Harm reduction prevents disease and promotes health by accepting people as they are rather than making judgments about where they should be. A harm reduction approach can be used with all people, including those who don’t want to stop using substances as well as those who are or strive to be abstinent from all drugs, including alcohol. It acknowledges that some ways of using drugs are safer or less risky than others. Harm reduction promotes behavior that reduces the negative consequences of their drug use, to prevent the spread of diseases associated with use, like HIV and HepC. Harm reduction aims to keep people alive by decreasing the chance of an overdose. Harm reduction interventions are evidence-based and known to be effective in saving lives.

Harm reduction doesn’t ignore the risk associated with drug use. Instead, harm reduction strives to create and maintain kind, compassionate relationships with people and break isolation often associated with drug use. These relationships help people talk about their drug use openly and encourage less risky behavior.

Harm reduction strategies rely on the stages of change model to understand a person’s use. If someone is not willing and ready for change then harm reduction interventions address higher risk behavior (using clean syringes, sterile water, not sharing needles or other drug supplies, providing cookers or water, etc.). If someone is seeking behavior change, they are supported in that choice. For example, if someone is not ready to stop using, the focus is on keeping them as safe as possible, not on encouraging detox or treatment unless it is asked for. For those asking for help, referrals and connections to care are made.

Examples of harm reduction:

• Using new syringes, not sharing, and using fentanyl test strips.

• Knowing your tolerance and using lower amounts to reduce overdose risk, particularly if someone has not used for even just a couple days.

• Swallowing, snorting, or smoking a drug rather than injecting.

• Not using alone.

• Taking turns using when in a group so someone can respond if a person overdoses.

• Not mixing drugs like benzos, alcohol, and opioids like heroin.

• Carrying Narcan and communicating with others about how to use it, where it’s found, and what to do if you overdose.

• Using a tester shot to gauge potency, especially if it is a new batch.

Accessing a Syringe Access Program.

Harm reduction is grounded in the understanding that there are many reasons people use drugs. Approaches grounded in harm reduction aim to humanize people, treat them with dignity and allow them to be the healthiest they can be, even if using drugs. Harm reduction emphasizes the continual work to build and maintain relationships, affirm self-worth and human connection. Stopping drug use is not the only measure of success for interventions and policies. Increasing feelings of well-being and quality of life is just as important. Harm reduction encourages people to explore multiple pathways to recovery.

Health care providers can help save lives by inviting open and honest conversation about safer drug use, by connecting people to syringe access programs, recovery centers, or detoxes. Providers should rely on a stages of change model to gauge the appropriate intervention based on the person’s willingness for behavior change. When someone relapses, invite more conversation. Give the person space to explore their relapse triggers and what they want their next steps to be. Understand this may not mean abstinence.

We all should reflect on our own prejudices and biases and consider where we are in the spectrum of stigma. It is important to check where we are to continue being a better support to someone who may be struggling. Consider assessing everyone for substance use, not just those who you may suspect. Learn and use the terminology used by persons who use drugs (PWUD).

Public health professionals are encouraged to ensure that people who use drugs and those in recovery have a real voice in the creation of programs and policies designed to serve them. Peer support in recovery is invaluable. It is important to recognize that people who use drugs have an expertise born of life experience and they should be invited to share information and support each other.

Public health approaches must address socioeconomic factors such as poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities that increase the risk of drug use and make it harder for them in treatment. And when developing policy and aiming to effect practice shifts within systems, public health professionals must collaborate with all sectors in the community.

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