Harm reduction in substance misuse is a well-established practice in USA, Australia and most western European countries like Ireland and United Kingdom. However, it is not practiced in many countries across the world due to social and cultural beliefs and due to political reasons and public opinion. This book gives an excellent overview of the practice of harm reduction in substance misuse across different countries of the world with respect to existing policies in various countries. The various sections of the book have been contributed by experts from a number of countries across the world like Argentina, USA, United Kingdom, Australia, Morocco, Canada and South Africa which has added to the value of this book.
The initial section of the book gives an insight in to the history of harm reduction followed by the second section, which focuses on policy. The chapter on ‘A history of harm reduction advocacy’ discusses extensively the reasons for resistance in implementing harm reduction policies in most developing and transitional countries and indicate the myths held by those against harm reduction. The emphasis is on British policies in the chapter on harm reduction and police services. However in this chapter, the authors have discussed the contentious issue of drug consumption rooms and the existences of around 90 such centres across different countries and the support to establish such services in United Kingdom from certain sections of the police department. Many readers would not find it acceptable the discussion in the chapter on international security and the global war on drugs as it calls for alternatives to failed global war on drugs. This appears to include legalisation of drugs in order to reduce organised crime and decriminalise drug users.
The chapter on harm reduction in prisons also discusses the risk of HIV, Hepatitis B and C transmission due to injectable drug misuse and reminds us of the International Guidelines on HIV/AIDS and Human Rights published in 1997. The authors also discuss the risk behaviours in prisons including sexual activity with data available from different countries and analyse the needle and syringe programmes and the availability of opioid substitution therapy across prisons.
The third section discusses extensively about harm minimisation in gambling and tobacco, which are often excluded when discussing about substance misuse issues. In the chapter on harm reduction in stimulants, there is emphasis on the need to target certain occupations who use stimulants such as truck drivers and the authors have also discussed the controversial issue of ‘crack kits’ which is used in some countries as a cocaine harm reduction strategy. This book does not fail to discuss the epidemic in the recent years of ‘designer or head shop drugs’ and the presence of substances such as mephedrone in ecstasy tablets. In addition, the authors call for a peer led harm reduction approach to stimulant misuse and the need for random ‘pill testing’ in club scenes to analyse the content of stimulant pills.
The final section deals with specific regions across the world with a separate chapter on ex-communist countries in central and eastern Europe. The authors describe the uniqueness of the problem in every country like fentanyl being the main injecting drug in Estonia and increased prevalence of amphetamine misuse along with heroin in Latvia and Lithuania and fast growing HIV epidemic in Ukraine.
The chapter on harm reduction in western Europe is interesting in that it discusses the effectiveness of decriminalisation of drugs in Portugal along with the dual track approach in Finland and the heroin prescribing project in Switzerland. It is hard to ignore the absence of discussion on Irish harm reduction policies in most chapters of this book including the chapter discussing harm reduction in western Europe. There are very few instances on the Health Research Board data being quoted in this book and also the absence of Irish contributors in this book is disappointing. Overall this book is a very good read for those interested in addiction issues and could be used as an excellent reference book for future policy making in harm reduction.
