Effectiveness Bank web site Matrix row
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Matrix Row logo Drug Treatment Matrix row 1: Reducing harm
The five cells in row 1 explore key research on reducing harm to the user as a result of their drug use. Prompted by HIV, from the start of modern-day harm reduction 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. A common theme is how this core dilemma affects service delivery and impact, from the face-to-face encounter between user and practitioner to national treatment systems.

Cell A1 Ways to reduce the harm
Learn how because it shunned methadone maintenance, Sweden most convincingly demonstrated its lifesaving value. In 1980s Britain the future of needle exchange was in the balance. That balance was tipped when their apparent failure was hidden: a good thing which has since saved thousands of lives, or should science have prevailed? Evaluations of the Scottish national programme are a litmus test of naloxone’s effectiveness; we guide you through the evidence.

Cell B1 The practitioner in harm reduction
Trust emerges as a fundamental ingredient in key studies on the impact of the practitioner on reducing harms from illegal drug use. Reconceptualise needle exchanges as safe havens in a largely rejecting world, and explore why a Philadelphia methadone counsellor stood out – for the wrong reasons.

Cell C1 Life and death management decisions
Highlights studies which showed that treatment-termination and needle-exchange policies can mean life or death for service users. Explores the dilemmas involved in squaring this responsibility with maintaining a safe and therapeutic environment and satisfying community concerns over discarded needles.

Cell D1 Going with the grain; organisation, ethos and harm reduction
Moving up to the level of the organisation, learn how misguided ‘good intentions’ placed service users at risk in methadone clinics and needle exchanges. A possible rule of thumb emerges: harm reduction is best served by going with the grain of substance use, not ‘for its own sake’ trying to work the grain in another direction. Preserving life, or abandoning hope?

Cell E1 Creating a lifesaving treatment and harm reduction system
Treatment and harm reduction services working in synergy are the best hope, but can any feasible local or national system substantially reverse the hepatitis C epidemic? Consider whether methadone programmes should be spread thin and wide to extend harm reduction benefits, or deepened with recovery-oriented support for the fewer patients who want and will benefit from these – and to whom we can afford to offer them.