The fast and the furious
Harm reduction programmes targeting stimulants like cocaine and (meth)amphetamines in several countries have shown positive results. However, these programmes are limited to Australia and North America. As the effectiveness of pharmacological and psychosocial interventions for stimulant users is limited, interventions to stabilise and minimise the negative consequences of ongoing methamphetamine use are of paramount importance. A wide range of health and social problems associated with stimulant use are largely unaddressed by current services.
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Scientific literature is overwhelmingly weighted toward the harms of stimulants (cocaine and ATS), with minimal literature on harm reduction interventions. Among the ill health effects associated with ATS, some are mediated by mode of administration (such as infections, overdose, and pulmonary damage) while others are independent thereof (such as neurologic, cardiovascular and mental health problems). But the distinction between the two categories of harm is subtle and contingent on the broader risk environment. Adverse (health) consequences and recommendations to address them include:
- Problem use is associated with poverty, unemployment, homelessness or unstable housing, lower socio-economic status, a variety of other social problems, as well as legal problems and incarceration.
- Adulterants and use of caustic chemicals in drug preparation are stipulated by market conditions beyond the control of individual users.
- Traditional harm reduction programmes may fail to reach problem stimulant users due to opiate-centred services and social barriers to young or female users.
- Innovative service development paired with critical evaluation is necessary in translating the successes of harm reduction for opiates to stimulants.
- There is an important and unmet need for services that enhance the ability of stimulant users to control their intake levels, chaotic behaviour and mental health problems, as well as limit pulmonary, cardiovascular and neurological harms.
- Stimulant-related harms are aggravated by external factors, such as selected aspects of international drug legislation, policing and public policies.
This chapter was originally published in Harm reduction: evidence, impacts and challenges,Tim Rhodes and Dagmar Hedrich (eds), European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), April 2010
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)