WHAT IS HARM REDUCTION?
Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. This fact sheet focuses on harm reduction applied to drug use and HIV.
Harm reduction incorporates a spectrum of strategies that includes safer use, managed use, abstinence, meeting people who use drugs “where they’re at,” and addressing conditions of use along with the use itself. Harm reduction requires that interventions and policies designed to serve people who use drugs reflect specific individual and community needs, therefore there is no universal definition of or formula for implementing harm reduction.
HARM REDUCTION PRINCIPLES
According to the National Harm Reduction Coalition, there are a core set of principles that are central to harm reduction practice:
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- Accepting, for better or worse, that licit and illicit drug use is part of our world and choosing to work to minimize its harmful effects rather than simply ignore or condemn them.
- Understanding drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence and acknowledging that some ways of using drugs are clearly safer than others.
- Establishing quality of individual and community life and well-being—not necessarily cessation of all drug use—as the criteria for successful interventions and policies.
- Calling for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
- Ensuring that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them
- Affirming people who use drugs themselves as the primary agents of reducing the harms of their drug use and seeking to empower people who use drugs to share information and support each other in strategies which meet their actual conditions of use.
- Recognizing that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.
- Not attempting to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use.
HARM REDUCTION IN ACTION
Harm reduction related to drug use includes:
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- Teaching people who use drugs about the risks of different drugs and their use.
- Providing information on using drugs more safely and reducing the harm of overdoses.
- Providing methadone as a substitute for heroin.
- Offering education and medication to prevent or counteract a drug overdose.
- Offering education and referral to drug treatment opportunities.
- Permitting people who use drugs to exchange used syringes for new ones or buy new syringes.
- Providing outreach services in areas where drug sales occur.
- Treating clients as the experts on their lives and dealing with them as they are.
There is research to support several harm reduction approaches, including methadone maintenance for heroin users and syringe/needle exchange for people who inject drugs.
HARM REDUCTION AND HIV
Some harm caused by drug use is related to HIV.
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- Sharing equipment for drug use can spread HIV infection if there is even a tiny amount of infected blood on the equipment.
- Drug use is linked to unsafe sexual activity. This increases the spread of HIV infection.
- Drug use is also related to missing doses of HIV medications (poor adherence). This can make HIV disease get worse.
Harm reduction can include:
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- Providing education about the HIV-related risks of drug use and unsafe sexual activity.
- Helping drug treatment counselors incorporate harm reduction skills into their work.
- Offering overdose prevention education and support to drug users.
CHALLENGES TO HARM REDUCTION
Drug use and its effects are huge challenges. They require the coordinated efforts of treatment specialists, law enforcement agents, public health professionals, corrections experts, and people who use drugs themselves.
Harm reduction suggests that drug treatment is usually more effective than arrest and imprisonment. It also says that the best approach to drug use problems involves public health providers working with people who use drugs rather than imposing legal punishment. Exceptions would be where drug use results in criminal activity that harms others, such as theft, violence, and driving under the influence of drugs.
Many communities combine harm reduction and law enforcement approaches to drug use. Unfortunately, many debates about drug policy put public health arguments on one side against morality and law enforcement on the other.
IS HARM REDUCTION LEGAL?
Some aspects of harm reduction are legal. People who use drugs can get information on methadone, on using drugs more safely, or referrals to drug treatment programs. In some states, people can purchase syringes without a prescription or obtain medications to reverse a drug overdose. People can get information on reducing the risk of HIV infection through sexual activity and can get condoms. Some countries (not the U.S.) have set up safe injection sites for drug users. At these sites, clean syringes and medical care are available.
Many other aspects of harm reduction require changes in laws or in law enforcement procedures. For example, syringe service programs (SSPs) operate under specific exemptions to existing laws or local emergency legislation. Programs to permit the purchase of new syringes without a prescription, or to distribute medications to prevent overdose, also require changes in laws. These legal changes may require cooperation from local law enforcement officials.
THE BOTTOM LINE
Harm reduction is a public health approach to behaviors that harm individuals and their communities. Harm reduction can be applied alongside law enforcement activities.
Harm reduction focuses on improving the health of individuals and the public, more than on eliminating harmful behaviors. Harm reduction principles can be applied to reducing the HIV-related risks of drug use or of unsafe sexual activity.
MORE INFORMATION
National Harm Reduction Coalition
North America Syringe Exchange Network (NASEN): Find a syringe service program (SSP) near you
NEXT Distro: Access mail-based naloxone
National Harm Reduction Coalition: Harm Reduction Issues
Reviewed March 2021
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