Prevention and harmreduction strategies

The most common approach to drug use, with many underlying political implications, has been to reduce either the availability or the supply of drugs. This prohibitionist approach has all too often served to exacerbate drug problems and their health consequences. Restricting drug supplies can actually encourage injection drug users to inject alternate substances, and can provide impetus for non-injectors to become injectors because injecting requires a smaller dose for an equivalent effect. Prohibition can even drive the drug trade into areas where individuals have not previously been exposed to injection drugs. In India, when the government tried to restrict the heroin trade, the price of heroin rose and addicts switched to synthetic opiates, yet actual injection behavior remained unchanged. Similarly, efforts to control opium smoking in Bangkok and Calcutta were followed by subsequent increases in heroin injection (Stimson and Choopanya, 1998). Even more telling is that, as a result of efforts to halt drug trade in other regions, West Africa has now emerged as an important transit point for cocaine originating in South America, and also for heroin from Southeast Asia. Threats of imprisonment have had similar deleterious effects and, furthermore, actual imprisonment tends to stimulate injection behavior rather than curtail it. As will be discussed in more detail later, since clean syringes are not widely available within prisons, prisoners often resort to shared or improvised equipment, which is difficult to sterilize (The World Bank, 1999).

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