Harm Reduction

What is Harm Reduction?

Harm reduction describes a set of practical strategies and services that reduce the negative consequences of drug abuse. At its core, harm reduction is also a humanitarian movement focused on rights and respect for people who struggle with drug addiction.

Harm reduction strategies include safer use, managed use, abstinence, and meeting people who overcame addiction. By using evidence-based harm reduction techniques accessible to anyone, the goal is to improve public health by minimizing the destructive effects of drug use.

Note: The editorial team at AddictionHelp.com does not take one side in the debate of ideas related to harm reduction, as they can vary tremendously. This page aims to provide insights that will help define harm reduction and allow you to determine your own opinions.

Harm Reduction Services

No universal definition or formula for the implementation of harm reduction exists. Therefore, each community works to address the problems unique to its area and population. While the intentions of harm reduction sound promising, criticism of these programs isn’t hard to find.

Examples of harm reduction services include:

• Community management of opioid overdose by use of naloxone, an injected drug that reverses the effects of overdoses
• Needle and syringe distribution programs (Syringe Service Programs and Needle Exchange Programs) that provide sterile injection equipment to help stop the spread of hepatitis C and HIV/Aids infections
• Overdose prevention sites (Supervised Injection Sites or SIS) where people who you drugs can do so under medical supervision to lower rates of overdose or infection
• Medication Assisted Treatment (MAT) with methadone and buprenorphine, medications that reduce cravings for heroin and other opiates
• Non-abstinence housing (sometimes called Housing First) that offers safe and sometimes permanent housing to homeless or under-housed people without the requirement of commitment to abstinence from drugs
• Community mobilization for rights protection, which recognizes the human right to health and access to a clean needle
• Legal empowerment to decrease police harassment towards people who currently use illegal substances, as well as advocacy for drug policy reform to lower rates of incarceration and reduce law enforcement interference with lifesaving services
• Peer programs to engage current and former drug users to help design and advocate for harm reduction programs and addiction treatment

Why is Harm Reduction Important?

Drug addiction, especially opioid addiction, remains a serious problem in the United States. Despite efforts to crack down on drug production, dealing, and use, these methods fail to address the core issue: addiction is a mental disease.

“If we’re going to end the current addiction and overdose crisis, we must treat combating stigma as no less important than developing and implementing new prevention and treatment tools.”

—Nora Volkow, MD, director of the National Institute on Drug Abuse

The reality is that people suffering from addiction will find a way to use substances, regardless of where they are or who they’re with. Many addicts use drugs or alcohol secretly, away from the prying eyes of family, friends, or sober companions. In fact, according to a study from Thomas Jefferson University, 90% of people using a supervised injection site reported they would otherwise be using needles in a public restroom, street, park, or parking lot.

What happens when addicts need emergency medical intervention but are hidden? What happens when users don’t have access to clean needles? What if they are experiencing an overdose and a passerby doesn’t realize it’s a medical emergency? Individuals struggling with drug addiction are worthy of empathy and life-saving measures.

Current and Proposed Harm Reduction Techniques

The broad topic of harm reduction applies to drug addiction and other areas like sexual health and disease prevention.

Supervised Injection Sites (SIS)

For better or worse, illicit drug use isn’t going away. One of the most controversial and life-saving features of harm reduction is Supervised Injection Sites (SIS). These facilities provide a safe location for people to use drugs under medical supervision and with access to sterile supplies.

Many critics have characterized SIS as “legal places for people to do drugs.” On the surface, that belief might be understandable, but these sites have been proven to save lives and help people ultimately seek treatment.

People who use drugs at SIS have an increased chance of avoiding infections, diseases, overdoses, and other drug-related complications. But, most importantly, individuals are exposed to treatment resources and a path to recovery from substance use.

Research from the College of Family Physicians of Canada shows that SISs are associated with lower overdose mortality (88 fewer overdose deaths per 100,000 person-years), 67% fewer ambulance calls for treating overdoses, and a decrease in HIV infections.

Syringe Service Programs (PPS)

One of the greatest threats other than overdose that drug users face is diseases spread by contaminated needles. Many drug users reuse and share their needles, elevating this risk. Community-based Syringe Services Programs (SSPs) provide a range of services like the access and disposal of sterile syringes, vaccination, testing, and treatment for infectious diseases.

SSPs also protect first responders, helping dispose of used needles and syringes safely, reducing the overall presence of discarded needles in the community. In addition, SSPs provide the injection equipment needed for naloxone and allow the prevention of death due to overdose.

After 30 years of research on SSPs, data shows that comprehensive SSPs are safe, cost-saving, and do not increase illegal drug use or crime. In fact, they play a major role in reducing the transmission of viral hepatitis, HIV, and other infections. According to the CDC, SSPs provide an estimated 50% reduction in HIV and Hepatitis C virus incidence.

Needle Exchange Programs (NEP)

Like Syringe Service Programs, Needle Exchange Programs (NEP) supply clean needles to drug users in exchange for used ones, safely destroying them. Exchanging needles and providing clean ones remains a basic public effort to prevent the spread of blood-borne infectious disease transmission.

Around 185 NEPs operate nationwide and, in addition to exchanging needles, provide other public health services like referrals to substance abuse treatment, prevention education for sexually transmitted diseases, HIV counseling and testing, tuberculosis screening, and primary health care.

A study by the National Institutes of Health found that NEPs reduce risk behaviors by as high as 80% in injecting drug users. In addition, NEPs throughout the country have reduced HIV transmission rates by one-third to two-fifths.

Medication Assisted Treatment (MAT)

Medication Assisted Treatment (MAT) has seen huge success in helping drug users recover from addiction. Methadone and buprenorphine reduce cravings for heroin and other opiates, lowering the likelihood of future relapse.

MAT programs also help improve adherence to HIV medications and other treatments, increasing overall personal and community stability.

Harm Reduction Psychotherapy (HRP)

Harm Reduction Psychotherapy (HRP) focuses less on addiction being the primary issue and instead addresses the biological, psychological, and social factors that lead to drug abuse. HRP assesses each person individually and tailors treatment to the individual’s relationship with alcohol and other drugs.

What makes HRP special is that it also incorporates other important mental health problems: emotional disorders, family problems, social alienation, and medical complications. The beginning of the consultation focuses on these issues without patients having to focus solely on their alcohol or drug problem.

Patients aren’t required to commit to abstinence as a condition of treatment. Instead, HRP seeks to identify and work with patients’ barriers to treatment adherence in hopes that addressing deeper issues will make later treatment far more successful.

Statistics on Harm Reduction

Harm reduction techniques have been utilized all over the world for several decades now. With so much time and research dedicated to these programs, the positive effects of harm reduction have become clear to healthcare providers and law enforcement personnel.

• Studies in New York found that legalized syringe exchange programs from 1990 to 2002 decreased HIV rates from 50% to 1%.
• In the District of Columbia, a syringe exchange program was introduced in 2016 and has since shown a 70% decrease in new cases of HIV among intravenous drug users.
• Over 25 studies have documented significant reductions in:
  • Needle sharing and reuse
  • Overdoses
  • Injecting/discarding needles in public places
  • Fatalities due to overdose
  • Increased enrollment in detoxification and other addiction treatments

Find Harm Reduction Solutions in Your Area

You can find overdose prevention solutions in your area using SAMHSA’s Harm Reduction program locator. Ultimately, an addict cannot get help if they are no longer living, and harm reduction strategies near you can help you or a loved one get on the path to a better life.

Alternatively, if you or your loved one are ready to make the crucial decision to get help for your addiction, you can find local treatment centers and programs on SAMHSA’s program locator page.