Responsible drug use

Responsible illegal drug use is a harm reduction strategy based on a belief that illegal drug use can be responsible in terms of reduced or eliminated risk of negative impact on the lives of both the user and others.

For illegal drugs that are not diverted prescription controlled substances, some critics believe that illegal recreational use is inherently irresponsible, due to the unpredictable and unmonitored quality of the drugs and the risks of addiction, infection, and other side effects. Nevertheless, harm reduction advocates claim that the user can be responsible by employing the same general principles applicable to the use of alcohol: avoiding hazardous situations, excessive doses, and hazardous combinations of drugs; avoiding injection; and not using drugs at the same time as activities that may be unsafe without a sober state. Drug use can be thought of as an activity that can be fun or beneficial, but risky at the same time; similar to driving a car, skiing, or skydiving; the risks of which can be minimized by using caution and common sense. These advocates also point out that the unregulated nature of illegal drugs is due to lack of government regulation, and that if certain drugs were regulated by governments it would be easier to use them responsibly.

Suggested rules
Duncan and Gold argue that to use controlled and other drugs responsibly, a person must adhere to a list of principles. They argue that drug users must understand and educate themselves on the effects and legal status of the drug they are taking, measure accurate dosages, and take other precautions to reduce the risk of overdose when taking drugs where an overdose is possible. If possible (rarely done), chemically test all drugs before use to determine their purity and strength. As well, they argue that drug users should avoid driving, operating heavy machinery, or otherwise situate themselves directly or indirectly responsible for the safety or care of another person while intoxicated. When taking hallucinogenic drugs, they suggest that a user have a trip sitter (or "copilot"). They also propose some ethical guidelines, such as; a person should never trick or persuade anyone to use a drug; a person should not allow drug use to overshadow other aspects of their life (i.e. financial and social responsibilities); a person should be morally conscious of the source of the drugs that a person is using.

Duncan and Gold suggested that responsible drug use involves responsibility in three areas: situational responsibilities, health responsibilities, and safety-related responsibilities. Among situational responsibilities they included concerns over the possible situations in which drugs might be used legally. This includes the avoidance of hazardous situations; not using when alone; nor using due to coercion or when the use of drugs itself is the sole reason for use. Health responsibilities include: avoidance of excessive doses or hazardous combinations of drugs; awareness of possible health consequences of drug use; avoiding drug-using behaviors than can potentially lead to addiction; and not using a drug recreationally during periods of excessive stress. Safety-related responsibilities include: using the smallest dose necessary to achieve the desired effects; using only in relaxed settings with supportive companions; avoiding the use of drugs by injection; and not using drugs while performing complex tasks or those where the drug might impair one's ability to function safely.

Responsible drug use is emphasized as a primary prevention technique in harm-reduction drug policies. Harm-reduction policies were popularized in the late 1980s although they began in the 1970s counter-culture where users were distributed cartoons explaining responsible drug use and consequences of irresponsible drug use.

Health and social consequences
Some drugs are associated with high rates of addiction. Some argue that even moderate use of these drugs could result in a strong physical need for an increased dosage.

Drug use and users are often not considered socially acceptable; they are often marginalized socially and economically.

Drug use may affect work performance; however, drug testing should not be necessary if this is so, as a user's work performance would be observably deficient, and be grounds in itself for dismissal. In the case of discriminate use of amphetamines and similar drugs, work capacity actually increases, which in itself raises additional ethical considerations.

Illegality
Illegality causes supply problems, and artificially raises prices. The price of the drug soars far above the production and transportation costs. Purity and potency of many drugs is difficult to assess, as the drugs are illegal. Unscrupulous and unregulated middle men are drawn, by profit, into the industry of these valuable commodities. This directly affects the users ability to obtain and use the drugs safely. Drug dosaging with varying purity is problematic. Drug purchasing is problematic, forcing the user to take avoidable risks. Profit motivation rewards illegal sellers adding a cutting agent to drugs, diluting them; when a user, expecting a low dose, procures "uncut" drugs, an overdose can result.

The morality of buying certain illegal drugs is also questioned given that the trade in cocaine, for instance, has been estimated to cause 20,000 deaths a year in Colombia alone. Increasing Western demand for cocaine causes several hundred thousand people to be displaced from their homes every year, indigenous people are enslaved to produce cocaine and people are killed by the land mines drug cartels place to protect their coca crops. However, the majority of deaths currently caused by the illegal drug trade can only take place in a situation in which the drugs are illegal and some critics blame prohibition of drugs and not their consumption for the violence surrounding them. The illegality of drugs in itself may also cause social and economic consequences for those using them, and legal regulation of drug production and distribution could alleviate these and other dangers of illegal drug use.

Harm reduction
Harm reduction as applied to drug use began as a philosophy in the 1980s aiming to minimize HIV transmission between intravenous drug users. It also focused on condom usage to prevent the transmission of HIV through sexual contact.

Harm reduction worked so effectively that researchers and community policy makers adapted the theory to other diseases to which drug users were susceptible, such as Hepatitis C.

Harm reduction seeks to minimize the harms that can occur through the use of various drugs, whether legal (e.g. alcohol and nicotine), or illegal (e.g. heroin and cocaine). For example, people who inject illicit drugs can minimize harm to both themselves and members of the community through proper injecting technique, using new needles and syringes each time, and through proper disposal of all injecting equipment. Smoking a 700-mg. tobacco cigarette or cannabis joint (with the attendant heat shock, carbon monoxide, and combustion toxins) can be avoided by serving individual 25-mg. "single tokes" in a miniature pipe or using a vaporizer.

Other harm reduction methods have been implemented with drugs such as crack cocaine. In some cities, peer health advocates (Weeks, 2006) have participated in passing out clean crack pipe mouthpiece tips to minimize the risk of Hepatitis A, B and C and HIV due to sharing pipes while lips and mouth contain open sores. Also, a study by Bonkovsky and Mehta reported that, just like shared needles, the sharing of straws used to "snort" cocaine can spread blood diseases such as Hepatitis C.

The responsible user therefore minimizes the spread of blood-borne viruses such as hepatitis C and HIV in the wider community.

Supervised injection sites (SiS)
The provision of supervised injection sites, also referred to as safe injection sites, operates under the premise of harm reduction by providing the injection drug user with a clean space and clean materials such as needles, sterile water, alcohol swabs, and other items used for safe injection.

Vancouver, British Columbia opened a SiS called Insite in its poorest neighbourhood, the Downtown Eastside. Insite was opened in 2003 and has dramatically reduced many harms associated with injection drug use. The research arm of the site, run by The Centre of Excellence for HIV/AIDS has found that SiS leads to increases in people entering detox and addiction treatment without increasing drug-related crime. As well, it reduces the littering of drug paraphernalia (e.g., used needles) on the street and reduces the number of people injecting in public areas. The program is attracting the highest-risk users, which has led to less needle-sharing in the Downtown Eastside community, and in the 453 overdoses which occurred at the facility, health care staff have saved every person.

In the Netherlands, where drug use is considered a social and health-related issue and not a law-related one, the government has opened clinics where drug users may consume their substances in a safe, clean environment. Users are given access to clean needles and other paraphernalia, monitored by health officials and are given the ability to seek help from drug addiction.

Due to the project's initial success in reducing mortality ratios and viral spread amongst injection drug users, other projects have been started in Switzerland, Germany, Spain, Australia, Canada and Norway. France, Denmark and Portugal are also considering similar actions.