How Harm Reduction Works

Needle and supplies for exchange program

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What Is Harm Reduction?

Harm reduction is a proactive approach to reducing the damage done by alcohol and drug use and related high-risk behaviors. It also works by addressing broader public health and social issues, such as human immunodeficiency virus (HIV) transmission.

Harm reduction can be contrasted with punitive approaches to drug use. Where punitive policies seek to penalize people for using drugs, harm reduction strives to humanize and de-stigmatize substance use and other risky behaviors.

The goals of harm reduction are to minimize the detrimental effects of substance use, help people connect with the care they need, and foster greater social inclusion of people who are affected by substance use.

The term harm reduction can be used to describe the philosophical beliefs that underlie strategies and programs or refer to the actual strategies and programs. Often, harm reduction strategies are used in conjunction with other community-based interventions.

Key principles of harm reduction include:

  • Focusing on specific risks and their associated harms
  • Utilizing evidence-based, cost-effective policies
  • Treating people who use substances with compassion and dignity
  • Contesting policies that increase harm, including the criminalization of drug use

Does Harm Reduction Encourage Drug Use?

A common misconception about harm reduction is that it condones or encourages drug use. While critics of harm reduction suggest that this approach increases drug use, there is a lack of evidence to support this belief.  

There is no evidence that harm reduction encourages or increases substance use. In fact, research has found that harm reduction connects people with community resources that can help them overcome substance use.

For example, one study found that people who utilized needle exchange services were more likely to eventually enter a drug treatment program. They were also more likely to eventually stop using substances when compared to people who did not access syringe exchange services.

Another study found that the use of fentanyl test strips was effective in preventing deaths. Fentanyl is a highly potent opioid that is often mixed with other substances such as heroin or cocaine. People who are using those substances usually have no way of knowing if the drugs they are taking might be laced with potentially fatal levels of fentanyl.

The study found that people who utilized fentanyl test strips often detected the substance in their drug supply and, as a result, used smaller amounts of those substances. They were also more likely to use substances in the presence of another person who could contact emergency services or administer naloxone in the case of an overdose.

Many advocates of harm reduction also support the goal of people working towards abstinence from alcohol, drugs, and addictive behaviors, but recognize that for many people, this process takes time.

In the interim period, while the person is still drinking, using drugs, or engaging in other risky behaviors, both they and the people around them are vulnerable to harm. The harm reduction approach seeks to minimize this damage.

Approaches to Harm Reduction

There are a number of different approaches to harm reduction that can help reduce the negative effects of alcohol, drugs, and risky behaviors. The harm reduction approach that is most effective depends on the prevention goals. Examples of harm reduction in action include the following.

Drinking and Driving Laws

It is well known that even small amounts of alcohol can affect people's ability to drive safely. However, drinking and driving laws allow drivers to have a small amount of alcohol in their bloodstream.

Such laws are an example of harm reduction. The focus is not on eliminating alcohol use from drivers completely but on setting a limit over which the greatest risk of causing a serious accident is defined.

Drinking and driving laws do not encourage drinking; they actually discourage it. But they accept the reality that many people will drink to some extent before driving, and that the overall harm to society is lessened by focusing attention on the worst offenders.

Research has found that per se laws, which set specific limits on blood alcohol concentration for drivers, are effective in reducing drunk driving.

Needle Exchange Services

Injecting drugs such as heroin is illegal, yet harm reduction advocates for clean needles to be provided for drug use free of charge. This is because there is more harm caused to individuals who inject drugs, the health care system, and society as a whole when need sharing practices lead to serious health concerns like HIV and hepatitis transmission.

Needle exchange programs do not encourage drug use. In fact, they are usually the first point of contact for many people to access addiction treatment services.

People who utilize exchange programs are five times more likely to quit using drugs than people who do not use needle exchange programs.

The most effective way to eliminate the negative consequences of injection drug use is to stop injecting drugs. However, harm reduction approaches acknowledge that many people are unable or unwilling to stop immediately.

According to a summary of research compiled by the Centers for Disease Control and Prevention (CDC), syringe service programs are safe, effective, and cost-saving. They are particularly useful when utilized in conjunction with other effective community-based prevention programs. 

Safe Injection Facilities

Safe injection sites go a step further than needle exchange services by providing clean needles and injection equipment, a safe space in which people can inject drugs, and medical supervision of the injection process.

The harm reduction goals of needle exchange services can help with reducing the transmission of HIV, hepatitis, and other infections. They also reduce damage caused by unclean equipment being used for injecting. These safe injection rooms also offer a safe space and immediate help if an overdose occurs.

One 2021 review of earlier studies found that injection sites led to safer injection conditions, reduced overdoses, and improved access to healthcare services. While critics of harm reduction sometimes suggest that these services increase drug use and crime, research has found no such negative effects.

Recap

Safe injection facilities do not encourage drug use. Rather, they provide a connection between the most vulnerable people and treatment services, such as detox. They save lives that would otherwise be lost to drugs.

Overdose Prevention

Naloxone is an FDA-approved medication that reverses the effects of an opioid overdose. It is an essential life-saving tool, but many people still do not have access to this medication.

Harm reduction services may provide naloxone along with overdose education kits. They may teach people to recognize the signs of overdose so they can provide assistance or get help.

The Centers for Disease Control and Prevention (CDC) notes that providing naloxone kits to individuals is safe, cost-effective, and reduces overdose deaths.

Such kits are recommended for people who might witness an overdose, people who are in substance use programs, people who are leaving prison, and people who have been prescribed opiates.

The Food and Drug Administration (FDA) recommends that naloxone should be available to all people who are prescribed opioid pain relievers, people who are prescribed medications to treat opioid use disorder, and anyone else who has an increased risk of an opioid overdose.

Free Condoms

Risky sexual behaviors, such as having unprotected intercourse or multiple sex partners, can also lead to harmful consequences including unintended pregnancy and an increased risk of sexually transmitted infections (STIs). Some harm reduction programs distribute free condoms to help minimize these risks.

Condom Programs Promote Safe Sex

Free condoms are not distributed to encourage people to have sex. Programs that distribute them recognize that people have unprotected sex for many different reasons and that factors such as embarrassment and poverty may get in the way of purchasing condoms.

By providing free condoms, these services help prevent a lot of illnesses and problems associated with unprotected sex. Research suggests that condom distribution programs are an easily implemented and cost-effective intervention that can reduce the transmission of HIV and other STIs. 

Impact of Harm Reduction

Studies support the use of harm reduction for a wide variety of purposes and to help with a variety of concerns. These approaches are beneficial and do not increase substance use or risky behavior. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) suggests that harm reduction is essential for keeping people who use substances alive and healthy. The U.S. Department of Health and Human Services (HHS) has made harm reduction a central pillar of its Overdose Prevention Strategy.

HHS suggests that harm reduction is focused on helping people, regardless of where they are in the course of their substance use, without judgment. These actions reduce stigma and discrimination against people who are affected by substance use.

Summary

Harm reduction is an umbrella term that encompasses a range of programs and interventions that are aimed at reducing the detrimental effects of substance use and risky behavior. Harm reduction does not encourage drug use and may actually increase the likelihood that people enter drug treatment. Examples of harm reduction programs that can be effective include needle exchange services, safe injection facilities, overdose prevention programs, and free condom distribution services.

A Word From Verywell

Substance use can have a serious impact on the life and well-being of people who use drugs and alcohol, and the harm associated with drug and alcohol misuse extends to loved ones as well as communities and societies at large. Harm reduction works to minimize these risks while treating people who are affected by substance use with humanity and dignity.

Talk to a healthcare provider to learn more about which harm reduction programs might be helpful for you or a loved one. Services may be available in your community that can help.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

14 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
  • Denning, P., Little, J. and Glickman, A. Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol. New York: Guilford. 2004.
  • Miller, W. and Munoz, R. Controlling Your Drinking: Tools to Make Moderation Work For You. New York: Guilford. 2005.

By Elizabeth Hartney, BSc, MSc, MA, PhD
Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada.