Speeding up the response

A global review of the harm reduction response to amphetamines
Sophie Pinkham
International Harm Reduction Association (IHRA)
April 2010

Despite heavy media coverage of amphetamines and increased research attention in some countries, the harm reduction response remains underdeveloped when compared with the response to opiates and injecting-related harms. Programmes do exist and new guidance is being compiled, but there is a need for evaluation, further documentation of experiences and expansion of effective interventions. This chapter will discuss the emerging responses to amphetamines-related harms and consider the next steps for the international harm reduction community.

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The first priority for the international harm reduction community should be to support the development, evaluation and expansion of harm reduction interventions specific to amphetamines. Though the evidence base for these interventions is not yet as substantial as that for harm reduction interventions among opiate users, the positive experience of programmes in several countries suggests their value. Research on these interventions should be prioritised, but in the meantime it is important to expand the range of services available to amphetamines users and to work to reduce the spread of HIV and other harms in this group. Harm reduction providers in many countries have expressed their need for training on work with amphetamines users, and efforts should be made to make such trainings available as soon as possible. The experience and knowledge of service providers in countries such as the United States or Australia can be used to develop expertise in regions such as Eastern Europe, Southeast Asia or South Africa.

Next, treatment for amphetamines users needs to be demystified. There is significant research on treatment modalities and some guidelines already exist. Interventions specific to amphetamines should be implemented and evaluated in other regions, and international guidelines for treatment should be developed and promoted.

Service providers, researchers and policy-makers also need to consider the role of drug policy in harms related to amphetamines. On a macro level, it is clear that efforts to suppress one drug often lead only to the ‘substitution’ of another that is more easily or cheaply available. For example, efforts to suppress opium production in Asia led to a boom in production of amphetamines. Vigorous and even violent prohibition efforts succeeded only in replacing one drug with another that is equally or more harmful. This experience indicates the need to re-examine global drug policy.

On a more local level, experience in countries as varied as Australia and Ukraine suggests that attempts to control precursors of amphetamines can lead to increased harms associated with their use. Decreased availability of cold medicines has been linked to increased pharmacy break-ins in Australia and to a shift in Ukraine to more neurotoxic preparations made using less tightly regulated precursors.

Prohibition can push production, trafficking and use towards more potent, easily concealable and transportable forms of drugs. More potent forms and more direct methods of administration – for example, injecting crystal meth instead of taking amphetamine pills – are more likely to cause dependence and other harms, including HIV infection. Moreover, punitive policies and law enforcement practices can push drug users to use quickly and wherever they can (e.g. in an alley), inhibiting their ability to practice harm reduction. Policy-makers and advocates need to consider the consequences of prohibition and explore other methods of reducing problem drug use, notably drug treatment, harm reduction and evidence-based drug education targeted at high-risk groups. Further research on the relationship between drug policy, drug use patterns and associated harms would be useful in supporting more effective public-healthoriented drug policies.

Finally, service providers need to take into account the role of production methods in harms related to amphetamines. Especially in situations in which users produce drugs themselves, a change in production methods could reduce neurotoxic effects, environmental hazards and perhaps other harms. Region-specific research into drug production methods could give providers and users a better understanding of exactly what drug they are synthesising and its specific dangers. It would be useful to explore the possibility of developing harm reduction interventions related to production, as well as the legal, political or ethical questions that such interventions might raise.

This chapter was originally published in: Global State of Harm Reduction 2010, International Harm Reduction Association, 2010