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    Read our latest report calling for a Harm Reduction Decade, sign the Harm Reduction Decade Declaration, call for #10by20, and stand up for human rights of people who use drugs, their families and communities.

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    Global State of Harm Reduction

    Our flagship publication is the biennial Global State of Harm Reduction report. First published in 2008, it involves a coordinated effort across practitioners, academics, advocates and activists to map global data and responses to HIV and hepatitis C epidemics related to unsafe injecting and non-injecting drug use. It is the only report to provide an independent analysis of the state of harm reduction in the world. The information collated within the report is stored and regularly updated on an interactive e-tool for researchers and advocates.

    The Global State of Harm Reduction report is supplemented by regular thematic reports and advisories on key issues and emerging challenges. Please search our Resource Library for more information or join our e-list for regular updates.

    Interactive e-tool

    Global State of Harm Reduction’ e-tool is an interactive resource containing up-to-date information on harm reduction policy and programming around the world. Users can select countries or regions and create tables for an at-a-glance guide to the current state of harm reduction worldwide.

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    About HRI

    HRI is a leading non-governmental organisation working to reduce the negative health, social and human rights impacts of drug use and drug policy by promoting evidence-based public health policies and practices, and human rights based approaches to drugs. Read more about HRI’s history.

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    Our vision is a world in which individuals and communities benefit from drug laws, policies and practices that promote health, dignity and human rights.


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    What is harm reduction?

    Harm reduction refers to policies, programmes and practices that aim to reduce the harms associated with the use of psychoactive drugs in people unable or unwilling to stop. The defining features are the focus on the prevention of harm, rather than on the prevention of drug use itself, and the focus on people who continue to use drugs.

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Naloxone Research

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Beletsky - CLosing Death's Door image

This section (alongside Section 6 below) focuses on one particular overdose intervention – naloxone. Naloxone is a medication (an ‘opioid receptor antagonist’) which counters the effects of an opioid overdose, reversing the depression of the central nervous system and respiratory system. Naloxone has long been a ‘pre-hospital’ treatment used by emergency staff in many high-income countries, but is now becoming more widely distributed by harm reduction services to people who use drugs and their friends and families. This section includes several research papers on naloxone – including the attitudes of drug users to the medication and to peer distribution, and the benefits of intranasal administration (spraying the drug up the nose rather than injecting it into the body), and legal aspects of naloxone distribution to heroin users.

Barton ED, Ramos J, Colwell C, Benson J, Baily J & Dunn W (2002) Intranasal Administration of Naloxone by Paramedics. Pre-hospital Emergency Care, 6 (1), pages 54 – 58.

This study aimed to prospectively test the effectiveness of intranasal naloxone administration by paramedics in the USA. A total of 30 patients received naloxone during the study period – 11 of whom responded to naloxone. The authors conclude that intranasal naloxone may provide a safe, rapid, effective way to manage suspected opioid overdoses, and use of this route – rather than intravenous naloxone - may be preferential as associated risks are minimal. Unfortunately, we are unable to provide free access to this article at this stage.

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Beletsky L, Burris S & Kral AH (2009) Closing Death's Door: Action Steps to Facilitate Emergency Opioid Drug Overdose Reversal in the United States.

This paper presents the findings from a summit on opioid overdose supported by the Drug Policy Alliance. The event brought together drug policy and public health experts to discuss strategies for preventing avoidable overdose by increasing access to naloxone and important basic overdose education. The authors explore the legal and policy obstacles to increasing implementation of naloxone prescription programmes in the United States and provide recommendations for increasing access to this life saving intervention. Unfortunately, we are unable to provide free access to this article at this stage.

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Burris S, Norland J & Edlin BR (2001) Legal Aspects of Providing Naloxone to Heroin Users in the United States. International Journal of Drug Policy, 12, pages 237 – 248.

This paper – in Harm Reduction International’s official journal – is a detailed legal analysis of naloxone provision in the United States. The authors found that the prescription of naloxone is fully compliant with state and federal laws regulating drug prescribing. They conclude that the risks of malpractice liability are consistent with those generally associated with providing healthcare, and offer simple guidelines to minimise these risks further.

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Kelly A-M, Kerr D, Dietze P, Patrick I, Walker T & Koutsogiannis Z (2005) Randomised Trial of Intranasal versus Intramuscular Naloxone in Prehospital Treatment for Suspected Opioid Overdose. Medical Journal of Australia, 182 (1), pages 24 – 27.

This research paper from Australia aims to determine the effectiveness of intranasal naloxone compared with intramuscular naloxone in the treatment of opiate overdoses and the associated respiratory depression. The authors conclude that, in prehospital settings at least – the intranasal delivery of naxolone may be preferable as it could reduce the risk of needle-stick injuries and exposure to blood-borne infections. It is also relatively safe to make more widely available – for example, to increase access to this life-saving treatment in the community.

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Kerr D, Dietze P, Kelly A-M & Jolley D (2008) Attitudes of Australian Heroin Users to Peer Distribution of Naloxone for Heroin Overdose: Perspectives on Intranasal Administration. Journal of Urban Health, 85 (3), pages 352 – 360.

This study examines the attitudes and willingness of people who inject drugs in Australia to administer naloxone to their peers in the event of an opiate overdose. Of a sample of 99 participants recruited from needle and syringe programmes, the majority reported positive attitudes toward naloxone distribution and 92% said they were willing to participate in a related training programme. Some participants raised concerns about peer administration (such as competencies, victim responses afterwards, and legal implications), and almost three quarters said that they would prefer intranasal naloxone. Unfortunately, we are unable to provide free access to this article at this stage.

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Kim D, Irwin KS & Khoshnood K. Expanded Access to Naloxone: Options for Critical Response to the Epidemic of Opioid Overdose Mortality. American Journal of Public Health, 99 (3), pages 402 – 407.

This paper explores the current evidence for scaling up access to naloxone in the United States and finds that extensive scale up is supported by findings from pilot programmes. The authors present a range of possible policy and programmatic responses to avoidable opioid overdose in the country and analyse the advantages and limitations associated with them. Unfortunately, we are unable to provide free access to this article at this stage.

Click here to view the abstract via PubMed

Lagu T, Anderson BJ & Stein M (2006) Overdoses among Friends: Drug users are willing to administer naloxone to others. Journal of Substance Abuse Treatment, 30, pages 129 – 133.

This study aims to explore the distribution of naloxone among heroin users, and whether or not drug users are willing to administer the medication to others. 329 people were recruited to the study, most of whom had used heroin and nearly two thirds of whom reported that they had injected drugs. 64.6% reported having witnessed a drug overdose in the past, and over half of these had experienced an accidental drug overdose. The majority of individuals reported that they would be willing to administer a medication to a peer in the event of an overdose, regardless of their knowledge of first aid etc. Unfortunately, we are unable to provide free access to this article at this stage.

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