Drug Treatment Matrix cell B1: Practitioners; Reducing harm
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Drug Treatment Matrix cell B1

Practitioners; Reducing harm

One of 25 cells in the Drug Treatment Matrix Matrix cell logo

Seminal and key studies on the impact of the practitioner on harm reduction. Trust emerges as a fundamental ingredient to harm reduction work with users of illegal drugs. Reconceptualise needle exchanges as safe havens in a largely rejecting world, and explore why a Philadelphia methadone counsellor stood out – for the wrong reasons.


S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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S Quasi-randomisation reveals methadone counsellor as an ‘active ingredient’ in reducing illegal drug use (1988). Effectively random allocation of patients to different counsellors at the same service revealed that one had patients who across all measures did consistently poorly while another more organised and proactive counsellor generated on average patients who rarely used illegal drugs despite lower doses of methadone. Reduced illegal drug use (in particular, fewer injections) and engagement with treatment are associated with reduced harm. For discussion click here and scroll down to highlighted heading in bite’s Issues section.

K Trust is the key to extending harm reduction among injectors (Finnish National Public Health Institute and Department of Infectious Disease Epidemiology and Control, 2008). Study of Finnish needle exchanges and health counselling centres which substantially informed the principles adopted in European guidance below. Built up during day-to-day contact between staff and a marginalised, stigmatised, and wary caseload, “Trust seemed the most significant single factor in the success of health counselling.” For discussion click here and scroll down to highlighted heading in bite’s Highlighted study section.

K Feeling accepted and safe promotes service access (2011). Users of Canadian needle exchanges saw them as safe places free of stigma, discrimination and judgments about drug use, and therefore places where they could access services such as counselling, nursing care, HIV, hepatitis C and sexually transmitted infection testing and information, welfare services and support, and housing. One of the Canadian studies which informed the emphasis on trust in a review which underpinned NICE guidance on needle exchange. For discussion click here and scroll down to highlighted heading in bite’s Highlighted study section.

K Counsellors differ in how well they retain methadone patients (1999). US study started off investigating methadone dose but found that when tailored to the individual it made no difference. What did make a big difference to retention and illegal substance use (the two were related) was which counsellor the patient had (essentially at random) been assigned to. Retention on methadone is (see cell A1) strongly related to harm reduction. This study was one of three featured in this Effectiveness Bank analysis (1999). For discussion click here and scroll down to highlighted heading in bite’s Issues section.

K Constructive responses from counsellors help keep methadone patients in treatment (1998). US patients stayed longer when their problems were constructively responded to by their counsellors such as by offering a dose increase or extra services. Retention on methadone is (see cell A1) strongly related to harm reduction. This study was one of three featured in this Effectiveness Bank analysis (1999). For related discussion click here and scroll down to highlighted heading in bite’s Issues section.

K See cell B 3 for other methadone maintenance studies.

R Extending harm reduction is built on trust (2013). Extensive UK review updated in 2013 which underpinned NICE guidance on needle exchange found evidence from Canada that “trusting relationships” between injectors and exchange staff “appears to be key to facilitating engagement in additional harm reduction services”. For related discussion click here and scroll down to highlighted heading in bite’s Where should I start? section.

R See cell B 3 for methadone maintenance reviews.

G European guidance on preventing infectious diseases among injectors (European Centre for Disease Prevention and Control and European Monitoring Centre for Drugs and Drug Addiction, 2011). Includes desired values and attitudes of services and staff, based partly on research from Finland listed above. For related discussion click here and scroll down to highlighted heading in bite’s Where should I start? section.

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