Why a European Letter for Risk reduction?
At present, when Europe is facing important changes concerning drug use
and abuse, we think it is important to appeal our group of states to build a global
and more adapted policy about drug abuse. From our point of view, risk
reduction is one of the undeniable pillars of this new policy. The European letter for Risk Reduction has the goal to enunciate the main and federative principles of this practice so it has its place in the
definition of a European policy for psychoactive
substances abuse.
Overlooking the contradictions and reinforcing the convergence points between
Professionals, this letter questions the political powers and appeals for the development and reinforcement of the actions
for risk reduction in all European countries.
The genesis:
In 1998, The Federation of European Professionals Working in the Field of Drug Abuse (ERIT) did, with the support of
the European Commission, a study of the evolution of professional practice about risk
reduction in Europe.
This study performed in seven European countries (Spain, Portugal, France, Belgium, Germany, Italy, England) has shown
a set of elements that outline the importance of risk reduction as an intervention model in the abuse field and the difficulties
of the professionals to develop this model more in the terrain.
Despite the cultural, economic and political differences among the different countries, and sometimes even among the
different regions of a same country, the convergent points among the Professionals are more numerous that we may believe on
first sight . Equally, the transactional analysis of this study, show us that some elements that nowadays are obstacles to
develop risk reduction find their roots in more or less similar situations whatever the country or region.
The initiative of a European Letter for Risk Reduction that states the main values and principles of this model appeared
to the Professionals as a logic continuation of the study done in 1998.
THE IMPORTANCE OF RISK REDUCTION AS A MODEL FOR INTERVENTION IN DRUG ABUSE
Risk Reduction as an intervention model in drug abuse started to develop
in Europe in the 80’s.
This model has had a positive reception by the Professionals for it is
mainly pragmatic: risk reduction obeys to a logic that does not have the goal to participate in the reasons for drug abuse,
but participates in the terrible health consequences related to this consume.
The development of the AIDS virus has had an important role in the
development of this model but other elements have also contributed.
The degradation of the life conditions of the European population under the effects of what is called “the economic crisis of the 80’s” that first reached the most fragile population, has
also been an important element and parallel to the AIDS epidemic.
Under the effects of this structural crisis, the lack and fractures that have affected the social links of the most
elemental existing life conditions have widely affected the situation of numerous
population groups, and among these are the drug users.
These historic elements allow us to understand why risk reduction can not and should not mean only a health problem.
If at the end of the 80’s
or the beginning of the 90’s the actions have followed the goal to reduce the incidence of viral infections (mainly HIV) with information campaigns and the distribution of clean injection materials, today these actions are very diverse
and pick up other needs that overflow the field of public health and the field
of the intravenous drug users.
This evolution has a different rhythm in the countries studied but seems to focus over three main axes.
1. The work related to injection evolves towards the consideration of other risk behaviour:
It is true, that the distribution of syringes is one of the main actions in the drug use and overall in the south of
Europe where the use of injections is very usual. But, other uses with risk have appeared in Europe and are the objective
of other action. The excessive consume of alcohol and medicines, the consume of illicit products parallel to substitution
treatments, the extended use of ecstasy, the early use of cannabis by the teenagers or medicines associated with alcohol,
the increment of cocaine and crack users, etc.. are the problems that the risk reduction teams find in Europe.
2. The actions of risk reduction are only limited to health aspects, social aspects are increasingly important
It is clear that today the problems to accede health attention are also accompanied by social problems that must be taken into account at the same time and even sometimes before treating health aspects. The matter of social rights has extended widely as a theme inherent to the work of risk reduction.
Although the actions of health goals
are major (access to clean syringes, to condoms, to substitution treatments, to medical treatments and in hospitals...),
many teams with low frame structures have been provided with specific mechanisms
that include accommodation, reinsertion at work, legal and administrative advice,
access to leisure, etc...
Whether in Spain, in Portugal, in Belgium, in Germany or in Switzerland, a wide number of institutions have been forced
to develop specific mechanisms for employment help, for culture access, for reception of specific categories of users (women,
women with children, people in the streets, immigrant communities, etc...)
The problems these institutions have are to find structures accessible and flexible enough to receive people, generally
unstable, that never stopped using drugs. The challenge of risk reduction is to make non specialized health services more accessible to drug addicts, and care
social services more permeable and more adapted to this population.
3. The work of professionals of risk reduction is not done only around the group of users, it tends more and more to integrate the environment social community :
The restoration of social links and the adaptation of social structures of the population with difficulties,
lead a great number of risk reduction teams to play a mediator role between the
drug users and the environment.
What really should be modified is the group of the social representations of drug users.
For the teams that work in risk reduction it is essential to establish nets among the politicians, the police, the
local associations and the administration.
This point shows the general difficulty to reach a social consensus
with satisfactory balances among the different political axes in drug matters.
These axes, the repression of drug trafficking , the risk reduction, the therapeutic action, and the prevention,
when they are not isolated and when on the contrary they are integrated in a general reflection , lead to a global and adapted policy that allows the birth of a new logic more adapted and more operative in the drug addiction
matter. This global policy can not be put into practice without a political will
strong enough from the European states.
THE VALUE
OF A MODEL MAINLY PRAGMATIC:
The risk reduction structure is an essential pillar in any policy against drug addiction. For us, the essential value
of risk reduction is not only to contribute to the lowering of infectious contamination between users or the decrease of the
number of deaths caused by overdoses or the significant decrease of criminality among users.
Risk reduction also allows to:
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To be nearer to concrete problems and to the consume modalities of the most endangered population.
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To transmit prevention messages in a more adapted way to the more reticent
groups. The results are much better than those obtained by the normal channels.
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The risk reduction frequently leads to a more positive evolution of very risky practice and sometimes plays a mediation
role between the care or health services and the direct environment of the users.
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When innovative practices happen, the risk reduction teams may sometimes lean on the users associating them more or
less directly to their work..
On the other side and without doubts, their work contribute to restore the dignity, the responsibility and the elemental
rights of people and population that were more and more rejected.
Propositions for a European Letter for Risk Reduction.
Ethic and goal principles.
Risk reduction is an intervention model in drug addiction that tries to respond to the health and social needs of drug users. This model is directed to all the consumers
and specially to those that cannot or do not want to stop its consumption. Its
goals is not only risk reduction and the harm linked to drug use, but also to contribute to the cure process of the subject,
to help acquire the civic and social rights
favoring the reinsertion of users. In this sense, harm reduction is at the same time a practice and a policy. Its action
is based on a double precept : the pragmatism of the action done on the terrain and
the respect to what the users choose.
1. Risk reduction cannot be limited to the improvement of health conditions:
Risk reduction should be
considered as a right of the users: the right to dispose
clean injection material when
there is no intention to stop consumption, the right to benefit from professional help without submitting to an abstention petition, the right to maintain positive social links though
the addictive behavior is considered socially deviant. For us, risk reduction allows not only to improve the health conditions of the users but also to create
spaces for resocialization that contribute to a major recognition of their citizenship.
Risk reduction also recommends more responsibility to the users encouraging for instance to return their injection material in the appropriate places, what leads to more respect and a better protection of other citizens.
2. The professionals of risk reduction are favorable
to a diversity of responses:
Risk reduction should focus as much as possible towards the individualization of the actions in order to avoid standard answers.
The central element of these actions is the drug user as a subject.
This principle leads the professionals involved in risk reduction to respect totally the user’s election. All the responses
given by the professionals in the terrain obey to a pragmatism principle which
makes them execute actions considered efficient in the terrain. The search of this efficacy explains the differences observed
in the practice of different countries and even among different regions of a country.
Any way to standardize the responses would be in contradiction with cultural, economic, political and individual determinants of the users.
Therefore we consider important not to confuse this pragmatism principle with the standardization of the responses.
3. Risk reduction demands a permanent effort to adapt to the terrain:
According to risk reduction principles, the professionals should adapt to the real situation of the user to work
from where he is. This forces the professionals to be in consonance with the
user avoiding to formulate judgment about them or about their lifestyle.
This lack of judgment should not be mistaken with a guaranty of
user behavior, it is the indispensable element to another postulate: not to condition
the action of the professionals to a subject adhesion to a pre-established health
project.
4. The incoherence induced by the penalization of consume are obstacles to develop risk reduction:
The adaptation capacity, creativity and innovation constitutes a force for this model but, on occasions it is
limited by the incoherence of public health policies, specially in countries where the laws outlines a repressive logic over
any other logic.
The signers of this letter report the incoherence generated by consumption
penalty and ask the public powers to elaborate legal frameworks adapted to the
actual context.
5. Assessment as a privileged tool:
In order to establish quality services, the signers of this letter compromise
to establish specific and adapted assessment mechanisms that allow to measure the adequacy of the actions and the impact on
the terrain.
These actions must follow adapted principles and specific rules for these actions.
6. The organization of the different ways to focus on drug addiction is a permanent need:
Though the long term goals of risk reduction are not forcibly the end of drug consumption, we must admit that in many
cases this type of intervention constitutes a first step towards a change of the lifestyle of the user.
For the signers of this letter, risk reduction shows all its dimension in a global policy that integrates prevention,
health aspects, drug trafficking repression, etc...
It is within this global policy where all the elements should be
organized and completed.
The signers of this letter call the public powers to sustain the associations and the NGO’s in order to
establish specific actions in risk reduction matters. These actors should be focused
on the teenagers, who are generally less sensitive to information campaigns.
It is also essential to perform specific actions to improve the
organization among the risk reduction, prevention and treatment mechanisms.
Therefore we ask the financial means to increase and the budgets for all these actions to be permanent.
7. The actions of the ex users is an essential tool for risk reduction practice:
In most the European countries the intervention of the ex users in the risk reduction actions is a necessity. But a great number of the participants work in precarious way, which implies
the recognition of the knowledge and the transmission of it.
8. The question of the status of the professionals.
The permanent search of demands related to the user, implies a high level of professional competence. The signers
of this letter compromise to do everything possible to encourage recognition and value the competence and specific techniques of the professionals that work in the different fields of risk reduction.
Training and qualification actions should be developed to guarantee the best status possible
to the participants of these type of programs, ex users or not.
