What is Harm Reduction?

You may have heard the term harm reduction in recent years but are unsure of its meaning. So, what is harm reduction, really? While it may appear to be a relatively recent addition to pathways of recovery strategies, the term has actually been around as far back as the 1960s.

To fully understand harm reduction, it’s necessary to understand its history, what problems it is trying to solve, and what it looks like in practice. 

What is Harm Reduction?

As the name suggests, harm reduction aims to reduce the harm associated with drug use. According to the Harm Reduction Coalition, harm reduction incorporates a set of practical strategies and foundational principles to minimize the negative consequences for people who use drugs. 

The roots of harm reduction date back to the 1960s, 70s, and 80s, in several human rights movements:

• The Black Panther Party providing health clinics and free breakfast for children
• The Young Lords’ providing acupuncture for people who used heroin in the South Bronx
• The women’s health movement arising from the 1970s feminist activism fighting for reproductive rights
• Activism surrounding the AIDS crisis in the 1980s and beyond

It is these movements that led to a model of harm reduction that promotes a philosophy that safer use, interventions, and policies must center the individual and be designed to meet them where they are at. 

What are the Main Principles of Harm Reduction?

The core principles central to the harm reduction philosophy include:

1. Accepts that people use drugs, and we can work towards minimizing their effects rather than ignoring or condemning the people who use them
2. Understands drug use is complex and involves a continuum of behaviors from abstinence to more severe use, and some ways of using drugs are safer than others
3. Promotes quality of life for individuals and communities rather than cessation of all drug use as measures used in interventions and policies
4. Advocates for non-judgmental and non-coercive provision of services and resources for the people who use drugs in the communities in which they live, with the goal of reducing harm
5. Ensures that people who use drugs, or have used drugs regularly, are consulted on the policies designed to serve them
6. Empowers and affirms individuals who use drugs as agents of their change, and promotes their sharing of resources and strategies that meet their specific needs
7. Acknowledges the role of racism, poverty, social isolation, trauma, class, sex-based discrimination, and other inequalities impact a person’s vulnerability to drug use and their capacity to reduce harm
8. Does not attempt to minimize or ignore the realities and dangers associated with illicit drug use. 

How Does Harm Reduction Work?

The main goal of harm reduction is to save lives. Specifically, the lives of people who use substances through a number of strategies to:

• Reduce the transmission of HIV and hepatitis B & C and improve the quality of life for people with these chronic conditions
• Decrease the stigma associated with substance use disorder
• Provide education on safer substance use, and associated behaviors, like promoting protected sex
• Improve access to vital resources, like wound care, housing, insurance, and other social services
• Provide free and widely available harm reduction drug supplies, like sterile syringes, Narcan, fentanyl test stops, smoking equipment, first aid kits, safe injection sites

Harm reduction also includes providing access to vital addiction treatment and related social services, like medication-assisted treatment, or medication-assisted recovery (MAT/MAR). MAT involves the use of FDA-approved medications to treat various substance use disorders. 

Is Harm Reduction Enabling?

Public health officials and proponents of harm reduction are often working to educate people and correct the belief that harm reduction enables people to use drugs. In fact, harm reduction improves health, increases access to addiction treatment services, provides vital medical care, and reduces the burden on the healthcare system. 

Expert Travis Rieder, PhD, MA, and associate professor at John Hopkins Berman Institute states “Opponents sometimes argue that giving people sterile syringes, clean pipes, naloxone, a space to use drugs under supervision, etc., incentivizes drug use or leads to drug use. But people are going to use drugs whether they have these resources or not, and so withholding them doesn’t prevent that use; it just makes it more dangerous. Making an activity more dangerous doesn’t stop people who are committed to engaging in that activity; it just hurts and kills more of them.”

Harm reduction, on the other hand, makes drug use safer which may support access to recovery, says Rieder “One can take the first steps of recovery while still using drugs fairly chaotically, and continue their road to recovery through small, slow steps that reduce the harms of drug use.”

Does Harm Reduction Work?

According to the National Institute on Drug Abuse (NIDA) decades of research show harm reduction works and has contributed to significant individual and public health benefits, especially in preventing deaths from overdose, decreasing the burden on the healthcare system, and improving treatment access. 

That’s likely why harm reduction is supported globally. The Harm Reduction International website shows:

• 92 countries have needle and exchange programs
• 88 countries offer opioid treatment therapy
• 17 countries have drug consumption sites
• 109 countries support harm reduction in national policies

The specific benefits have been well researched. According to the Recovery Research Institute, harm reduction shows benefits in the following areas:

• Cost savings: harm reduction has shown to be cost effective with the expense of interventions being relatively small. There is compelling evidence that syringe exchange programs are cost effective from a societal, economic, and healthcare perspective. 
• Reducing the spread of disease: harm reduction programs have been shown to lower HIV and hepatitis transmission
• Overdose prevention: harm reduction prevents overdose and greatly reduces the incidence of fatal drug poisonings. 
• Treatment initiation and referral: research demonstrates that harm reduction programs are a gateway to addiction treatment, with 85 percent of syringe access programs making referrals to treatment, and reducing drug use. Participants are 5 times more likely to enter addiction treatment. 
• Improvements to community safety: harm reduction programs improve proper syringe disposal resulting in less contaminated syringes in the community and protects emergency response and officers from accidental injuries.