Policy from a harm reduction perspective

Purpose of the review: The present review addresses recent literature on the effectiveness of reducing drug-related harm in a number of domains which might be promoted, facilitated, hindered, or prohibited by drug policy. Recent findings: Increasingly, there is a recognition among health professionals, the judiciary, and the public, that it is possible design a system of drug control which has less of an emphasis on criminal law. However, for countries contemplating models of drug law other than strict prohibition, the three main international drug treaties limit the scope of changes to domestic laws. In the last 25 years alcohol policies have shifted from reducing the total population consumption to addressing risky drinking situations and patterns of use to reduce alcohol related problems. With regards drug use the evidence supports: needle and syringe provision schemes in the community; prison drug substitution treatment and needle exchange programs; removal of criminal penalties for minor cannabis offences; and supervised injecting facilities in localised areas with open, public drug scenes and associated amenity problems. Schemes which divert drug offenders from the criminal justice system to treatment are increasingly common, but their effectiveness is yet to be demonstrated. Provision of naloxone hydrochloride to heroin users and their friends and family to aid in management of heroin overdose has promise, but more research is needed before widespread distribution is advocated. Summary: Clinical and research practitioners should use their influence to call for policy that facilitates interventions which have been shown to be effective in reducing drug-related harm