Harm Reduction Key Terms

A

Addiction
A commonly used term that describes a pattern of drug use indicating physical or mental dependence. It is not a diagnostic term and is no longer used by the World Health Organization (WHO).

Advocacy
Harm reduction efforts often include an advocacy component, which may involve lobbying for drug users’ rights, or for funding for harm reduction programs, or trying to change public perception of drug users and of harm reduction.

AIDS
Acquired Immunodeficiency Syndrome (AIDS) is the severe manifestation of infection with the Human Immunodeficiency Virus (HIV).

Alcohol pad
A small piece of fabric soaked with alcohol, used to swab the skin before injecting. (Washing with soap and water is thought to be more effective at reducing infection than rubbing with an alcohol pad. Cleaning hands and potential sites of injection also reduces the potential for infection.)

Amphetamine-type stimulants
Refers to a group of drugs including amphetamine (also referred to as speed), methamphetamine, methcathinone, fenetylline, ephedrine, pseudoephedrine, methylphenidate, and MDMA (also called ecstasy – an amphetamine-type derivative with hallucinogenic properties). Amphetamine-type stimulants cause increased wakefulness and focus; use is increasing worldwide.

Anti-Retroviral Therapy (ART)
Anti-retroviral drugs inhibit various phases of the life-cycle of the human immunodeficiency virus (HIV), thus reducing HIV-related symptoms and prolonging life expectancy of people living with HIV.

B

Backloading and frontloading
“Backloading” and “frontloading” refer to a practice whereby one syringe is used to prepare the drug solution, which is then divided into one or more syringes for injection. The drug solution is shifted from one syringe into another with the needle (frontloading) or plunger (backloading) removed. HIV, hepatitis, and other infectious agents can be transmitted if the preparation syringe has been contaminated.

Biohazard containers
Puncture-resistant containers used for disposing of hazardous waste such as used syringes. The contents of biohazard containers are disposed of at a location specifically designed to negate the potential dangers of hazardous waste. The containers are ideally designed so that hazardous material cannot be removed once it is placed into the container.

Buprenorphine
A medication used in substitution therapy programs. Buprenorphine is included in the World Health Organization (WHO) Model List of Essential Medicines. See also

Buprenorphine Maintenance Treatment
See Substitution or replacement therapy.

C

Community-based outreach programs
These programs are an effective way to provide information and outreach services to drug users with the goal of prevention and health promotion.

Consumption rooms
Safe, clean places for drug users to inject sterilely and under medical supervision. Information, sterile injection equipment, and health services are often provided.

Cooker
Any item used to heat injectable drugs in order to turn them from powder or other non-liquid form into a liquid suitable for injection. (According to some experts, injection drug users often reused metal spoons for cooking drugs until harm reduction service providers began promoting the one-time use of disposable items, such as bottle caps or similarly shaped objects, in order to reduce the risk of disease transmission.)

Cotton
Any item used to filter out particles of solids from injectable liquid drugs, in order to prevent them from clogging syringes. From the point of view of sterile injection, the ideal filter is a sterilized cotton pellet, made of natural cotton fibers and especially cut for this purpose.

D

Decriminalization
Unlike legalization, decriminalization refers only to the removal of penal and criminal sanctions on an activity, which retains prohibited status and non-penal regulation.

Demand reduction
Programs and policies aimed at directly reducing demand for illicit drugs via education, treatment, and rehabilitation, without reliance on law enforcement or prevention of production and distribution of drugs.

Drop-in centre
Centers provide easy-to-access basic care and information to drug users.

Drug consumption rooms
Drug consumption rooms are medically supervised sites that provide a safe and hygienic site for consumption of illicit drugs. The sites often provide sterile injection equipment as well as information about drugs and medical and treatment referrals. Some sites may offer additional medical or counselling services.

Drug policy
Refers to the sum total of policies and laws affecting supply and/or demand of illicit drugs, and may include issues such as education, treatment, and law enforcement.

Drug use
Preferred term for use in harm reduction context, acknowledging that drug use is a nearly universal cultural behavior with a wide range of characteristics and impacts, depending on the individual user.

Drug-related harms
Include HIV and AIDS, other viral and bacterial infections, overdose, crime, and other negative consequences stemming from drug use and from policies and problems relating to drug use.

H

Harm reduction
Refers to a set of interventions designed to diminish the individual and societal harms associated with drug use, including the risk of HIV infection, without requiring the cessation of drug use. In practice, harm reduction programs include syringe exchange, drug substitution or replacement therapy using substances such as methadone, health and drug education, HIV and sexually transmitted disease screening, psychological counseling, and medical care.

Hepatitis B and C
Hepatitis B and C are blood borne diseases causing inflammation of the liver. Hepatitis B and C can be contracted through sharing needles and hepatitis B can also be spread through unprotected sex.

Heroin
An illegal narcotic whose use is rare compared to the use of other drugs, but which has been viewed in many areas as a social scourge dangerous to health and related to criminality.

Heroin-assisted treatment
Refers to the prescription and use of medical heroin for heroin or opiate users. Heroin-assisted treatment is proven as effective treatment and is currently utilized as a second-line treatment for users who failed to respond to opioid replacement therapy using methadone or buprenorphine.

HIV
The Human Immunodeficiency Virus (HIV) attacks and weakens the immune system. HIV infection eventually leads to AIDS, but proper medical treatment can delay symptoms for years.

I

Injection equipment
Items such as syringes, cottons, cookers, and water used in the process of preparing and injecting drugs. Each of these can be contaminated and transmit HIV or hepatitis. The broader term “drug paraphernalia” comprises injection equipment, as well as items associated with non-injection drug use, such as crack pipes.

Injecting drug use
Refers to the consumption of a drug through injection into the body by use of a needle or syringe.

L

Legalization
As opposed to decriminalization, legalization refers to the process of transferring an activity from prohibited status to legally controlled status.

M

Methadone
A medication used in opioid substitution therapy programs. It is included in the WHO Model List of Essential Medicines.

Methadone maintenance treatment
See Substitution or replacement therapy.

Methamphetamines
A group of substances, most of them synthetic, that have a stimulating effect on the central nervous system. Methamphetamines can be injected, snorted, smoked, or ingested orally. The popular term “crystal meth” usually refers to the smokeable form of methamphetamine. Other amphetamine-type stimulants include anoretics (appetite suppressants) and non-hallucinogenic drugs such as “ecstasy.”

N

Needle or syringe exchange points
Programs that provide sterile syringes in exchange for used ones. In addition to exchanging syringes, needle exchange points often provide HIV prevention information and screening, primary health care, and referrals to drug treatment and other health and social services.

Needle sharing
The use by more than one person of the same needle, or, more generally, of the same injecting or drug-preparation equipment. It is a common route of transmission for blood-borne viruses and bacteria, and the prevention of needle sharing is a major focus for many harm reduction interventions.

O

Opioid substitution therapy
See Substitution or replacement therapy.

Overdose prevention
Overdosing is a significant cause of morbidity and mortality among drug users, and is a major focus of harm reduction initiatives, including outreach, health services, safe injection rooms, and access to information on how to reduce the likelihood of an overdose.

R

Risk behavior reduction
Behaviors that place drug users at risk of adverse consequences are a main focus of a set of harm reduction initiatives referred to as risk reduction for their focus on reducing the risk of drug-related harm.

S

Safe injection facility
See Drug consumption room.

Sex worker
A non-judgmental term which avoids negative connotations and recognizes that people sell their bodies as a means of survival, or to earn a living. (UNAIDS)

Shirka
The popular name for one of the most commonly injected opiate derivates used in Ukraine, a homemade preparation of acetylated or extracted opium. In the Odessa region, shirka refers to a homemade amphetamine derivate known elsewhere in the country as vint or perventin.

Substance abuse
A widely-used but poorly defined term that generally refers to a pattern of substance use that results in social or health problems, and may also refer to any use of illegal drugs.

Substitution or replacement therapy
Medically supervised administration of a psychoactive substance pharmacologically related to the one creating dependence (often buprenorphine or methadone) to substitute for that substance. This aims at preventing withdrawal symptoms while reducing or eliminating the need or desire for illicit drugs. Substitution therapy seeks to assist drug users in switching from illicit drugs of unknown potency, quality, and purity to legal drugs obtained from health service providers or other legal channels, thus reducing the risk of overdose and HIV risk behaviors, as well as the need to commit crimes to obtain drugs.

Syringes or needles
The main components of a syringe are a needle, a tubular syringe barrel, and a plastic plunger. Graduated markings on the barrel of a syringe are used to measure the water or saline solution used to dissolve a solid substance into liquid form. Syringes and needles vary in size and do not always come as one piece; a syringe with the needle attached is often referred to as an “insulin syringe.” While disinfection of syringes is possible, public health authorities recommend a new sterile syringe for every injection.

T

Ties or tourniquets
Items used to enlarge or “plump up” veins to facilitate injection. Ties should be clean because blood on a tie can be a source of infection. Common ties include a piece of rope, a leather belt, a terry cloth belt, a rubber hose, and a piece of bicycle inner tube.

V

Vint or perventin
The popular names for an injected homemade amphetamine derivate. (See Shirka.)

W

Water
Water is used to dissolve solid substances (such as pills or powder) into a liquid form suitable for injection. Having a clean source of one’s own water is important to prevent disease transmission. Harm reduction programs often distribute vials of distilled water, sterile water or sterile saline solution (all referred to as “waters”) for this purpose.

Withdrawal
Clinical symptoms associated with ceasing or reducing use of a chemical agent that affects the mind or mental processes (i.e., a “psychoactive” substance). Withdrawal usually occurs when a psychoactive substance has been taken repeatedly and/or in high doses.