Harm reduction isn’t explicitly a pathway of recovery — although some do identify that way — it is however, a health strategy aimed toward reducing the harm associated with drug use.
One of the most established organizations that advocates for harm reduction is the Harm Reduction Coalition, formed in 1993 by a working group of needle exchange providers, advocates, and drug users. They are now an extensive and diverse network of allies who challenge the stigma faced by people who use drugs, and advocate for policy and public health reform.
What does harm reduction mean?
While there is no universal definition of harm reduction, the Harm Reduction Coalition helpfully define it as: “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.”
Harm reduction strategies vary depending on the individual and where they are currently. They incorporate a wide range of approaches including managed use, safer use, and abstinence. The goal is to provide strategies that address drug use and conditions of use.
Central to the mission of the Harm Reduction Coalition — and echoed throughout other harm reduction advocates — is the understanding that drug use is complex and can be impactful, but that doesn’t negate the need to treat drug users with dignity and respect. There is significant social inequality and injustice toward drug users silencing their valuable voices which deserve to participate in public policy conversations.
The role of the harm reduction coalition is to:
- Eliminate the existing disparities in health care and services for drug users and their communities
- Train community-based organizations and other community stakeholders nationally
- Advocate for and provide overdose prevention and advocacy
- Organize national conferences
- Provide resources and publications
Principles of harm reduction
The key principles of harm reduction practice outlined by the HRC include:
- Accepts, for better and or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.
- Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.
- Establishes quality of individual and community life and well-being–not necessarily cessation of all drug use–as the criteria for successful interventions and policies.
- Calls 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.
- Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.
- Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.
- Recognizes 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.
- Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.
Key harm reduction strategies
There are some key strategies that can reduce harm and address conditions of use among those who use drugs, including:
Safe injection sites
Otherwise known as supervised injection sites (SISs), these facilities are to facilitate the safe use of drugs, reduce the risk of death and the transmission of diseases, and provide access to services, like substance use disorder treatment. They also offer a secure environment free from criminal prosecution. SISs provide clean needles and needle disposal, kits to treat infections, primary care, withdrawal management, condoms, naloxone kits, and information about health and social services.
Despite heavy criticism, studies show that SISs are associated with a four-fold increase in people seeking substance use disorder treatment, 67 percent decrease in 911 calls, a decrease in communicable diseases like hepatitis C and HIV, lower overdose mortality, and an array of community and public health benefits without evidence of adverse impacts.
Managed use/Syringe exchange programs
The use of needles increases the risk of transmitted diseases like hepatitis C, and HIV if the needle isn’t sterile or if it is shared with others. Intravenous drug use also increases the risks of other medical conditions, like abscesses.
Syringe exchange programs are available throughout the US in clinics and pharmacies without prescription. Similar to SISs, managed use services also include safe disposal units, overdose rescue kits including naloxone, safer sex supplies, wound and abscess care, referrals to medical and mental health resources, shelter services, and substance use disorder treatment.
Approved by the Food and Drug Administration, and the Substance Abuse and Mental Health Services Administration, certain medications used to treat substance use disorder can be an effective treatment resulting in successful and long-term outcomes. There are three common medications used: methadone, naltrexone, and buprenorphine. For more information about these drugs and their effects, check out our blog, Medication-assisted Recovery: What You Need to Know.
Also called naloxone, Narcan is a drug used to reverse the effects of an opioid-related overdose. Available via injection or nasal spray, this drug has saved a lot of lives. It is becoming more widely available among first responders, people who use drugs, and the general public. It is available in most states without a prescription. Click here to locate Narcan in your state.
Good Samaritan Laws
There is now legal protection to individuals who volunteer to help a person experiencing a drug-related overdose in all 50 states. Good Samaritan laws vary in protection and potential criminal violations. You can find out more information about the specific protections within your state here.
Treatment instead of jail
Some states have drug courts that present treatment options as an alternative to criminal convictions. Typically, drug courts target adults facing convictions for driving while intoxicated, crimes committed by veterans, juvenile offenses, child welfare, and other offenses. If the individual chooses treatment, they will be required by the court to adhere to certain stipulations, like regular court monitoring appointments and progress reports. There are over 3,000 drug courts in the US — they can be located here.
Overdose education & naloxone distribution programs in jails and prisons
According to the Harm Reduction Coalition, people exiting jails and prisons are at a very high risk for opioid-related overdose, as the most common cause of death of those released. Many people entering jail or prison are opioid-dependent and during their stay their opioid-tolerance decreases due to decreased access to opioids while incarcerated. And when leaving institutions, these individuals may return to use, using the previously tolerated dose despite their reduced tolerance, resulting in overdose.
Programs that provide overdose education and naloxone save lives.
Some people who use drugs may wish to enter recovery with a goal of abstinence. Pathways for abstinence can be clinical including professional treatment services, non-clinical including mutual-aid programs, recovery community organizations, and alternative supports, or natural recovery which is undertaken without any formal support. For more information, read our blog Pathways of Recovery.