Drucker Ernest, Anderson Kenneth, Haemmig Robert, Heimer Robert, Small Dan, Walley Alex, Wood Evan, van Beek Ingrid
John Jay College of Criminal Justice, City University of New York, New York, USA.
Department of Anthropology, 524W. 59th St., New York, NY, 10019, USA.
J Bioeth Inq. 2016 Jun;13(2):239-49. doi: 10.1007/s11673-016-9720-6. Epub 2016 Apr 26.
This paper examines the role of clinical practitioners and clinical researchers internationally in establishing the utility of harm-reduction approaches to substance use. It thus illustrates the potential for clinicians to play a pivotal role in health promoting structural interventions based on harm-reduction goals and public health models. Popular media images of drug use as uniformly damaging, and abstinence as the only acceptable goal of treatment, threaten to distort clinical care away from a basis in evidence, which shows that some ways of using drugs are far more harmful than others and that punitive approaches and insistence on total abstinence as the only goal of treatment often increases the harms of drug use rather than reducing drug use. Therefore the leadership and scientific authority of clinicians who understand the health impact of harm-reduction strategies is needed. Through a review of harm-reduction interventions in Canada, the United Kingdom, the United States, Australia, Switzerland, and the Netherlands, we identify three ways that clinicians have helped to achieve a paradigm shift from punitive approaches to harm-reduction principles in clinical care and in drug policy: (1) through clinical research to provide data establishing the effectiveness and feasibility of harm-reduction approaches, (2) by developing innovative clinical programmes that employ harm reduction, and thereby (3) changing the standard of care to include routine use of these evidence-based (but often misunderstood) approaches in their practices. We argue that through promotion of harm-reduction goals and methods, clinicians have unique opportunities to improve the health outcomes of vulnerable populations.
本文探讨了国际上临床从业者和临床研究人员在确立减少物质使用危害方法的效用方面所发挥的作用。因此，本文说明了临床医生在基于减少危害目标和公共卫生模式的促进健康的结构性干预措施中发挥关键作用的潜力。大众媒体将吸毒一概视为具有破坏性，将禁欲视为唯一可接受的治疗目标，这有可能使临床护理偏离证据基础，而证据表明，某些吸毒方式比其他方式危害大得多，惩罚性方法以及坚持将完全禁欲作为唯一的治疗目标往往会增加吸毒的危害，而不是减少吸毒。因此，需要了解减少危害策略对健康影响的临床医生发挥领导作用并具备科学权威。通过对加拿大、英国、美国、澳大利亚、瑞士和荷兰的减少危害干预措施进行回顾，我们确定了临床医生帮助在临床护理和毒品政策中实现从惩罚性方法到减少危害原则的范式转变的三种方式：（1）通过临床研究提供数据，确立减少危害方法的有效性和可行性；（2）制定采用减少危害方法的创新临床项目，从而（3）改变护理标准，在实践中纳入这些基于证据（但往往被误解）的方法的常规使用。我们认为，通过推广减少危害的目标和方法，临床医生有独特的机会改善弱势群体的健康状况。
