1. Walking a Thin “Wire”: The Attitudes and Principles of Harm Reduction Niladri Das, MD UPMC St. Margaret Family Medicine Residency Daniel Dejoseph,MD Drexel Family Medicine Residency

2. Objectives Identify principles of harm reduction Explore the learner’s response to substance abuse Discuss barriers to the treatment of addiction

4. The Wire The Origins of Hamsterdam

5. What is Harm Reduction? Defined by the WHO as: A concept aiming to prevent or reduce negative health consequences associated with certain behaviors What’s the connection with “The Wire”? “WPRO: Harm Reduction Among Injecting Drug Users” WPRO 2013. http://www.wpro.who.int/topics/harm_reduction_injection/en/

6. Principles of Harm Reduction Pragmatism Humanistic Values Focus on Harms Balancing Costs and Benefits Priority of Immediate Goals Hunt, Neil. “A review of the evidence-base for harm reduction approaches to drug use” IHRA, http://www.ihra.net/files/2010/05/31/HIVTop50Documents11.pdf = Are we going to Eliminate Drug Use? = Not approval but not moral judgement = Not the Use Itself = Evaluation = Goal Setting

7. Lancet 2010; 376: 1558–65

8. What are the substance abuse disorders you self identify as the most problematic in you practice?

9. Lancet 2010; 376: 1558–65

10. JAMA. 2004 Mar 10;291(10):1238-45.

12. Back to “The Wire” Areas of Most/Least Harm

13. Does Harm Reduction Work? Depends on your goals. What are some examples of harm reduction that you think work? Portugal: New diagnoses of HIV 1430 in 2000 to 352 in 2008 BMJ 2010;341:c4554 Opioid Substitution Therapy: Metanalysis showing reduction of injection, sharing, and risk. Harm reduction among injecting drug users — evidence of effectiveness, EMCDDA, Lisbon, April 2010 Peer Naloxone Distribution: Multiple studies, 15months Boston; 385 participants=74 Reversals Am J Public Health. 2009 May; 99(5): 788–791. Syringe Services Programs: Overwhelming evidence for HIV reduction; SAMHSA Wet Houses

14. Back to “The Wire” Difficult Patient Encounter Think about the difficult patient encounters that you have had. What made them difficult?

16. Consider Again Your Practice Are you using any harm reduction principles or programs now? Are there any ideas that you would consider implementing in your practice?

17. The END dasn@upmc.edu Daniel.Dejoseph@DrexelMed.edu