This volume addresses the interface of two major national problems: the epidemic of HIV-AIDS and the widespread use of illegal injection drugs. Should communities have the option of giving drug users sterile needles or bleach for cleaning needs in order to reduce the spread of HIV? Does needle distribution worsen the drug problem, as opponents of such programs argue? Do they reduce the spread of other serious diseases, such as hepatitis? Do they result in more used needles being carelessly discarded in the community? The panel takes a critical look at the available data on needle exchange and bleach distribution programs, reaches conclusions about their efficacy, and offers concrete recommendations for public policy to reduce the spread of HIV/AIDS. The book includes current knowledge about the epidemiologies of HIV/AIDS and injection drug use; characteristics of needle exchange and bleach distribution programs and views on those programs from diverse community groups; and a discussion of laws designed to control possession of needles, their impact on needle sharing among injection drug users, and their implications for needle exchange programs.

This book reports on research on and experience with needle exchange and bleach distribution programs and their effects on rates of drug use, the behavior of injection drug users, and the spread of HIV and other infectious diseases among injection drug users. It discusses U.S. needle exchange data, international evaluations of needle exchange programs, legal issues and drug paraphernalia laws, evaluation methods, and bleach distribution programs.

From “one of the bravest, smartest writers about addiction anywhere” (Johann Hari, New York Times bestselling author)—the untold story of harm reduction, a surprisingly simple idea with enormous power Drug overdoses now kill more Americans annually than guns, cars or breast cancer. But we have tried to solve this national crisis with policies that only made matters worse. In the name of “sending the right message,” we have maximized the spread of infectious disease, torn families apart, incarcerated millions of mostly Black and Brown people—and utterly failed to either prevent addiction or make effective treatment for it widely available. There is another way, one that is proven to work. However, it runs counter to much of the received wisdom of our criminal and medical industrial complexes. It is called harm reduction. Developed and championed by an outcast group of people who use drugs and by former users and public health geeks, harm reduction offers guidance on how to save lives and improve health. And it provides a way of understanding behavior and culture that has relevance far beyond drugs. In a spellbinding narrative rooted in an urgent call to action, Undoing Drugs tells the story of how a small group of committed people changed the world, illuminating the power of a great idea. It illustrates how hard it can be to take on widely accepted conventional wisdom—and what is necessary to overcome this resistance. It is also about how personal, direct human connection and kindness can inspire profound transformation. Ultimately, Undoing Drugs offers a path forward—revolutionizing not only the treatment of addiction, but also our treatment of behavioral and societal issues.

Since the First International Conference on the Reduction of Drug-Related Harm, held in 1990, the term 'harm reduction' has gained wide currency in the areas of public health and drug policy. Previously the field was characterized by heated struggle between prohibition and legalization of addictive substances, and this debate tended to obscure practical, collective approaches. Harm reduction, an approach which encompasses various policy directives and program initiatives was inspired by the positive outcomes of such public measures as needle-exchange programs for reduction of HIV risk, methadone maintenance programs, education on the risks of tobacco use, and programs designed to limit alcohol consumption. The essays in this book illustrate the scope and vigour of the emerging harm reduction model. The essays, drawn from seven international conferences on harm reduction, cover a wide variety of topics, including public policy, women and reproductive issues, the experiences of special populations, human rights; defining and measuring harm, and intervention. Researchers and practitioners will benefit from the varied papers in the volume, which combine insights into policy-making and front-line outreach efforts with comprehensive conceptual and empirical approaches. Harm Reduction represents an important initiative in making academic work accessible and useful to a larger community, and provides guidance for the development of effective policies and programs.

In this collection of essays, Lawrence O. Gostin, an internationally recognized scholar of AIDS law and policy, confronts the most pressing and controversial issues surrounding AIDS in America and around the world. He shows how HIV/AIDS affects the entire population--infected and uninfected--by influencing our social norms, our economy, and our country's role as a world leader. Now in the third decade of this pandemic, the nation and the world still fail to respond to the needs of persons living with HIV/AIDS and continue to tolerate injustice in their treatment, Gostin argues. AIDS, both in the United States and globally, deeply affects poor and marginalized populations, and many U.S. policies are based on conservative moral values rather than public health and social justice concerns. Gostin tackles the hard social, legal, political, and ethical issues of the HIV/AIDS pandemic: privacy and discrimination, travel and immigration, clinical trials and drug pricing, exclusion of HIV-infected health care workers, testing and treatment of pregnant women and infants, and needle-exchange programs. This book provides an inside account of AIDS policy debates together with incisive commentary. It is indispensable reading for advocates, scholars, health professionals, lawyers, and the concerned public.

Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

Harm reduction programmes accept the reality of drug use while attempting to reduce its harmful consequences to individuals and society. Here, contributors discuss the philosophical basis and history of such policies and examine their outcomes.

After surviving nearly a decade of heroin abuse and hard living on the streets of San Francisco's Tenderloin District, Tracey Helton Mitchell decided to get clean for good. With raw honesty and a poignant perspective on life that only comes from starting at rock bottom, The Big Fix tells her story of transformation from homeless heroin addict to stable mother of three—and the hard work and hard lessons that got her there. Rather than dwelling on the pain of addiction, Tracey focuses on her journey of recovery and rebuilding her life, while exposing the failings of the American rehab system and laying out a path for change. Starting with the first step in her recovery, Tracey re-learns how to interact with men, build new friendships, handle money, and rekindle her relationship with her mother, all while staying sober, sharp, and dedicated to her future. A decidedly female story of addiction, The Big Fix describes the unique challenges faced by women caught in the grip of substance abuse, such as the toxic connection between drug addition and prostitution. Tracey's story of hope, hard work, and rehabilitation will inspire anyone who has been affected by substance abuse while offering hope for a better future.

Intravenous drug users account for nearly one-third of the current AIDS cases in the United States--second only to gay males--and are responsible for 72 percent of female and 59 percent of pediatric cases of AIDS. Thus the National Institute of Drug Abuse launched a major effort in 1987 to locate hidden users and to see how they function and to evaluate strategies and community-based programs in 50 cities and 60 nearby communities around the country in order to lower risks to IV users and to reduce the dangers that they pose to others in the population. Brown and Beschner present the very latest findings and come to well-tested conclusions about how to change behaviors positively. This handbook is written for use in college, university, and professional libraries and for students, teachers, policymakers, and practitioners in public health service and in public policy at all governmental levels to study carefully. Brown and Beschner open with an introduction showing how injection drug users and their sexual partners are at risk for aids. Part I describes the spread of AIDS in the United States and Puerto Rico. Part II depicts patterns of injection drug and crack use and their effect on sex partners. Part III deals with gender issues. Part IV goes into demographic and background factors. Part V discusses key issues in the use of drug abuse treatment. Part VI analyzes outreach and behavior change strategies. And Part VI looks into how risk can be reduced as a result of outreach and specific intervention strategies. The final chapter comes to some conclusions about the effectiveness of various interventions by the National AIDS Demonstration Research Project. Background readings also add to the importance of this major reference.