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When does harm minimisation become harm maintenance?

May 23 2009
Stopping smoking of crack and/or heroin must have tobacco smoking cessation factored in Why does the "health aspect" within the drugs treatment industry find so hard to make connections for themselves and wilfully disguise their role in maintaining harm as harm reduction. When does harm minimisation become harm maintenance? And as The Pavement is now distributed in Scotland too, I tried to get some info regarding smoking and drug use off the Scottish government website for health and community care. I could find nothing of any use. All the substances are, as in England, pigeonholed into their own little categories - drugs here, alcohol there and smoking over there. Most people I have worked with who are chronically dependant on substances, use all three. Many use a vicious cycle of drugs (licit and illicit), alcohol and tobacco - "killing them(selves) softly" comes to mind! There are two strands to this: smoking and drug use go hand in hand; and smoking (crack and heroin, not to mention cannabis) is seen by the harm reduction lobby as a better way of using drugs. Quoted in Drink and Drug News on 6th Oct, Gay Sutherland (and let's give her full title: research psychologist and expert in smoking cessation) stated: "most people in drug treatment smoke..." Really? Wow! ...and went on to say: "hardly any are offered help to stop smoking". She omitted that that smoking drugs is encouraged in many circles, especially front-line prescribing services. It's seen as safer than injecting by many. Advocating smoking cessation is all well and good; however, once again there seems to be a wilful "taking one's eye off the ball again". Mixed messages and job creation. I try and remain positive, but Hell's bells - come on! Tobacco, drinking and drugs go hand-in-hand. A pint of lager and a snout - lovely! Just had a nice hit of heroin? A fag will do nicely to reinforce the buzz‚Äö?Ѭ? And with coke or speed, I can smoke till the cows come home - 60 fags a day is not unheard of. And because methadone is such a "boring little drug", you need a fag and can of lager to liven it up. And smoking crack cocaine‚Äö?Ѭ? The mind boggles. (Someone told me that the hardest thing to give up once you have "cleaned up" is "fags and the dole", but I digress.) There is also evidence that respiratory-related illnesses are on the increase within the drug-using population. My observations at Narcotics Anonymous meetings, and from research I have carried out, indicates that more drug users have emphysema and that they also have an increased chance of developing the condition. I hasten to add that this area needs to be researched in greater depth so we can get a clearer picture. In public health terms, this is not the same as HIV/AIDS or Hepatitis C. But for the individual, the consequences of death by "lack of breath" are too horrendous to imagine. Quite apart from the cost to the public purse, this is a "no brainer" from a human perspective. Once again, harm minimisation becomes harm maintenance. Stopping smoking of crack and/or heroin must have tobacco smoking cessation factored in. This insistence on looking at drugs/alcohol and tobacco separately is losing ground by the day. Too much vested interest, not enough common sense.