What is harm reduction?
Harm Reduction refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption.
Harm reduction benefits people who use drugs, their families and the community.
Harm reduction complements approaches that seek to prevent or reduce the overall level of drug consumption. It is based on the recognition that many people throughout the world continue to use psychoactive drugs despite even the strongest efforts to prevent the initiation or continued use of drugs. Harm reduction accepts that many people who use drugs are unable or unwilling to stop using drugs at any given time.
In Malaysia two harm reduction programs namely Methadone Maintenance Therapy (MMT) and Needle & Syringe Exchange Program (NSEP) have been hugely successful in effectively reversing the tide of HIV infections among People Who Inject Drugs (PWID). Malaysia is now a best practice model regionally for these harm reduction programs which will be explained in more detail below.
Is harm reduction similar to behaviour change?
Yes. Harm reduction practitioners acknowledge how difficult it is for people who are addicted to make changes to their life. They acknowledge the significance of any positive change that individuals make in their lives. Harm reduction interventions are facilitative rather than coercive, and are grounded in the needs of individuals. As such, harm reduction services are designed to meet people’s needs where they currently are in their lives. Small gains for many people have more benefit for a community than heroic gains achieved for a select few. People are much more likely to take multiple tiny steps rather than one or two huge steps.
For more on harm reduction, see: https://www.hri.global/what-is-harm-reduction
What is Methadone Maintenance Therapy?
MMT has been proven to be effective in reducing drug related crime and allowing people to recover from their addiction, and to reclaim active and meaningful lives.
What is Methadone?
Methadone is a liquid medication that is used to treat addiction to heroin/morphine. It is a recovery medication that stabilises the emotional/mental state of the drug user and usually has an effectiveness of 24 hours.
What is the purpose of using MMT?
The purpose of MMT is to help drug users to overcome
- Addiction, which is affecting their daily lives
- Paranoia and fear
- Tension with their family
Methadone has the advantage of having a longer-lasting effect than heroin/morphine. This means it has a stabilising effect on the user and can enhance the recovery process.
Who is qualified to take MMT?
A heroin/morphine user who is:
- Above 18 years of age
- Has been using the drugs for more than a year
- Is willing to take part in the program voluntarily
How long does a user have to take MMT?
It can be for a lifetime as addiction is a lifelong chronic condition. There are cases where some users are able to wean off methadone gradually.
Can a person who uses drugs become ‘clean’ via MMT therapy?
Once stabilised, and with proper adherence to the MMT program dosage, peer support and counseling, methadone may have the added benefit of overcoming the addiction in the long run by gradually reducing the dosage.
Can a pregnant person take methadone?
Yes. In fact, it is safer for pregnant mothers, as heroin/morphine use can result in complications for the fetus.
Can higher dosage of MMT make a person addicted?
No. Dosage is tailored to individual needs by a health care professional.
Will MMT users’ urine test positive for drugs?
No—unlike heroin or other drugs, methadone does not show up in drug use screening tests.
Will heroin still have stimulant effect while on MMT?
No. Provided the Methadone dosage is enough, heroin will no longer have any stimulant effect.
Can I take the prescribed methadone home to use it there?
Normally, clients come to the clinic every day to get their dose of methadone. Only clients who have become stable and have shown to be very compliant will be allowed, at the discretion of the healthcare provider, to take home prescribed methadone, usually at most for a supply of three days.
Can I get MMT from another clinic if I move to another location?
Yes, the healthcare provider can arrange this. He/she will have to transfer the client’s file, a referral letter and a copy of the latest prescription to the new health care provider.
What is the difference between methadone and heroin?
In the table below the main differences between methadone and heroin are listed:
Does methadone damage the liver?
If used following the dosage prescribed by the heath care provider, methadone dosage is safe and will not damage the liver.
Is Methadone basically a drug to replace another drug?
Methadone treats the addiction and must not be seen as a substitute for heroin.
Will the long-term use of methadone have negative health effects?
Methadone is safe to use in the prescribed dose under the supervision of a healthcare provider.
Does methadone cause tooth decay and/or bone density loss?
There is no scientific evidence that methadone use has these effects.
Can ARV medications and methadone be taken together?
Yes, but there are certain interactions between methadone and antiretroviral medications that may lead the doctor to need to prescribe a higher or lower dose of Methadone or of ARV medications. The bottom line is that people taking methadone need to be aware of the possibility of interactions with any of the following medications: nevirapine, efavirenz, ritonavir, nelfinavir, lopinavir/ritonavir. Also, the time it takes for drug interactions to occur is different depending on the person and the drugs involved. People with concerns or questions should talk to their HIV doctor to have the dose of either methadone or the other medications changed. Together, optimal therapy for both methadone maintenance and HIV medications can be worked out.
More information can be found here:
What is the Needle & Syringe Exchange Program?
The Needle & Syringe Exchange Program (NSEP) is a harm reduction service. It allows people who inject drugs to exchange used needles and syringes for sterile ones to prevent the transmission of HIV and hepatitis through shared injecting equipment.
NSEP clinics also serve as a space to effectively educate people who inject drugs about supplies and proper techniques for safer substance use. Studies have shown that NSEP programs gradually reduce the rate of injection drug use.