What is Harm Reduction?
by Stacey
Trigger Warning: Substance use, Addiction, Overdose.
A popular topic in recent years, harm reduction aims to reduce the negative impacts (health, social and economic) of substance use and substance use disorders through policy, programs and practices. Harm reduction looks at the issues surrounding substance use and substance use disorders. It works to improve on the current system which is often rooted in discrimination, coercion, and judgement.
Harm reduction is a whole-person approach that focuses on compassionate care - “meeting people where they’re at.” The approach accepts and understands that abstinence is not the only path to recovery and that should not be the deciding factor on whether or not a patient can receive healthcare, social and other support.
Recovery is not a straight line, so treatment and support shouldn’t be grounded in the idea that slip-ups, relapses, and mistakes don’t happen.
Principles of Harm Reduction
Harm reduction encompasses the following principles that focus on compassionate care and ethical treatment:
Pragmatism
The idea that substance use is a universal cultural occurrence spanning centuries with our modern idea of substance abuse being traced back to the early 1800s. While harm reduction does not ignore that there are risks involved in substance use, it focuses on recognizing the benefits substance use has for the individual and takes that into account when helping to initiate safer practices and/or treatment options for them.
Human rights
Harm reduction treats the individual with dignity and suspends judgement regarding the individual's substance use and associated choices. It recognizes that access to care and support is a basic human right that should be provided without having to meet discriminatory criteria (such as abstinence) and that an individual maintains agency over their health and their life despite their substance use activities.
Focus on harms
The primary focus in harm reduction is minimizing the risks and harms to the individual, their use of substances is a secondary concern. Reducing harms must be done at every level from policy to the point of contact.
Priority of immediate goals
This includes “meeting the person where they’re at” and prioritizing small goals focused on the immediate needs and care of the individual.
Goals of Harm Reduction
While the main goal that drives the Harm Reduction model is improving health outcomes and decreasing the negative consequences of substance use, that overarching goal can be broken down into small actionable goals.
Meet people where they’re at - provide high-quality, evidenced-based options that seek to end or prevent substance use.
Meeting people where they’re at means helping to reduce the risk of their drug-taking behaviours and offering a comfortable, supportive environment where they have access to information and care when and if they choose to ask for it. Treatment must be initiated by the individual on their terms, and not forced or pressured by outside forces.
If an individual chooses to pursue treatment, options should be available to them that encompass all types of evidence-based treatment options from Medication-Assisted Treatment (MAT) to abstinence-based approaches. The decision should lay with the individual on whether or not they choose to engage in abstinence-based treatment programs and not be framed as the only or preferred treatment option.
Improve drug laws, policy and law enforcement practices.
As it stands currently, drug laws, policy and law enforcement practices in most places worldwide are damaging to the well-being of those that use substances. This goal targets many, deep-rooted issues that need to be addressed systemically - from the criminalization of substances and those that use substances to the excessive discriminatory practices based on race, gender, socioeconomic status. These policies and practices tend to rank compassionate, and life-saving care as less important than incarceration, stigmatization, and enforcement of the abusive (and racialized) policy.
Harm reduction aims to inform policymakers on the devastating effects of these laws and practices in hopes of igniting change.
Protect the health and lives of those using substances.
The most important part of harm reduction is keeping those that use substances alive and in good health. Harm reduction works with the understanding that a majority of those that use substances do not experience negative consequences. Instead of leading with the forceful idea of getting every person that uses drugs into treatment, the focus is instead, on the safety of the individual and small positive changes that prioritize their health and well-being such as using clean needles or entering treatment.
Harm Reduction Interventions
Hard reduction encompasses a wide range of services and interventions. These services and intervention include:
Safe Consumption Sites
Safe consumption sites refer to supervised sites where individuals that use substances can safely inject or consume substances. These sites often provide:- Supervision of use by trained professionals who can respond quickly to overdose or other health events during and immediately after consumption.
- A hygienic environment.
- Access to new supplies for safer consumption and proper disposal of used supplies (i.e. needles).
- Education on safe consumption, infection prevention, and overdose prevention practices.
- Training and distribution of Naloxone.
- On-site access or connections to counselling services, health care, housing services and other supports.
- Referrals to treatment services.
There’s a wide body of research that highlights the many benefits of safe consumption sites in communities. Some of the major benefits include:Additionally, to these benefits research has suggested no increase in crime in communities that incorporate safe consumption sites, and in fact, the prevalence of substance use in public spaces often decreases.
Syringe (Needle) Exchange Programs
Syringe exchange programs are often offered by various organizations depending on the community - safe consumption sites, pharmacies, healthcare facilities, etc (check out the Find Harm Reduction Services Near You section below).
These programs allow you to safely dispose of your used needles and syringes and provide access to sterile needles, syringes and other consumption supplies. In providing this service, these services educate individuals that use substances on the risks of sharing supplies and using supplies that are no longer sterile and advise them on safe consumption practices. The goal is to reduce their risk of HIV, Hepatitis C and other blood-borne illnesses.
These sites often provide HIV, STI and TB testing services and access to other interventions that minimize their risk of HIV and STI transmissions such as PrEP and prophylactics. If the Needle Exchange Program does not offer these services they will often provide referrals for individuals or make connections for them to access these services.
MAT - Medication-Assisted Treatment
Medication-Assisted Treatment (MAT) is the use of certain medications in combination with therapy and counselling services to treat substance use disorders. For many individuals, abstinence is not a treatment that works for them in terms of sustained recovery and harm reduction respects that by offering MAT services.
MAT has been proven to be effective in reducing the need for inpatient detox services, and when combined with counselling services has been shown to successfully treat substance use disorders and help sustain recovery.
MAT is typically used for a few types of substance use disorders:- Alcohol - There are a few approved medications that help with the treatment of alcohol use disorders. In particular, MAT is useful in detoxing from alcohol use and the beginning stages of treatment.
- Opioids - Perhaps the most notable use for MAT is in the treatment of opioid use disorders. MAT is particularly helpful for those that misuse short-acting opioids such as heroin, morphine or codeine as well as prescription opioids such as oxycodone. Medications for the treatment of opioid use disorders have been proven to be safe for use long-term, meaning individuals and their health practitioner can decide if it’s best for them to use to aid in detox, initial stages of recovery or for their lifetime.
Naloxone
Naloxone, often referred to as its brand name - Narcan, is a nasal spray medication that may reverse the effects of an overdose. It is approved for use in the treatment of suspected or known overdoses and Naloxone only works when there are opioids in the system. There will be no effect if none are present in the system.
Naloxone previously was administered only by first responders and health professionals in cases of a suspected overdose, but Narcan has allowed for community education and prevention initiatives. Narcan and overdose training is now provided by many pharmacies, public health services, harm reduction services and doctors to those with substance use disorders, those close to individuals with substance use disorders (family/friends), and community services.
Training will educate the individual on signs of overdose, administering Narcan and what to tell first responders and how to support the individual while waiting for EMS services.
Drug Checking
Drug checking is a service that allows the individual who uses substances to test or bring their substances to be tested to ensure that it contains the substance they wish to consume. This harm-reduction intervention is especially important with the rise of fentanyl and fentanyl-laced substances on the market which is easier to overdose on.
Drug checking can be done with test strips or kits that are available in some locations through harm reduction services, public health or whenever substance misuse services are offered locally. These allow the individual to test a small amount of the substance they intend to use before consuming. Test strips are quick and typically use a simple colour-coded system for showing the presence of each substance in the drug being tested.
Two well-known at-home drug testing kits are available from DanceSafe and TestKitPlus.
Another option is to have your drug professionally tested. These services can be limited depending on where you live but your local public health or harm reduction services should be able to point you in the right direction.
Abstinence
While abstinence isn’t pushed on individuals under the harm reduction approach, it is recognized as an important option for many of those that use substances. The focus of harm reduction is not to lead the treatment decisions of the individuals that use their services, it’s to connect them with whatever services that individual feels are best for them, or when asked, make recommendations based on knowledge of the individual and their beliefs.
Abstinence-based programs are widely available and include the recovery principles taught at many rehabilitation centers and services, as well as the well-known AA (Alcoholics Anonymous) and NA (Narcotics Anonymous) meetings.
Find Harm Reduction Services Near You
To find harm reduction programs near you, visit:Harm Reduction Myths
Harm reduction does not condone or enable the use of illicit substances. Harm reduction realizes that drug use is a part of society and there are ways to decrease the negative impacts of that drug use. Harm reduction services offer places and services that connect individuals to the supports and services that they need to consume substances safely or approach recovery on their terms.
The NIMBY (Not-in-my-backyard) beliefs of many of those that oppose harm reduction focus on the idea that offering harm reduction services in their community will increase rates of crime, public drug use and overall safety all of which have not been supported by research.
Resources- Lifeguard Digital Health App - An overdose prevention tool with a built-in timer for those that use substances alone, if the timer is not stopped manually after a certain amount of time emergency services will be called and location is given so EMS can quickly find you in case of overdose. Also offers a map of harm reduction services in your area and guides to CPR, Naloxone, etc.
- Medication-Assisted Treatment via. SAMHSA
- What is NARCAN (Naloxone HCL)?
- Naloxone Training Guide
- Medications used for the treatment of SUD via. American Addiction Centers
- Harm Reduction International
- Eleanor Health - Accessible, affordable, compassionate evidence-based treatment in the United States.
- Shatterproof - Helping people find high-quality addiction treatment options. Offering education and resources.
- National Harm Reduction Coalition
- Addictionary - Dictionary of unified substance use disorder terminology.
- In the Realm of Hungry Ghosts - Gabor Mate [book]
- Beyond Addiction: How Science and Kindness Help People Change - Jeffrey Foote, Ph.D., Carrie Wilkens, Ph.D., & Nicole Kosanke, Ph.D. [book]
- Last Day [podcast]
- Crackdown [podcast]
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