Harm Reduction for People who Use Stimulants – the need for an inclusive and human development-oriented approach

Joost Breeksema, Sara Woods, Rafaela Rigoni

Background:
In recent years and in different parts of the world, the use of stimulants has been on the increase. People who use stimulants (PWUS), especially those living in challenging socio-economic contexts, are often marginalised and face a diverse range of social and health problems. However, people who use stimulants, and especially those who do not inject, have limited access to harm reduction and other services. To increase the evidence-base for harm reduction for PWUS, researchers at Mainline conducted literature and empirical research into harm reduction interventions. It is the first study to comprehensively and systematically compile a literature review on harm reduction for various types of stimulants, routes of administration, and harm reduction strategies.

Methodology:
Between September 2017 and July 2018, Mainline’s team reviewed academic and grey literature on the effectiveness of harm reduction for stimulants. We also conducted site observations and in-depth interviews with both staff and service users of seven harm reduction services on five different continents.

Results:
We found evidence of effectiveness for twelve HR interventions for stimulants. The seven good practice case studies have demonstrated that irrespective of the substances used, it is essential to offer low-threshold services, to empower and meaningfully involve peers, to adapt to local and individual needs, and to address the whole person, as opposed to merely focusing on drug use. Approaches specific to stimulant use include addressing sleep deprivation and mental health problems.

Conclusion:
The study presents an evidence base for harm reduction interventions for PWUS. The report provides practical guidelines for current and future interventions, as well as a basis for further research and the development of implementation tools to facilitate setting up high quality harm reduction services for people who use stimulants. A selection of the lessons learned through the case studies will be shared at the conference.