What is Harm Reduction?
Harm Reduction is a realistic, pragmatic and non-judgmental approach to drug use and people who use drugs; it is based on openness, understanding and respect. Harm reduction meets people where they’re at, incorporates their unique situations and goals, and seeks to reduce the harms associated with drugs.
History of Harm Reduction
The roots of harm reduction are planted in the 1980’s, when an outbreak of heroin use across major cities in the United Kingdom coincided with the emergence of a Human Immunodeficiency Virus (HIV) and the advanced stage Acquired Immunodeficiency Syndrome (AIDS). To intercept the spread of HIV through risky injection drug use practices, improved connections with the injecting drug using community were needed. The harm reduction approach was initiated in Merseyside, England where multi-agency drug services ensured people who used prohibited drugs had easy access to clean needles, pharmaceutical grade drugs, condoms, and education about safer sex practices and safer injecting techniques. While these services reduced immediate harm, the project quickly found that the harm reduction approach built relationships and trust and mitigated some of the adverse effects on individuals, families and communities.
The UK government realised that instead of refusing to help people until they are committed to abstinence, they needed public health and social welfare organisations to engage with the drug using communities. Harm reduction in Merseyside was a rapid and effective intervention so the approach was adopted nationwide. The result - lowered rates of HIV and Hepatitis C among people who inject drugs in the UK, especially when compared to international rates. Harm reduction was adopted in New Zealand in 1987 when parliament enacted legislation to permit a national state-sponsored needle exchange programme, the first of its kind in the world. Rates of HIV transmission were reduced, ensuring the peer-led needle exchange would continue to the current day.
While harm reduction began as a public health approach, it has evolved and extended to reducing risks in social, legal, psychological and structural aspects of life
Principles of Harm Reduction
Key principles of harm reduction include:
Pragmatism: Acknowledging that people use drugs, every day, regardless of legality, is key to harm reduction. If people begin to have substance-related issues, abstinence may not be achievable or desirable. Harm reduction approaches aim to decouple substance use from substance harm by offering practical strategies to minimise harm associated with drugs, regardless of abstinence.
Human Rights: Harm reduction respects agency and bodily autonomy. People are empowered to make their own decisions regarding what they ingest, their health and well-being, without being subjected to punishment or coercion.
Dignity: Harm reduction promotes counselling principles: respect for the person, non-judgmental support, no hidden agendas, self-determination, empowerment and education.
Risk Reduction: The harms that may be minimized by this approach are numerous, including overdose, disease transmission, crime, social exclusion, homelessness, and stigma. Harm reduction also fully supports people abstaining from a particular drugs, provided this is their self-defined goal.
Interconnected: Harm reduction acknowledges the quality of an individual's life, their overall well-being and community impact — not necessarily cessation of all drug use — as the criteria for successful interventions and policies.
Evidence-Based Interventions: Harm reduction strategies are grounded in scientific research and data, lived & living experience, gold-standard industry practices and effective person-centered programs.
Community Engagement: People with lived experience who use prohibited drugs should be at the forefront of policy development and delivery. There should be ‘Nothing about us without us’.
Why Harm Reduction? What’s Wrong with the Traditional Approach?
The graphic below illustrates the contrasting goals, values and strategies between traditional approaches towards the use of prohibited drugs and a harm reduction approach. Traditional approaches have tended to assume the sole way to reduce harm is for people to abstain from drugs, and that the only way to ensure people abstain is to stigmatise, criminalise and punish people.
With a harm reduction approach, many more doors open to help people having issues with prohibited drugs, and to help those whose use is not problematic avoid unnecessary risks.
What are some Examples of Harm Reduction Strategies?
Harm reduction refers to policies, programs and practices that aim to minimise the negative health, social and legal impacts associated with drug use, drug policies and drug laws. Examples of harm reduction strategies include:
Naloxone - provision of this opioid overdose reversal medication alongside training to anyone who needs it (including agencies, community groups, users, family and friends).
Good Samaritan laws - safety from arrest for people who call emergency services when someone who is overdosing.
Supervised drug consumption rooms - a space, often medically supervised, where people can consume drugs of any kind, via any route including smoking and injecting, with staff and support services available. Pubs and bars are good examples of spaces like this.
Peer-led programming - as people with lived / living experience of drug use are the experts in what is needed to most benefit, and ways to effectively engage people who use drugs.
Client-led maintenance prescribing - programs such as Opioid Substitution Therapy allow a person who is addicted to access a prescription-quality substance, for maintenance and stabilisation.
Free distribution of new drug-use equipment as well as condoms and needle/syringe (sharps) disposal boxes in public toilets and public agencies.
Drug checking at public clinics and festivals allow for people who use drugs to understand what they’re putting in their body, converse about ways to stay safer, and contribute to publicly-available early warning systems for concerning (adulterated and/or high-risk) substances.
Prisons - needle exchange, drug prescriptions, education and “buddying systems” in prisons, along with post-release supportive housing.
Wet houses for unhoused people with substance use issues.
Unhoused People - laundry and shower facilities, basic health and dental care, referrals to programs and drop-in centers for people who are unhoused.
Decriminalisation of possession and cultivation of any drug for personal use.
Legalisation of use, cultivation and production of all drugs and regulation of the supply.
The possibilities of harm reduction programs are endless as creative new programs are conceptualized each year. Harm reduction is not a new concept. We adopt harm reduction strategies when we install seat belts in cars, filters on cigarettes, or use life jackets when people go in the sea. These measures don’t encourage people to be reckless, they reduce harm. They’ve been adopted to minimise known risks.
