A ‘Latin’ approach to harm reduction: some suggestions from the Italian experience

Abstract

Following the example of many northern European countries, harm reduction strategies were introduced in Italy at the beginning of the 90s in response to the spread of HIV/Aids. The peculiarities of Italian culture and tradition led to the adoption of a ‘Latin’ model, while in northern countries the culture of pragmatism and evidence‐based practices, together with a long tradition of public health policy were determinant in promoting harm reduction. In Italy, the ‘social perspective’ on the drug problem adopted by a large part of professionals working in public services and by most non‐governmental organisations (NGOs), has prompted a synergy between ‘cure’ and ‘care’ (ie. treatment and harm reduction), leading to the ‘integration’ of harm reduction and the traditional drug‐free work on addiction. As a result, since the mid 90s, public services and therapeutic communities have been cooperating to build a complex system of low to high threshold facilities. Until the 90s, most NGOs only ran drug‐free programmes in therapeutic communities, but from then onwards many began running harm reduction programmes as well, especially street units and needle exchange programmes, secondary prevention units at rave parties, drop‐in centres, and low‐threshold detoxification centres. Similarly, there has been an increase in methadone maintenance in public services, after the ‘retention in treatment’ of clients was established as the primary objective in the effort to protect users from drug related death and HIV infection. Though harm reduction interventions are far from being fully implemented, data shows that in the past 15 years the harm reduction/treatment system has reduced health risks for drug users and has been instrumental in referring a remarkable number of injecting drug users into treatment programmes. In the mean time, drugs of choice, patterns of use and ways of drug consumption have substantially changed. Now the question is, will the Italian approach be able to address these new challenges?