Harm reduction

It was pointed out earlier that the low nucleophilicity of fluoride ion and its low concentration in HF solutions can create circumstances not commonly observed with the other halogen acids. Under such conditions rearrangement reactions either of a concerted nature or via a true carbonium ion may compete with nucleophilic attack by fluoride ion. To favor the latter the addition of oxygen bases, e.g., tetrahydrofuran, to the medium in the proper concentration can provide the required increase in fluoride ion concentration without harmful reduction in the acidity of the medium. 

Substitution therapy with methadone or buprenorphine has been veiy successfiil in terms of harm reduction. Some opiate addicts might also benefit from naltrexone treatment. One idea is that patients should undergo rapid opiate detoxification with naltrexone under anaesthesia, which then allows fiuther naltrexone treatment to reduce the likelihood of relapse. However, the mode of action of rapid opiate detoxification is obscure. Moreover, it can be a dangerous procedure and some studies now indicate that this procedure can induce even more severe and long-lasting withdrawal symptoms as well as no improvement in relapse rates than a regular detoxification and psychosocial relapse prevention program. 

Denning P (2002). Harm reduction psychotherapy An innovative alternative to classical addictions theory. American Clinical Laboratory, 21, 16-18. 

Ayo-Yusuf OA, Reddy PS, van den Borne BW (2008) Association of snuff use with chronic bronchitis among South African women implications for tobacco harm reduction. Tob Control 17 99-104... 

Treatment aimed at short-term cessation of amphetamine use was considered completely unrealistic. After the necessary discussions the substitution prescribing option was initiated, with the harm-reduction objective of at least reducing Peter s injecting and use of street amphetamine. He was given dexamphetamine sulphate liquid 60mg per day, with a plan to reduce gradually over the following months. 

Much of the ethos of community drug treatment as it has developed has been firmly grounded in harm-reduction policies. There is frequent debate as to exactly what such principles entail, and even how appropriate they are in countries at different stages of development. Those interested in the philosophy are referred to a paper by AL Ball (2007) from the department of HIV/Aids at the World Health Organization, which clearly still sees avoidance of HIV as one of the key aims of this policy agenda. A short commentary on that article succinctly sums up the areas of importance in drug service provision, as follows ... 

Harm-reduction advice - drugs, sex Health advice... 

It was the threat of widespread transmission of HIV that led to national policy recommendations for more maintenance opioid substitution treatment to be used in the UK, as part of a package of harm-reduction measures. Two decades on there appears little doubt that the overall approach in this country was successful in limiting HIV rates in injecting addicts (Farrell et al. 2005), although with voluntary testing the true prevalence is unknown, and may possibly be rising at the present time. The resources provided at the time of the... 

Treatment - often methadone - made easy to obtain, as part of a harm-reduction approach... 

Baker A, Lee NK, Claire M, Lewin TJ, Grant T, Pohlman S, Saunders JB, Kay-Lambkin F, Constable P, Jenner L Carr VJ (2005). Brief cognitive behavioural interventions for regular amphetamine users a step in the right direction. Addiction, 100, 367-78 Ball AL (2007). HIV, injecting drug use and harm reduction a public health response. Addiction, 102, 684-90... 

Fleming PM Roberts D (1994). Is the prescription of amphetamine justified as a harm reduction measure. Journal of the Royal Society of Health, June, 127-30 Fleming ME, Mundt MP, French MT, Manwell LB, Staauifacher EA Barry KL (2002). Brief physician advice for problem drinkers longterm efficacy and cost-benefit analysis. Alcoholism Clinical Experimental Research, 26, 36-43... 

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