Does Harm Reduction Work?

Harm reduction aims to help you if you are unwilling to stop drug use or other potentially harmful behavior. Instead, you are given options to reduce harm to yourself and others that may be related to the behavior. Your decision to continue with risky behavior is accepted as a fact by proponents of harm reduction. Harm reduction treats you with dignity rather than as a criminal.⁴

Benefits of Harm Reduction

Evidence suggests that harm reduction effectively lessens morbidity and mortality related to the behaviors it addresses.³ For example, geographic areas that have implemented needle exchange programs have shown decreases in HIV prevalence than those that have not.³

Similarly, places with methadone maintenance clinics show decreased fatalities in people who use opioids, whether by overdose or other causes, compared to areas without these programs.³

Harm reduction has helped many people dependent on a drug to contribute meaningfully to their communities and live as productive members of society.⁴ As the name implies, it reduces the harm to yourself and others without requiring abstinence. In this way, it lessens the marginalization and stigma of these behaviors that may prevent you from seeking health and finding safe alternatives.

Even if the outcome does not involve complete abstinence, you may be able to achieve health and lifestyle outcomes that you wouldn’t be able to without assistance from harm reduction programs and policies.

Cost

Harm reduction is also cost-effective. Often, implementing harm reduction programs cost less than the hazards they are trying to prevent. For example, preventing overdose is much less costly than treating overdose.⁷

What Does Harm Reduction Mean?

There is no universally accepted definition of harm reduction. In general, harm reduction means reducing the hazardous consequences of certain behaviors without necessarily reducing the behavior’s incidence. To use harm reduction resources, you do not have to stop using drugs or engaging in other dangerous behaviors. You are still entitled to access resources that can help you. This is why 12-step programs and other programs that focus on abstinence are different from harm reduction.

Harm reduction measures might lead you to addiction treatment, and ultimately abstinence. But this is not really the goal of harm reduction. Many people who achieved abstinence credit it to how well they were treated in harm reduction programs.

The harm reduction model includes a variety of strategies to combat public health issues related to risky behaviors. In the ’60s and ’70s, harm reduction referred to activism that aimed to fight the perceived injustice and stigma towards recreational drug use. In the ’80s, harm reduction evolved to involve programs that limited or stopped the spread of HIV and AIDS.¹

That meaning persists today, but harm reduction also includes the innumerable efforts to address the hazards associated with:^2,3

• Alcohol dependence
• Sex work
• HIV/AIDS
• Drug overdose
• Access to clean syringes
• Medication to treat opioid use disorder
• Supervised consumption
• Teen pregnancy
• Sexually transmitted
• Hepatitis

What Are the Goals of Harm Reduction?

Generally speaking, harm reduction has a goal to keep you alive and protect your health if you behave dangerously, such as using drugs or doing sex work. It includes policy change and community programs that try to reduce the risk and harm to you if abstinence is not realistic at this time.

Harm reduction can be an alternative to abstinence-only treatment so that you can have options to make safe lifestyle choices. It offers you the dignity to choose how you want to live your life while reducing the risk of harming yourself or others.

Can Harm Reduction Help with Addiction Recovery?

Harm reduction is often compared to abstinence-based addiction recovery programs, because in many ways, they are trying to get the same end, with different means. Some even consider abstinence-based recovery programs like SMART Recovery and 12-step models to fall under the umbrella of harm reduction.

Most harm reduction advocates see abstinence programs as separate from harm reduction. However, you may find harm reduction programs can lead you to abstinence and addiction recovery. Many people who achieve abstinence would not have had the resources necessary without going through harm reduction programs first.

Abstinence is rarely or never the goal of harm reduction, and people who become abstinent do so by personal choice.

Opioid Use and Harm Reduction

There are multiple programs out there that help prevent drug overdose—particularly with opioids—that are considered harm reduction.

Fentanyl

Fentanyl, which is 80-100 times stronger than morphine and 50 times stronger than heroin, is often “laced” into street drugs. This can create a very high risk for overdose if you are not aware of the composition of drugs you purchase. Certain harm reduction projects like The DOPE Project in San Francisco offer fentanyl test strips so that you can test drugs for the presence of fentanyl.

Naloxone

They also offer naloxone, a medication that can rapidly reverse an otherwise fatal opioid overdose. Additionally, they provide support and advice to help you take safety precautions while continuing your drug use. In so doing, accidental harm or death from opioid use can be, and is, prevented.²

Clean Syringes

Clean syringe access is a widely used and well-known harm reduction strategy. These programs offer clean syringes and other sterile supplies to allow people who use intravenous drugs to avoid viruses, such as HIV and hepatitis, that they can get through shared or dirty syringes.²

Injection Facilities

A newer and more controversial harm reduction strategy is supervised injection facilities. In some areas, this has even expanded to include inhaled drug use, such as crack cocaine and crystal meth, as well as alcohol consumption supervision.

These types of programs already exist in Switzerland, The Netherlands, and British Columbia. The United States does not currently have a supervised injection facility.

These types of facilities have trained healthcare professionals who offer oversight of illicit injection drug use. They intend to provide safe, clean injection resources and to prevent overdose. They also connect people who use drugs to help with addiction treatment programs and social and health assistance.⁵

Research on the outcomes of these centers shows improvement in the long-term achievement of either abstinence or alternative therapies, such as methadone, reduced infectious disease transmission, and reduced legal consequences of street drug use.⁵

Alcohol Use and Harm Reduction

Many harm reduction programs offer therapeutic techniques to address the psychological aspects of risky or excessive alcohol use. For example, abstinence-focused counselors in alcohol treatment programs might see clients who continue drinking as a failure, whereas harm reduction counselors would see a reduction in drinking, or safer drinking, as a success.⁶

Some colleges also have harm reduction programs to help students learn ways to reduce their risk of alcohol poisoning and blackouts. These programs favor less risky drinking habits over complete abstinence, seeing abstinence programs as unrealistic and ineffective for many young adults.⁶

Critics of Harm Reduction

You can see why harm reduction often generates a certain amount of controversy. Harm reduction critics believe that these programs may actually promote the behavior they are trying to stop. Many critics also dismiss the idea that addiction is a disease or a condition that can’t be changed and that harm reduction for drug use prolongs a problem that a more diligent pursuit of abstinence could fix.¹

Others feel that harm reduction helps with short-term relief and safety but with no sustainable long-term solution.¹

Harm reduction critics are correct in pointing out that the only way to avoid the dangers of risky behavior is to abstain from the behavior completely. Harm reduction proponents agree with this point but suggest ways to meet you if you are not ready to stop completely.

If you’re not ready to stop, the alternatives are often far more dangerous without harm reduction strategies than with them.

References

1. Roe, G. (2005). Harm reduction as paradigm: Is better than bad good enough? The origins of harm reduction. Critical Public Health, 15(3), 243-250.
2. National Harm Reduction Coalition. (2020, August 31). Harm reduction issues. Retrieved March 03.
3. Leslie, K.M. (2008). Harm reduction: An approach to reducing risky health behaviours in adolescents. Paediatrics & child health, 13(1), 53–60.
4. Single, E. (1995). Defining harm reduction. Drug and Alcohol Review, 14(3), 287-290.
5. European Monitoring Centre for Drugs and Drug Addiction. (2018). Drug consumption rooms: An overview of provision and evidence (Perspectives on drugs).
6. Logan, D. E., & Marlatt, G. A. (2010). Harm reduction therapy: a practice-friendly review of research. Journal of clinical psychology, 66(2), 201–214.
7. Harm Reduction International. (n.d.). What is harm reduction?