Project “Harm Reduction Program among Intravenous Drug Users (IDUs)” is based on two segments: 1) outreach work with IDUs and substitution of contaminated needles and syringes for sterile ones, which are distributed through this program among IDUs, and 2) substitution methadone treatment in Primary Health Care Center Podgorica. Other partners of CAZAS in realization of this program are NGOs YYC Juventas from Podgorica and Preporod from Nikšic, so as Office for Drug Abuse Prevention of Municipality of Podgorica and Institute for Public Health of Montenegro. Through night outreach work we distribute sterile needles and syringes and on these occasions we collect contaminated (used) sets or tools. These contaminated tools are later on destroyed and distribution of sterile sets is going on continuously in order to avoid transmission of sexually and blood transmitted infections (especially HIV and HCV). In that way work on reduction of damage (harm) arisen by intravenous usage of narcotics. In Primary Health Care Center Podgorica is conducted substitution methadone treatment since 2005. Methadone treatment can be conducted only under the supervision of the medical doctor and is used in treating the heroin addiction as a substitute for heroin.
- In the proper dose relieves symptoms of abstinence and hunger for drug, and does not create effects of euphoria or sedation.
- Pharmacological profile makes him as useful substitution medicament, considering that it allows oral usage, one daily dose and achieving stabile levels in plasma after the repeated usage.
- One oral dose per day is enough for the most of the users.


Definition

Harm reduction is any program or policy designed to reduce drug-related harm without requiring the cessation of drug use. Interventions may be targeted at the individual, the family, community or society.
Not all interventions intended to minimize the adverse consequences of substance use are harm reduction. Harm reduction programs and policies must demonstrate that they have the desired impact without producing unacceptable unintended consequences. If its evaluation reveals no support for the reduction of specified adverse consequences, or shows the unintended consequences are too serious, the program should not be considered part of a harm reduction approach and other alternatives should be developed.
The primary focus of harm reduction is on people who are already experiencing some harm due to their substance use. Interventions are geared to movement from more to less harm. Examples of proven harm reduction programs are: server intervention programs which decrease public drunkenness; needle and syringe exchange programs which prevent the transmission of HIV among injection drug users; and, environmental controls on tobacco smoking which limit the exposure to second hand smoke.

Guiding Principles

In the sense of adequate development and evaluation of the program and harm reduction policies, there has been made clear the following guiding principles be used to guide the development and assessment of harm reduction programs and policies.

1. Pragmatism

Harm reduction accepts that some level of drug use in society is inevitable and normal, though this view varies widely according to culture and cultural values. Harm reduction seeks to reduce the more immediate and tangible harms rather than embrace a vague, abstract goal related to some future ideal like a drug free society.

2. Focus on Harms

The focus of harm reduction policy and programs is the reduction of harmful consequences of substance use without necessarily requiring any reduction in use. These harms may be related to health, social, or economic factors that affect the individual, community and society as a whole.

3. Determination of the prior goals

Harm reduction strategies prioritize each user's goals with an emphasis on immediate and realizable goals. The eventual goal may be abstinence but the user does not have to begin this way. Where community and individual goals appear to conflict, there is an attempt to reconcile them.

4. Flexibility and maximization of intervention options

Harm reduction initiatives are flexible in design, in recognition of individual differences and the reevaluation of individual set goals. They provide a maximum range of options for intervention, such as diverting users to alternative community-based measures and a variety of treatment options such as drug substitution, drug maintenance and interventions that adopt safer methods of use.

5. Autonomy

The drug user's decision to use drugs is acknowledged as a personal choice, for which they take responsibility. Drug users are not stigmatized as deviants. The user is an active rather than a passive entity in managing their addictions. Reintegration is emphasized over social exclusion. According to the Aboriginal Community: "The philosophy of harm reduction encourages us to reach those outside of the circle and welcome them back in... [we] recognize that everyone in the circle is affected and thus has a responsibility to make this circle whole."

6. Evaluation

Responsiveness and innovation are to be encouraged in program and policy design but there is a strong need for evaluations of their effectiveness. Programs and policies should have clear mission statements and goals and also identify what "harms" are being addressed. Both the health and functioning of the individual and the net impact on harm indicators in the community are important indicators of the success of harm reduction.

7. Conclusion

There is evidence that programs that reduce the short and long term harm to substance users benefit the entire community through reduced crime and public disorder, in addition to the benefits that accrue from the inclusion into mainstream life of previously marginalized members of society. The improved health and functioning of individuals and the net impact on harm in the community are notable indicators of the early success of harm reduction. Therefore we believe that public policy should be guided by the principles outlined above to support innovative strategies that most effectively respond to the needs of substance users and their communities.