Page 17 - ONLINE – Nursing Matters October 2020_Vol 11

current issues

relation to commonly used substances in who use methaqualone (also known poisoning, contributes to stigma and how many people and their families
[5]
the United Kingdom. In order of overall as mandrax), methamphetamine and discrimination of people who use drugs become frustrated when substance use
harm, alcohol is followed by heroin, crack cocaine are unknown, but there are likely and results in many people entering the treatment services are unavailable, or
cocaine, methamphetamine, powder to be hundreds of thousands of people criminal justice system. The healthcare how they become disillusioned when
[20]
cocaine, tobacco and other less harmful, who use these drugs in the country. system is largely affected by this ineffective the available interventions do not work.
[5]
yet scheduled, substances. Most of the and harmful approach. For people with opioid dependence,
harm related to alcohol is in relation to It is important to note that most people over 90% of those who are treated
harm to society. However, alcohol causes who use drugs will not develop depend- Injuries and complications from using through detoxification followed by
more harm to individuals than powder ence; so not all people who use drugs (unsafe) drugs in high-risk and unhygienic abstinence-based drug rehabilitation
[23]
cocaine or cannabis. On the other hand, require treatment. The likelihood of places to avoid arrest are usually dealt return to opioid use within a year.
the induvial and social harms linked to developing dependence, and the need with by the healthcare system. This system The inaccessibility and unaffordability
[24]
cannabis are less than tobacco. And for treatment, is higher for heroin than for also supports people experiencing acute of methadone or buprenorphine
MDMA causes little harm to individuals other illegal drugs (see text box below). psychiatric emergencies (e.g. drug- – essential medicines for opioid
and negligible harm to society. [5] Entry into the criminal justice system is a induced psychosis), severe infections (e.g. substitution therapy (OST) – creates
Emerging trials, repeating what was strong predictor of developing harmful, abscesses) or complications of chronic despair for many people who have
[16]
suggested in the 1980s, are confirming ongoing substance dependence. illness (e.g. late stage HIV infection), often heroin dependence, and their families.
MDMA’s efficacy as part of treatment due to avoidance of health services for
for post-traumatic stress disorder and The effects of drug policy and the fear of arrest or fear of stigma. [14, 21] The high prevalence of substance
anxiety. So, the unscientific scheduling healthcare system use and its criminalisation affects

[7]
of drugs and moral perspectives within The limited access to evidence-based healthcare workers. Professionally, the Harm reduction includes a set of principles The first needle-and-syringe service in
the drug conventions have been applied Kofi Annan believed that ‘drugs have prevention and treatment interventions health workforce is at the forefront of that can be applied to any health issue. South Africa started in Cape Town in
[10]
across the world, reflected in national destroyed many lives, but wrong for people who use drugs results in managing the health-related harms of Needle-and-syringe services and OST are 2013. Needle-and-syringe services
legislation, internalised and are often government policies have destroyed further harm. For example, the risk current approaches to drug use and sometimes seen to be controversial, with currently operate in nine South African
[19]
viewed as truth. many more’. The criminalisation of of infectious diseases (notably HIV of problematic drug use itself. Many the controversy based on moral reasons, Health Districts, and also in Mozambique,
[29]
drugs significantly increases drug-related and viral hepatitis) is increased where healthcare workers use substances, as their effectiveness is unequivocal. Kenya, Tanzania, Mauritius and 81
[25]
[33]
The scale of drug use harms. The criminalisation approach injecting equipment needs to be reused and many more have family members with Harm reduction is much more than these other countries across the world.
increases the likelihood of drug-related or shared. Another example is potentially harmful patterns of use. These two services, but dispelling myths about Political interference has resulted in the
[22]
The availability and use of drugs has factors negatively affect the wellbeing of what these services are, why they are (temporary) halting of needle-and-syringe
increased despite the war on drugs the health workforce and their capacity needed and how well they work, is a services in several South African cities.
and criminalisation of people who use to provide quality care. It is for this reason good start. In Durban, for example, the service has
them. Many people and communities that healthcare professionals should been on hold for 2 years – leading to
[9]
in Southern Africa experience a range Nyaope and whoonga be aware of effective drug treatment Needle-and-syringe services hundreds of people having to reuse and
of social challenges that negatively interventions and alternatives to current share equipment, despite the related

affect their health and well-being. These are heroin approaches – like harm reduction – and Needle-and-syringe services, or needle- risks .[34] Efforts are ongoing for services in
include high rates of unemployment, be at the forefront of advocating for the and-syringe programmes, involve the Durban to resume, and the consequences
[26]
socioeconomic inequality, violence decriminalisation of drug use. provision of sterile injecting equipment to of blocking this public health intervention
and a high burden of physical and Nyaope and whoonga are not uniquely South African drugs. people who inject drugs, with mechanisms need to be shared to avoid this from

[10]
mental illness. For many people, The main, and often only ingredient, is heroin. They do not What is harm reduction? for the safe collection and disposal of happening again.
[29]
substances provide relief, comfort and [17] used equipment. This intervention is
analgesia against the stress and trauma contain antiretrovirals. Heroin is an opioid, derived from Harm reduction can be viewed as effective and cost-saving. Consistent From a public health perspective, denying
[30]

in their lives, and give them pleasure. the sap of the opium poppy. Opioids bind to receptors in the ‘polices, programmes and practice access to sterile injecting equipment access to needle-and-syringe services for
[11]
The substances used depend on a brain and results in analgesia, euphoria and sedation. After that aim primarily to reduce the significantly reduces HIV infection through people who inject drugs is the same as
combination of accessibility, affordability repeated exposure to opioids, changes in the sensitivity and adverse health, social and economic parenteral transmission routes. They denying access to condoms to people
[29]
and preference. responses of receptors takes place, as well as adaptations consequences of the use of legal are the foundation of HIV and viral who have sex. The difference lies in
to neuronal circuits responsible for motivation, memory, and illegal psychoactive drugs hepatitis prevention programming for personal perspectives and judgements
Data on the prevalence of drug use are without necessarily reducing drug people who inject drugs. The service is around ‘acceptable’ behaviour, and
[31]

[27]
often limited, mostly due to the legislative behaviour control and disinhibition. Tolerance to opioids consumption’. Harm reduction is an linked to counselling and support around ultimately stigma.
framework. The number of people develops after prolonged exposure, due to changes and approach that focuses on concerns and safer drug use, and provides links to other
accessing substance-use treatment in reduction in the number of opioid receptors. Withdrawal is the interventions at various levels. It does not health and social services. Needle-and- Opioid substitution therapy
South Africa for opioids in the last two result of cessation of an opioid after tolerance has developed. focus on the causes of drug use and the syringe services can easily and affordably
decades has increased six-fold. United Withdrawal is very unpleasant. Symptoms include sweating, ways to stop it. Emphasis is placed on be integrated into all levels of health OST (also known as opioid agonist

[12]
Nations agency estimates suggest that tearing, coryza, yawning, restlessness, irritability, tremor, ways to support people to achieve health services as well as be provided through treatment or medication-assisted therapy)
[31]
there are around 200 000 people who nausea, vomiting, diarrhoea, increased blood pressure, through beneficent, equitable and fair community pharmacies. Needle-and- is the practice of prescribing an opioid
[14]
use heroin and 75 000 who inject [18] means. This is done while limiting harms, syringe services do not increase injecting agonist medication such as methadone
[13]
[29]
drugs in the country. Local research into cramping and myalgia, which can last several days. and acknowledging that change takes practices and are often the first point or buprenorphine at an appropriate dose
[18]
the heroin market suggests that these are time, and that resolution of a substance of contact people who inject drugs have for as long as a person needs it. OST
underestimates. The numbers of people use disorder is a long-term goal. [28] with service providers who care. [32] is the gold standard treatment for opioid

[15]
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