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|Drug Matrix row 1. First task: save lives, reduce harm|
Cells and bites in row 1 explore seminal and key research on reducing harm to the user as a result of their drug use. From the start of modern-day harm reduction prompted by HIV, it was recognised that engaging active drug users was the essential first step, and that meant accepting them on their own terms. Yet also from the start, generating health-promoting and addiction-ending change was on the agenda. That dilemma sharpened when recovery was promoted as the overarching paradigm for all services. A common theme across the bites is how this core dilemma affects service delivery and impact, from the face-to-face encounter between user and practitioner to local or national systems for reducing harm.
Return to the Matrix, click on cells in row 1 and unfold bites by clicking the Matrix Bite link at the bottom or go to your chosen cell and bite below.
The five cells
A1. Interventions: Ethical dilemma and irony in evidence for harm reduction
Reveals that what might have been crucial findings on the first needle exchanges in Britain were never published, and that a country among the most antagonistic to methadone programmes provided the best evidence for their lifesaving potential.
B1. Practitioners: Difficult balancing act required of needle exchange staff
How the skill of the practitioner affects attempts to reduce harm is under-researched but critical. Focus is on the ability to create an accepting haven for needle exchange users, yet one which promotes change – a difficult balance.
C1. Management: Life and death decisions for service managers
How harm reduction impacts are affected by service management. Features a study which found heroin users face a high risk of death on leaving or being forced to leave treatment, highlighting the challenge of making what could be a life or death decision.
D1. Organisations: What is a harm reduction service for?
Exploring how organisational ethos and structures affect harm reduction brings us to arguably the central question: just what is a harm reduction service for? It might seem obvious, but interpretations sharply conflict.
E1. What will it take to tame hepatitis C?
Can any feasible harm reduction system substantially reverse the hepatitis C epidemic? Should methadone programmes be spread thin and wide to extend harm reduction benefits, or deepened with recovery-oriented support for fewer patients?
More ways to appreciate the matrices
Visit the matrices page of the Effectiveness Bank web site for articles, presentations, and a video explaining their genesis and construction.