ncetanceta.flinders.edu.au/files/7112/5004/0922/2-3_tna_harm… · web viewcarmichael, c. 2001,...

Harm Minimisation (HM)

Trainer Notes& Activities

Overview

KEY POINTS1. HM is a national policy and the key concept underpinning the current National

Drug Strategy.

2. HM does not condone drug use but recognises that: despite efforts to prevent use, a proportion of the population will continue to

use psychoactive drug use is not risk free.

3. HM aims to prevent/decrease the harms associated with psychoactive drug use.

4. Abstinence is one of the range of goals of HM.

5. The HM framework encourages personal responsibility for those who choose to use drugs.

6. HM has a demonstrated efficacy (e.g., Needle and Syringe Programs significantly reduced the rate of HIV among injecting drugs users in Australia).

7. GPs are well placed to design and deliver harm reduction interventions and they are an important source of advice and information for people experiencing AOD-related harms.

8. GPs can help patients change their drug use goals and support those who choose to reduce harms related to their drug use.

SUGGESTED OBJECTIVESTo enable GPs to: understand the efficacy of harm minimisation for their patients

implement strategies to reduce drug-related harm.

Resource Kit for GP Trainers on Illicit Drug IssuesPart B2 AOD Background: Harm Minimisation

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Please check that these objectives are relevant for the particular group you are about to train. If not, write down alternatives.

Topic Contents

SLIDESThe slides with slide notes cover: development and formulation of the National Drug Strategy

definition, principles and goals of harm minimisation

HM strategies

GPs’ role in HM

application of HM strategies to individuals.

The slides are on the Resource Kit CDROM under this topic. Trainers are encouraged to select and/or adapt this slide set to meet the focus of the training and information needs of their participants.

ACTIVITIESThe activities provide opportunities for GPs to: discuss various HM issues

develop strategies to implement HM in general practice.

HANDOUTS1. Potential Harms from Drug-Related Behaviours

Carmichael, C. 2001, ‘Harms Arising from Drug-related Behaviours’, in QADREC (Queensland Alcohol & Drug Research & Education Centre), The DISE Manual: A Resource Manual for Direction in Illicit Substance Education, QADREC, Brisbane, p.16.

Please refer to the Resource Kit CDROM for a copy of the handout (Word).


Slides, Activities & Handouts from other topics may be useful. Please refer to Part A3 for: Examples of Potential Links to Other Slides, and for a Listing of Activities and Handouts.

Sources of Additional Information

PATIENT RESOURCES AIVL 2000, Safer Injecting, Australian Intravenous League, Canberra.

Harm Reduction Coalition no date, Avoiding Arteries and Nerves When You Want a Vein, http://www.harmreduction.org/pamphlets/arteries.pdf [Accessed 31 July 2003].

Harm Reduction Coalition no date, Getting Off Right: A Safety Manual for Injecting Drug Users, http://www.harmreduction.org/gor.html [Accessed 31 July 2003].

Harm Reduction Coalition no date, Taking Care of Your Veins: Rotate the Spot. http://www.harmreduction.org/pamphlets/rotate.pdf [Accessed 31 July 2003].


Patient resources are a valuable tool in the clinical setting. They can be obtained through ADIS or the publisher – free or at nominal cost.

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KEY READINGSAddy, D. & Ritter, A. 2000, Clinical Treatment Guidelines #4, Reducing Harm for Clients Who Continue to Use Drugs, Turning Point, Melbourne, Victoria.

Carmichael, C. 2001, The DISE Manual: a Resource Manual for Directions in Illicit Substance Education, QADREC (Queensland Alcohol & Drug Research & Education Centre), Brisbane.

CDHA (Commonwealth Department of Health and Ageing) no date, Return on Investment in Needle and Syringe Programs in Australia, report, CDHA, Canberra.

Gossop, M. 2000, Living with Drugs, 5th edn, Ashgate Arena, Sydney.

Hamilton, M. & Cape, G. 2002, ‘History of Drug Use and Drug Policy Responses’, in G. Hulse, J. White, & G. Cape (eds.), Management of Alcohol and Drug Problems, Oxford University Press, South Melbourne, pp. 3–15.

Hamilton, M., Kellehear, A. & Rumbold, G. 1998, ‘Addressing Drug Problems: The Case for Harm Minimisation’, Drug Use in Australia: A Harm Minimisation Approach, Oxford University Press, South Melbourne, pp.130–144.

Hilton, B., Ann, R., Thompson, R., Moore-Dempsey, L. & Janzen, R. 2001, ‘Harm Reduction Theories and Strategies for Control of Human Immunodeficiency Virus: A Review of the Literature’, Journal of Advanced Nursing, vol. 33, issue 3, pp. 357–370.

Ministerial Council on Drug Strategy 1998, National Drug Strategic Framework 1998–99 to 2002–03, Building Partnerships: A Strategy to Reduce the Harm Caused by Drugs in Our Community, Commonwealth of Australia, Canberra.

Roche, A., Evans, K. & Stanton, W. 1997, ‘Harm reduction: Roads Less Travelled to the Holy Grail’, Addiction, vol. 92, issue 9, pp. 1207–1212.

Ryder, R., Salmon, A. & Walker, N. 2001, Drug Use and Drug-related Harm: A Delicate Balance, IP Communications, Melbourne.


Harm Minimisation (HM)Activities

Activity 1: Harm Reduction in General Practice

PURPOSETo demonstrate how harm minimisation principles are applied in many situations, including everyday clinical practice.

You will needCopies of Handout 1, Harms Arising From Drug-Related Behaviours, located on the Resource Kit CDROM.

PROCESS1.1 Ask participants to give their understanding of ‘harm minimisation’

1.2 Write responses on the whiteboard

1.3 Divide participants into small groups and give each group Handout 1

1.4 Ask each group to list examples of strategies they use in the context of general practice to reduce harm: in general in relation to alcohol and other drug use

1.5 Discuss anticipated benefits and costs for patients for implementing those strategies

1.6 Bring the larger group back together to provide feedback, share strategies, and identify benefits and costs.

Source: adapted from QADREC (Queensland Alcohol & Drug Research & Education Centre) 2001, National Needle & Syringe Program (NSP) Workers’ Training Package, University of Queensland & Queensland Health, Brisbane.


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Activity 2: Explore Factors Contributing to Harm

PURPOSETo explore factors contributing to drug-related harm: is it the drug, the behaviour or the situation?

PROCESS2.1 Explain to participants that the activity:

aims to explore factors associated with certain behaviours and factors which may influence harm associated with these behaviours

is an exploratory exercise and there are no right or wrong answers

2.2 Allocate one end of the room as ‘most harmful’ and the opposite end as ‘least harmful’

2.3 Nominate a drug or a behaviour (from the list below)

2.4 Ask participants to move toward the space that represents their beliefs regarding the ‘harm’ associated with the nominated drug or behaviourWhen all participants have grouped: ask one person to describe the rationale for their position and invite comment

from others repeat with two to three other participants summarise the views expressed in terms of how harms may vary for different

environments, individuals or drug factors stress that there are no wrong or right answers to these issues and that many

factors may influence drug-related harms.

Drugs BehaviourCannabis Sky DivingHeroin Rock ClimbingMethadone Driving a CarTobacco Air TravelAspirinCoffeeAlcoholEcstasyBenzodiazepines

Source: adapted from Pharmaceutical Society of Australia & Pharmacy Guild of Australia 2003, Illicit Drugs: National Training Package for Pharmacy, Australian Government Department of Health and Ageing, Canberra.

Topic Cross Reference2.1 Making Sense of Drugs: Social Interaction Model [slide].


Activity 3: Identify Harm Reduction Principles

PURPOSETo identify harm reduction principles relevant to the GP setting.

PROCESS3.1 Draw three columns on the whiteboard to represent Supply Control, Demand

Reduction and Harm Reduction (but do not label the columns)

3.2 Nominate a licit drug and ask participants to brainstorm how society reduces the problems related specifically to that drug

3.3 Write the responses in the most appropriate whiteboard column Repeat the activity for a prescription drug Repeat for an illicit drug

3.4 Ask participants to propose appropriate labels for each column

3.5 Finally, write the labels above each column.

Source: adapted from Munro, G., Illicit Drugs Training Pharmacy Project [training package], Australian Drug Foundation.


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Activity 4: Thinking about Harm Minimisation Approaches

PURPOSETo generate thoughts about harm minimisation approaches that GPs may implement with patients experiencing illicit drug-related harms.

PROCESS4.1 Divide the group into two

4.2 Provide one group with information about Patient A and the other with information about Patient B

Patient A is a person with a diagnosis of type 2 diabetes who has high blood sugars and is unable to stick to the recommended diet

Patient B is an amphetamine user who wants Valium to assist them to sleep at night but doesn’t want to cease their amphetamine use

4.3 Ask each group to discuss and note: how they would raise the issues about the patients’ behaviour what information they would provide a brief action plan for each patient

4.4 Ask groups to give feedback about their discussion as a whole by: comparing and contrasting each group’s approach highlighting similarities and differences suggesting possible reasons for differences

4.5 Facilitate discussion.


Activity 5: Relate Advice to Harms

PURPOSETo generate strategies for reducing harms associated with illicit drug use.

You will need1. Copies of Cycle of AOD-Related Harms for Individuals. This is in the Harm Minimisation topic slide set

2. Copies of Activity 5 Handout: Relating Advice to Harms (on the next page)

3. Overhead pens

PROCESS5.1 Display the overhead transparency ‘Cycle of AOD-Related Harms for Individuals’

5.2 Divide participants into small groups. Select a particular drug as the topic of the activity

5.3 Allocate one harm from the cycle (e.g., ‘Administration’) to each group and invite them to brainstorm: sub-harms related to the selected drug strategies to provide advice, information or interventions to help reduce sub-

harms related to that drug

5.4 Each group shares their proposed activities and advice with the larger group.

Source: adapted from Pead, J., Lintzeris, N. & Churchill, A. 1996, From Go to Whoa, Amphetamines and Analogues, The Trainer’s Package for Health Professionals, Commonwealth Department of Human Services and Health, Canberra.


Harm Minimisation

Acquisition

Administration

Drug affectedbehaviour

Recovering from drug use

Withdrawal

Cycle of AOD-related Harms forIndividuals

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ACTIVITY 5 HANDOUT: RELATING ADVICE TO HARMS1. Write the name of the drug selected for discussion in the first row.

2. Write the drug-related harm from the ‘Cycle of AOD-Related Harms for Individuals’ in the second row (e.g., ‘Administration’).

3. In the first column, list sub-harms associated with the topic (e.g. list specific sub-harms associated with ‘Administration’).

4. In the second column, list strategies to reduce/prevent sub-harms related to that drug.

Name of Drug:AOD-Related Harm:

Sub-Harms Strategies to Reduce/Prevent Sub-Harms


ncetanceta.flinders.edu.au/files/7112/5004/0922/2-3_tna_harm… · web viewcarmichael, c. 2001,...

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