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Panel discussion
  1. John R Hughes,
  2. John C Ball,
  3. Carl C Peck,
  4. Stephen I Rennard
  1. University of Vermont Human Behavioral Pharmacology Laboratory, Burlington, Vermont, USA
  2. University of Maryland School of Medicine, Department of Psychiatry, Baltimore, Maryland, USA
  3. Center for Drug Development Science, Georgetown University Medical Center, Washington DC, USA
  4. University of Nebraska Medical Center, Pulmonary and Critical Care Medicine, Omaha, Nebraska, USA

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John C Ball

I have been working in methadone maintenance treatment programmes for many years, and there are some differences between that field and what we are discussing here. I think the concept of harm reduction, as Dr Henningfield anticipated, is very useful in terms of encouraging discussion and debate, and breaking us loose, perhaps, from a preoccupation with smoking cessation. But other than that, I think the concept muddies the water tremendously because it does not have a clear cut goal.

We have a semantic problem with the term “harm reduction. “ Some people say all medicine is harm reduction. I think it is. Harm reduction can mean just a decrease in the number of cigarettes. It can mean a decrease in the amount of nicotine. It can mean - as used by many advocates in the drug abuse fields - less treatment and cheap treatment.

We normally do not talk in the United States about methadone maintenance as being harm reduction. We talk about methadone maintenance as long term treatment and rehabilitation, and very good data show that the more money and resources put into the programme, the better the outcome. So it is not, as it is in some places in Europe, just giving out methadone. Even in Europe harm reduction can mean different things.

So I think the term has tremendous semantic problems with it, and my own suggestion is to drop the term fundamentally and replace it. I like the term “improvement” a great deal more than I do “harm reduction.” What do you mean? What kind of harm? But if you talk about health improvement or less adverse effects, such as a reduction in mortality or morbidity, you are sending a clearer message.

So where does this leave us ? This leaves us with talking about alternative …

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  • Moderator: John R Hughes

  • Panellists: John C Ball, Carl C Peck, Stephen I Rennard

  • 1 Grudzinskas CV, Wright C. An 18-day approval becomes reality. Pharm Exec 1994: 74-80.