School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia.
Int J Drug Policy. 2010 Mar;21(2):131-3. doi: 10.1016/j.drugpo.2010.01.001. Epub 2010 Jan 21.
Despite a plethora of health-related problems, access to primary healthcare is often limited for drug users (DUs). Many seek care at emergency departments and tertiary hospitals because of late presentation of illness. The costs to both DUs and the health system are such that harm reduction based healthcare centres (HRHCs) have been established in various settings and utilising a variety of models. These provide a range of medical and sometimes social services, in one, integrated, low-threshold facility, including (or closely linked with) programs such as needle syringe provision. In some countries these HRHCs are becoming an alternative healthcare system for DUs. However, the need to provide such services on a broad, public health scale, in a sustainable, cost-effective manner, raises the question as to whether such programmes should be mainstreamed. This commentary provides insights on advantages and disadvantages to mainstreaming HRHCs, and approaches and barriers to achieving this. Two approaches suggest themselves: (i) providing harm reduction services through the regular healthcare system, or (ii) more closely integrating HRHCs with mainstream services. Funding and stigma are major barriers to mainstreaming. Diverse national policies towards DUs, healthcare systems and contexts, necessitate different approaches. Because of the various barriers to mainstreaming, any steps towards mainstreaming should be taken whilst maintaining the option of continuing the current targeted harm reduction services.
尽管存在大量与健康相关的问题，但吸毒者（DU）往往难以获得基本医疗保健。由于疾病晚期出现，许多人到急诊部门和三级医院寻求治疗。DU 和卫生系统的成本如此之高，以至于在各种环境中建立了基于减少伤害的医疗中心（HRHC），并利用各种模式。这些中心在一个综合、低门槛的设施中提供一系列医疗服务，有时还提供社会服务，包括（或与）诸如提供针具注射器等计划紧密相关。在一些国家，这些 HRHC 正在成为 DU 的替代医疗系统。然而，需要以可持续、具有成本效益的方式广泛提供此类服务，引发了一个问题，即此类方案是否应成为主流。本评论提供了将 HRHC 纳入主流的优势和劣势的见解，以及实现这一目标的方法和障碍。有两种方法可供选择：（i）通过常规医疗保健系统提供减少伤害服务，或（ii）更紧密地将 HRHC 与主流服务相结合。资金和耻辱感是纳入主流的主要障碍。各国对 DU、医疗保健系统和背景的不同政策，需要采取不同的方法。由于主流化的各种障碍，在朝着主流化迈出任何步骤的同时，应保留继续提供当前有针对性的减少伤害服务的选择。
