Harm reduction is a recognized public health model that has been used since the early 1980s to reduce the harms of active drug use, including reducing the spread of infectious disease.
Harm reduction accepts that licit and illicit drug use is part of our world and chooses to minimize the harmful effects rather than ignore, condemn, or criminalize them. Some of the principles of harm reduction include:
- Providing a spectrum of strategies from safer use, to managed use, to abstinence.
- Addressing the conditions of use.
- Approaching with a non-judgmental, non-coercive provision of services and resources.
- Including the voice and insight of people that use or have used drugs in the creation of programs and policies.
The biggest misconception is that harm reduction denies that drugs are harmful or even that harm reduction promotes drug use. In fact, harm reduction addresses and mitigates the harms to themselves and others. Another misconception is that harm reduction encourages use. Rather, harm reduction recognizes that when licit and/or illicit drug use is happening, there are effective strategies to make use less harmful.
Harm reduction applies to anyone along the spectrum:
- Some people use experimentally
- Some people use occasionally
- Some people use regularly
- Some people use chaotically
Harm reduction asks care providers to meet everyone where they’re at. In order to do this, it is important to know why and how drug use started or why someone is considering using. The reasons are unique to each person, and change over time.
- It’s what’s known
- Pleasure, entertainment, or sense of wellbeing
- Pills from a doctor aren’t working anymore
- It’s cheaper than other kinds of care
- Escape, coping, or numbing
- Distance from emotions or feelings of unworthiness
- Soften the pain of another trouble
- Self-medicating for anxiety, depression, or trauma
- To stay awake all night, or squelch hunger or cold
Considerations about how to implement a harm reduction approach in a clinical setting are complex. Some settings think of harm reduction as any positive movement towards sobriety. Other settings think of harm reduction as any positive movement, even if sobriety is not the current goal. Other settings think of harm reduction as anything to reduce risk in that moment, regardless of what happens in the next moment. These theoretical differences can be difficult to operationalize in programmatic standards.
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