this four year period ended. (Stoker).
 

In comparison, Sweden has by tradition had a restrictive drug policy. However,

there was once a short period (1965-1967) when a more permissive drug policy was in operation. During this period, a number of doctors were allowed to prescribe drugs (stimulants, opiates) to addicts. Though drugs were legally obtained, this permissive policy was seen to increase the amount of drugs on the black market and criminal activity among the addicts. Because of this, the government returned to a restrictive drug policy by the end of the 1960s. This policy has been maintained and reinforced since then. Swedish studies have shown that there has been a steady decline in the proportion of young people reporting that they have ever tried narcotics (from a maximum of 15% in 1971 to 4% in 1991) (Allebeck). In 1988, Professor Nils Bejerot,

The Carnegie Institute, Stockholm reported that a restrictive drug policy not only halts the spread of addiction but also makes considerable reductions in the rate of current drug use. In contract, a permissive drug policy leads to "a rapid spread of drug use" [Allebeck and Bejerot's reports are presented in "Cannabis: Physiopathology, Epidemiology, Detection" (CRC Press, London, 1993)].

Harm reduction, through its acceptance and "normalization" of drug use actually sets in motion the increased use of drugs in society. There are no studies showing that harm reduction has decreased drug use.

In the recent report from the Scottish Affairs Committee, House of Commons ("Drug Abuse in Scotland, Volume 1," 1994), it is clearly stated that harm reduction should not be applied to schools and children indiscriminately because it is not appropriate for them. It is believed that using a harm reduction approach on all young people would be "totally counter-productive".

The Committee also takes a firm stand on the proven harm of cannabis and state that "the lesson of history is that the dangers of a drug are more often under-estimated than over-estimated" (eg the harm of smoking tobacco and that "heroin itself was originally developed as a non-addictive substitute for morphine"). They also cite cannabis as a gateway drug (as well as cigarettes and alcohol) and state that "the greater the prevalence of cannabis use, the greater the risk will be that more young

people will enter into a drug taking subculture and develop a serious drug problem".

Based on the Scottish Committees' experience in assessing the Dutch drug policy (described earlier in this paper), they state "we are totally opposed to any experimentation with the Dutch approach to cannabis in Scotland". They note that "at a time when Scotland faces a massive drug problem we believe that any move to decriminalize cannabis would send the wrong signal to young people. As the Association of Directors of Social work put it to us: There comes a point where you have to draw the line somewhere and if you keep moving the line practice suggested that people's behavior will move to wherever you draw the line".

In fact, the Scottish Committee does not believe that the fight against drug trafficking is being hampered by the diversion of police resources to a vast number of minor cannabis offenses and that fiscal fines, when applied to minor cannabis offenses, should act as credible deterrents.
 

The socio-economic costs of drug use are high. For example, in the U.K. in 1992, it was estimated that alcohol and other drug use costs industry 3 billion pounds each year (1992). However, the costs of providing prevention are low and the results of research show that prevention, not harm reduction, works in halting potential drug

users. In the U.S.A. young people who have been the focus of prevention programs were found to use less alcohol and other drugs each year between l979 and l991. (NIDA,199ISurvey). Twenty-five million Americans who will not use drugs in the next month might have if it were not for prevention ("Alcohol, Tobacco and Other Drug Prevention and Prevalence: A White Paper," 1993, Social and Health Services Inc.).
 

The amount of money spent each year on health care in the U.S.A. could be reduced by $90.4 billion if alcohol and other drug problems were prevented (U.S. Department of Health and Human Services, 1985).

More than twenty research studies evaluating prevention programs based on

personal and social skills training have demonstrated significant reductions in substance use (typically cigarettes).

Reductions in the onset of smoking ranged from 42% - 75%. Alcohol and marijuana use have also been significantly reduced. Results across studies were consistent and effects generally lasted for at least two years after post-testing.

Research into Life Skills Training has shown that it significantly reduces the use of cigarettes, alcohol and marijuana (by 50% - 83%) when used with 12 and 13 year olds. The positive effects from this programming apply to various population types and may last for at least two years after the conclusion of the program.

A study of drug prevention (Project Alert, aimed at cigarettes, alcohol and marijuana) by the Rand Corporation (1990) tracked 6,500 12 year old children from 30 schools over a period of three years. Students in the program were one-third less likely to try marijuana than the control group students. The number of children who experimented with marijuana was reduced by 50%. For students who tried cigarettes, the program reduced smoking from 30% - 50%.

In 1990, the long-term impact (over a period of eight years) of the "I'm Special" (ISP) drug abuse prevention program for primary school students (8-10 year olds) was assessed in America. The study showed that a lower percentage of the ISP students used alcohol, cigarettes, marijuana and other drugs. They also had a lower incidence of other problem behavior than did non-ISP students.

A long-term study looking at the PRIDE prevention program (for youth and parents) over five years found that there has been a continuous decrease in use of all substances by almost all age groups (the younger children have smaller percentages of use and as such, the changes may not be statistically significant). One example is that cannabis use by 16-17 year olds has decreased from 45% to 30%.

In the U.K., an evaluation of the Brigantia Smoking Prevention Program has shown a reduction in experimental smoking in 9-1 1 year olds. A study of another UK program, the "My Body Project" also showed a reduction in experimental smoking.

A community program which included social resistance training and normative influences modification with 10-13 year old was effective in reducing cigarette and marijuana use prevalence. These effects are still very strong after three years and during the ages when youth are more apt to use drugs.
 

The school setting has also been shown to be an effective site for prevention programs. Drug use risk factors have been reduced, while skills for coping with social pressures/influences to smoke, drink or use other drugs have increased. Programs in schools that include cognitive and behavioral skill building have been successful in preventing the start of drug use. (Prevention research information from "Evaluation Studies Supporting the Successes of Drug Prevention," October 1993. All reference materials are cited in this report).

Also, in Ontario, Canada prevention has had a major impact on adolescent drug use which has declined steadily from 32% in 1979 to 14% in 1991. (Lambton Families in Action, Newsletter, Fall 1993).
 

With the widening chasm between treatment and prevention theories, a vacuum

has been created. This vacuum is increasingly being filled by applying treatment theory's harm reduction strategy to the prevention field. Harm reductionists have claimed that prevention and the "war on drugs" have not worked, despite the multitude of studies which clearly show that prevention programs for young people do work. Instead, harm reductionists believe drug use is "inevitable" and young people need to be educated on ways to make their own drug use "safer". While it has been shown that prevention does work, there is no evidence of the effectiveness of harm reduction.