There is no universal definition for harm reduction. It is best to think about harm reduction as a set of principles and practices that focus on improving public health and decreasing mortality with evidence based methods. Harm reduction can be a theory, describe a public policy, or manifest itself as a course of action or program. Harm reduction does not promote harmful behaviors or ignore the risks of engaging in dangerous activities. Rather, it accepts that people will engage in dangerous, risky, or otherwise socially ostracized activities. Thus, it focuses on evidence and methods that reduce the dangers to people who choose to engage in certain activities.
Harm reduction outreach requires practitioners to be empathetic, understanding, and non-judgmental when approaching populations who need and deserve harm reduction practices. Along with the required demeanor of advocates, harm reduction meets clients/patients/citizens where they are in life rather than requiring that they adapt to receive the information and aid they deserve. In this way, harm reduction is a non-coercive and contingency-free way of helping members of our community. The philosophy contends that all people are deserving of the best care and evidence possible regardless of their life choices of actions. In order to effectively practice harm reduction, one must be aware of systems of oppression that encompass class, gender, race, nationality, poverty, homelessness, incarceration, among other systems.
Methods of Harm Reduction
Harm reduction can manifest itself in several ways and is not bound by any set of social problems or relevant courses of action. A few methods of harm reduction and how they address a certain problem, this is by no means a complete or all-encompassing list.
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Safer-sex education acknowledges that sex is a human activity and that people and adolescents will have sex. Thus, an effective way to limit harmful repercussions of sex such as sexually transmitted infections (STI) and unwanted pregnancies is to education people on the proper uses of protection and contraception. Providing abstinence education neglects that a significant number of people will have sex and increases the risk of STIs and unwanted pregnancies simply because individuals lack the necessary information to effectively prevent them.
Syringe Exchange Programs (SEPs)
SEPs realize that substance-abuse and general drug use is a human experience. There has never been nor will there ever be a drug free society. Thus, syringe exchange programs play a pivotal role in limiting the socially influenced harms of injection drug use. Simply put, injection drug use is scientifically associated with many acute and chronic health and social problems. However, injection drug use does not have to correlated to a massively increased risk of infectious diseases. Providing syringe exchange services prevents the spread of infectious diseases and allows for a supportive community that ultimately allows people who use injection drugs to recover from their addiction.
Naloxone Training and Distribution
Naloxone is an opiate antagonist and is a lifesaving medication that reverses an opioid overdose. Amid the largest opiate epidemic in American history, Naloxone outreach programs train members of the community to save lives using naloxone which can come in an intramuscular or nasal form. Naloxone programs do not promote opioid abuse, rather they promote saving lives.
Decriminalization of Drugs/ Ending the War on DrugsAdvocating for the decriminalization of all drugs is an example of policy-driven harm reduction. It is helpful to view drug decriminalization in the lens of alcohol prohibition. During alcohol prohibition, the United States saw the rise of paralysis, blindness, and other negative health effects of bootleg liquor. When substances are criminalized a door is opened to profit driven black-markets to fill the gap without regulation of the substances they are trafficking. This will certainly lead to amplified health dangers that can be minimized by legalization and regulation. Additionally, during prohibition the United States saw a massive rise in organize crime as it rushed at the opportunity to supply the demand for alcohol. This is analogous to the rises in black markets for criminalized substances now where we see the rise of fentanyl, other adulterants, and drug cartels. Further, the War on Drugs has not stopped the flow of drugs onto American streets. In contrast, it has provided an opportunity for criminal enterprises to be become incredibly wealthy and violent to supply the demand for drugs in the United States and abroad. What the War on Drugs has accomplished on a massive scale is the criminalization and incarceration of black and brown communities. A harm reduction perspective that ends the War on Drugs would allow for greater regulation on substances, a decrease in organized crime, a decrease in drug overdose deaths, and blunt the criminalization of communities of color.
Summary of Harm Reduction
Harm Reduction doesn’t promote or encourage harmful life choices. But, it does acknowledge that people sometimes act in dangerous activities and seeks to minimize the potential for harm through evidence-based practices and education. Harm reduction does not abide by a barrier and is fluid in its form. The ultimate goals of harm reduction are to treat people with empathy and respect, empower ostracized/oppressed populations, educate and advocate for sensible public health policy, minimize the spread of infectious diseases, and acknowledge/address systems of oppression that exist in our society.
If you have any questions about harm reduction, how we practice harm reduction tenants at American Addiction Institute, or how you can get involved in harm reduction advocacy please contact our HRI Clinical Operation Coordinator: Mahan Naeim at firstname.lastname@example.org.