Harm reduction

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Harm reduction can refer to a policy, strategy, or particular intervention that presumes continuation of an undesired behavior while aspiring to lower the risk of harmful consequences associated with the continuance of this addictive behavior.[1]



The fact that a high level of physical activity. i.e. exercise, has a broad variety of protective effects prompted researchers to analyze the extent to which exercise could prevent smoking-related mortality and morbidity.[2] It can be estimated that the magnitude of the protective effect is major, and that, given the poor efficacy of smoking cessation techniques (less than 30%), it should be actively promoted to all smokers.

At the biochemical level, tobacco smoke attacks lung cells and other cells through pro-oxidant mechanisms. Maintaining high concentrations of vitamin C in the blood appears to largely prevent these effects, while other antioxidants are poorly effective.[3] To date, no large-scale clinical trials have been conducted to conceive public health guidelines on this harm reduction strategy.




Goals of harm reduction treatments: the case of opiate addiction[4]

assist the patients to stay healthy until, with the appropriate care and support, they can achieve a life free of drugs

reduce the use of illicit and non-prescribed drugs by the individual

deal with the problems related to drug use

reduce the dangers associated with drug use, particularly the risk of death by overdose and HIV and hepatitis infections from injecting and sharing injecting paraphernalia

reduce the duration of episodes of drug use

reduce the chances of future relapse to drug use

reduce the need for criminal activities in order to finance drug use

improve overall personal, social and family functioning

Injected drug use, and in particular opioid use, is a major public health and social concern (see box). Substitution treatments with other opiods (methadone, a synthetic opiod similar to morphine, which mainly acts as a mu-opiod agonist and buprenorphine), which were initially rejected under the "so called 'abstinence paradigm'",[4] became increasingly acceptable and accessible, in the 1990, due to raising concerns about the spread of HIV infection. In developing countries in Asia and transition countries in Europe, the WHO collaborative research project on drug dependence treatment and HIV/AIDS[5] showed that methadone maintenance treatment provided "convincing results": enhanced health status and quality of life, as well as a strong decline in the development of depression; clear decrease in the severity of dependence (over 50%); neither HIV nor hepatitis C rates increased.

Heroin-based treatments, analogous to nicotine replacement therapy, are additional harm reduction treatment options under development.[4]


  1. Stratton, K., Shetty, P., Wallace, R. and Bondurant (Eds.), S. (2001b) Clearing the smoke: Assessing the science base for tobacco harm reduction. National Academies Press , Washington, DC
  2. deRuiter W, Faulkner G (2006). "Tobacco harm reduction strategies: the case for physical activity". Nicotine Tob. Res. 8 (2): 157–68. DOI:10.1080/14622200500494823. PMID 16766410. Research Blogging.
  3. Panda K, Chattopadhyay R, Chattopadhyay D, Chatterjee IB (2001). "Cigarette smoke-induced protein oxidation and proteolysis is exclusively caused by its tar phase: prevention by vitamin C". Toxicol. Lett. 123 (1): 21–32. PMID 11514102[e]
  4. 4.0 4.1 4.2 Michels II & al. (2007). "Substitution treatment for opioid addicts in Germany". Harm Reduct J 4: 5. PMID 17270059.
  5. WHO collaborative research project on drug dependence treatment and HIV/AIDS World Health Organization Online.