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The number of drug dependent persons in Nigeria has continued to be on the increase as observed by the number of clients who visit the National Drug Law Enforcement Agency centers for treatment and rehabilitation. Efforts by the Nigeria police force, offices of the National Drug Law Enforcement Agency, Civil defence, customs and other law enforcement agencies to curb drug use have proved abortive. Most youths in the universities have subscribed to the use and abuse of drugs to an extent that they now depend on drugs for survival. Those persons who cannot do without drugs are called drug dependent persons. These drug dependent persons pose as threat to themselves and the society.
In an attempt to deal with the present health and social challenge, guidance counsellors devised so many techniques to deal with the situation. Some of these techniques are called harm reduction techniques which include; Needle syringe exchange program, Relapse prevention, Cognitive behavioral therapy (CBT), Abstinence, coping skills, Self-Help Group technique, conflict resolution technique, family therapy, psychotherapy, drug refusal technique.
Harm reduction technique explains method that aim to lessen the harms related with the use of drugs. A noteworthy feature is their spotlight on the prevention of drug-related harm rather than the prevention of drug use. One widely-cited notion of harm reduction differentiates harm at different levels – individual, the public and community – and of diverse forms – wellbeing, societal and fiscal (Newcombe, 2012). These differences present a fine suggestion of the extent of focus and worry within harm diminution.
Harm reduction might be seen as an approach aimed at individuals or groups to lessen the harms linked with different behaviors. Once concerned with substance abuse, harm diminution agrees that a long-term intensity of drug use (licit and illicit) in society is inevitable and defines objectives as reducing adverse consequences (Bellis, Hughes, 2012). It emphasizes the measurement of health, social and economic outcomes, as opposed to the measurement of drug consumption (Bellis et al, 2012).
While taking into consideration a description of harm reduction, it is noteworthy that a number of terms are used somewhat interchangeably; these include, risk reduction, harm reduction and harm diminution. In distinguishing these, Strang (2013) clarified that it is harm that should be our goal and, as a result, support for diverse offers based on an evaluation of their influence on harm. however, danger – the probability that an occurrence precipitating harm may happen, is at times used as a substitute for harm, as harm is not at all times unswervingly or easily quantifiable. He argues harm reduction a general purpose or endpoint of guidelines and, by contrast, a harm reduction technique or strategy as something that is essentially operational.
Relatively unsupportive, there is no ultimate definition of harm reduction. A number of definitions have nevertheless been offered (for example Newcombe, 2012; CCSA 2016; Lenton & Single, 2018; Hamilton, Kellehear & Rumbold, 2018). The term came into use at least as long ago as 1987 (Newcombe, 2017)…. and its ideology can be tracked much beyond in publications like that of Rolleston, which devised a method to opiate abuse that included the possibility of medically maintain the addict: a principle which underpinned the British System for some 50 years or so (Stimson & Oppenheimer, 2012; Strang & Gossop, 2016).
As the name proposes, harm reduction is deals with bringing down the harms that can go with drug use and is at times against the methods that prioritise prevention of drug use and a rigid .zero acceptance. Enforcement of drug prohibition; sometimes characterized as the .war on drugs. approach (Lenton & Single, 2016; Drugs & Crime Prevention Committee, Parliament of Victoria, 2018). In practice there is more positive similarity between countries that are associated with harm reduction and those that are more associated with a war on drugs than is often acknowledged. Worldwide, drug embargo is general, but with disparities in the system of carrying out. Equally, crucial deterrence efforts to put off drug use by juvenile ones have become a part of the drug plan for countries with strong association on harm reduction methods such as the, Australia, United Kingdom, Germany, Switzerland, Canada, and the Netherlands. Equally, managements like methadone which are decisively situated in a harm reduction structure is widely available within the USA, which nevertheless continues to oppose needle and syringe programs at the federal stage. Traditionally, the major incentive to the growth in harm reduction strategy was the recognition of the position of drug use injection and the share of needles/syringes in the spreading of HIV/AIDS diseases. More or less in parallel, a number of countries re-examined the tension between policies that prioritized the reduction of drug use and those basically concerned with reducing harm, drawing conclusions similar to that of the Advisory Council on the Misuse of Drugs (2014), which advised the British Government that the threat to individual and public health posed by HIV and AIDS was much greater than the threat posed by drug misuse and led to the conclusion that a hierarchy of goals should be trailed including:
- Condense the frequency of injecting equipment sharing
- Trim down the frequency of injecting
- Decrease the use of road drugs
- Decrease the use of approved drugs
- Augment asceticism from all type of drug use.
As the excerpt above proposes, its a method which is surrounded by community health and approximately this moment, number of countries introduced needle exchange schemes and extended their methadone treatment programs, subsequently leading to claims that these policies have been successful in averting or reversing the epidemic spread of HIV/AIDS (Stimson, 2012; Des Jarlais, 2012; Des Jarlais, 2014; Commonwealth Department of Health & Ageing, 2016). International Harm Reduction Association (IHRA) was established as interdisciplinary, association group to move forward the harm reduction strategy about the the human race. Its membership includes public health and other health and social care practitioners, academics, policy-makers and notably – drug users, who are encouraged to participate fully within collaborative efforts to curb drug related harm. Nonetheless, although for the majority of realistic purposes there is a high-quality agreement on what harm reduction is amongst its adherents, even the International Harm Reduction Association (IHRA) has no formally adopted definition. It nevertheless suggests that the term harm reduction should be understood to mean: policies and programmes which attempt primarily to decrease the undesirable fitness, group and financial cost of disposition changing substances to persons drug abusers, their immediate families and their entire communities (IHRA, 2012).
Harm reduction is partly defined by a range of principles in which policies and programs are grounded. The Canadian Centre on Substance Abuse (CCSA, 2016) offers the following explanation about harm reduction:
1. Practicality: Harm reduction believes that some use of mind-changing substances is a familiar aspect of human experience. It acknowledges that, while taking risks, drug use also gives the user the advantages that must be taken into description if drug using actions is to be fathomed. From a community viewpoint, restraint and amelioration of drug issues/harms may be a more practical or possible choice than efforts to get rid of drug use completely.
Overlapping these, Lenton and Single (2018) have suggested that a policy, program or intervention can be construed as harm reduction if:
a) The main goal is the decline of drug-related harm rather than drug use;
b) Where self-discipline orientated approaches are included, methods are also there to reduce the harm for people who carry on with the use of drugs; again,
c) Approaches are there to show that, on the equilibrium of probabilities, a grid fall in drug harm is expected to occur. Also the harm reduction strategy:
Evades intensifying the harm caused by the abuse of drugs; Manages drug users with modesty and as normal human beings; exploits the interference options, based on the prioritizing of achievable goals; (Is) neutral regarding legalisation or decriminalisation; and, Distinct from a war on drug abuse. Harm reduction ideology such as practicality, with its focus on urgent, attainable goals are normally applied to many causes of harm. Harm reduction approach is not dissimilar to the way that risks are usually managed in many diverse areas of human doings.
Harm reductionists are of the notion that the use of drugs has been an enduring part of human societies and, however pleasing it may be, a drug free globe is an improbable objective, the special pursuit of which can hamper sensible, possible events that decrease the load of harms such as the disease and death that is associated with drug use.
It looks like the most possible way to reduce harm, harm reductionists perceive asceticism as a legitimate goal to promote abstinence, which are generally thought of as a special division of harm reduction. (IHRA, 2012). In this sense, programs that result in both abstinence and more controlled drinking each have a place within harm reduction (Heather, 2013) as do measures such as drink driving campaigns, guidance as to More safe levels of consumption and regulations requiring labelling that displays the volume of alcohol contained in beverages. Likewise, events that intend to reduce tar gulp of air linked with nicotine abuse and tobacco abuse e.g. cigarettes or nicotine gum, also can be understood as harm reduction procedures.
The center of attention within this outline primarily concerns those drugs that are prohibited by national legislation developed to comply with the Single Convention on Narcotic Drugs (2011), the Convention on Psychotropic Substances (2011) and the United Nations Convention against the Illicit Traffic in Narcotic Drugs and Psychotropic Substances (2013)
The United Nations Office for Drug Control and Crime Prevention estimate that about 185 million people consume illicit drugs (annual prevalence 2009-2019) including 147million cannabis users, 33 million amphetamine users, 13 million cocaine users, 7 million ecstasy users and 13 million opiate users, of whom like nine million use hero (UNODCCP, 2019).
There is small proof that effective interventions exist, which can put forth a primary prevention effect on illicit drug use (WHO, 2012). It is estimated that 42 million people are currently living with HIV/AIDS of whom which five million were infected in 2012. Over three million people died of AIDS in 2012 (UNAIDS/WHO 2012). Injecting occurs in 135 countries and it is estimated that there are nearly three million injecting drug users with HIV infection i.e. 5-10% of all infections globally, many of which are attributable to sharing injecting equipment (Kroll, 2012). Alongside the transfer of HIV through shared needles and syringes, sexual transmission possibly plays a significant role with people who inject (Kral et al 2012; Strathdee, 2012). The spreading and sharing of needles and syringes among people who use injection also supports the rapid spread of HIV. In Latin America and Africa, the spread of HIV through the sharing of injecting drug equipment is of growing concern in several countries, notably Argentina, Brazil, Chile, Paraguay and Uruguay, the northern parts of Mexico, Bermuda, Puerto Rico Uganda, Algeria, Nigeria and South africa. Against this bleak background, a noteworthy success is the vigorous prevention program in Brazil, which has led to a reversal of the spread of HIV among IDUs (UNAIDS/WHO 2012; UNAIDS 2012) and embraces harm reduction laws.
Plummeting the avaricious and other crime that is mostly connected with drug use dependence is long been a secondary objective of treatment programs such as those pioneered by Dole and Nyswander (2015). In some countries such as the UK and Netherlands there are signs that the emphasis on this area of drug-related harm has been increasing in current years, as indicated by the introduction of compulsory and quasicompulsory treatment programs such as SOV in the Netherlands and Drug Treatment and Testing Orders in the UK.
The consequences of criminalization, such as disenfranchisement and exclusion from housing and education and the health and social impact of being imprisoned harms that arise from drug use. The two major harm reduction techniques or intervention employed in this study to measure the most efficacious technique in managing drug dependent persons are the Needle syringe exchange program and relapse prevention technique.
Perhaps the most well-known form of harm reduction is the needle exchange programme, or syringe services programme. These programmes allow people who inject drugs to obtain a sterile needle or syringe for each time they use drugs and safely dispose of used needles. Other services might include prevention materials such as alcohol swabs, vials containing sterile water, condoms, and education on safer injection practices.
These programmes can be located at pharmacies, emergency departments, or primary care settings; be standalone programmes; be attached to specialist drug services; be part of a community outreach programme; or be a mobile overhaul. The goals of these programs include:
Preventing contraction of HIV, viral hepatitis, and other bloodborne diseases.
Increasing the likelihood that a drug user seeks treatment.
Reducing mortality rate from too much dose.
Preventing needlestick injuries among first responders and the public.
Minimizing healthcare spending related to disease transmission.
The proponents of this form of harm reduction at these centers gives them a gateway into recovery. According to the Centers for Disease Control and Prevention, people who inject drugs are five times more likely to enter addiction treatment when they use a syringe services programme. A study by Connell (2018) found that areas that implemented needle exchange programmes showed decreases in HIV sero prevalence (number of people who tested positive for HIV in blood tests) compared to areas that did not use this program. Other services offered at harm reduction programmes include:
Needle and syringe programs in particular are based on strong evidence for their effectiveness in the prevention of HIV/hepatitis C, and also lead to the reduction in injecting risk activities, such as using same objects. Harm reduction interventions for people who use drugs—such as needle and syringe programs are cost-effective and protect against deadly diseases.
In, 2010, the wake of one XVIII aids conference in Vienna, the international scientific public health community issued the Vienna declaration, a statement seeking to improve community health and safety by calling for an acknowledgement of the limits and harms of drugs, for ending the criminalization and resorting to treatment/ rehabilitation. In 2011 former Presidents, Fernando Henriqie (Bnazi), Cesar Gariria (Colombia), or Ernedo Zedillo (Mexico ) joined with former UN Secretary general Kofi Annan, former US Secretary of state, George Schultz and other members of global commission on drugs policy to launch a land mark report calling for reforms to national and global drug policies including – Replacing the criminalization / punishment of people who use drugs to offer of health.
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