Principles, Programs, and Outcomes
Principles, Programs, and Outcomes
What is Harm Reduction
Harm reduction is a set of ideas and practical strategies designed to reduce the negative consequences of drug abuse. The Harm Reduction Coalition (HRC) was founded with a mission of advancing harm reduction policies and practices. The HRC also created programs that address and help reduce the negative effects of drug use, such as addiction, overdose, incarceration, and HIV.
Harm reduction programs operate with the assumption that people who use drugs are unable to quit or do not view their substance abuse as an issue. This philosophy aims to meet people where they are by promoting safer use, managed use, or abstinence. Harm reduction includes addressing social inequality and injustice, which decreases drug-related harm to vulnerable populations.
Harm reduction is not a treatment for addiction, however it can act as an avenue to treatment for those struggling with substance abuse.
Principles of Harm Reduction
Harm reduction encompasses a wide range of practical strategies to help reduce drug use and its consequences. Local advocates drive a community’s harm reduction interventions, therefore should reflect the specific needs of the community and the individual. Due to this, there is no single formula for harm reduction. However, the HRC identifies core principles that should guide harm reduction practices, policies, and interventions.1
The core principles state that an effective harm reduction practice:
Accepts that drug abuse is part of our world, and works to minimize its harmful effects rather than condemning or ignoring them. This helps protect and restore lives and communities.
Understands that drug abuse is complex and runs along a continuum, from severe abuse to total abstinence. It acknowledges that in some cases, abstinence is unlikely, and promoting safety over abstinence can reduce the negative personal and social consequences of drug abuse.
Establishes that successful policies and interventions that will promote quality of life and community health and wellbeing rather than focusing exclusively on abstinence.
Calls for non-judgmental and non-coercive administration of services and resources to people to help reduce potential harm.
Ensures that people who use drugs and those who are in recovery have a voice in the development of the programs and policies that are designed to serve them.
Affirms that the individual is the primary agent of reducing the negative consequences of their own drug use.
Seeks to empower people to share information and support each other to implement harm reduction strategies that meet their current conditions.
Recognizes that poverty, class, racism, trauma, discrimination, social isolation, and other social inequalities affect people’s vulnerability to drug abuse and their capacity to effectively deal with drug-related harm.
It does not minimize or ignore the real harm and danger associated with drug abuse.
Types of Harm Reduction Programs and How They Help
Harm reduction programs can take any number of forms, depending on the needs of the community and the individuals in the community. Here are some of the most effective programs used to reduce drug-related harm in communities across the country.
According to the Centers for Disease Control and Prevention, more than 700,000 people died from a drug overdose between 1999 to 2017, and around 68 percent of the drug overdose deaths reported in 2017 involved opioids.2 Currently, around 130 people die each day from an opioid overdose in the U.S. Overdose prevention helps people with substance abuse disorders through:
- The person with substance abuse disorder
- Family and friends
- First responders
- Service providers
- Community members
These prevention services result in greatly reduced overdose deaths.
Naloxone Distribution Programs
Naloxone distribution programs are making a big difference in overdose numbers in communities across the country. Naloxone is an opioid antagonist that reverses an opioid overdose. Naloxone distribution programs educate members of the community about overdose. Naloxone kits are given to people who are likely to overdose or be in the presence of someone who overdoses.
The DOPE Project
The Harm Reduction Coalition’s Drug Overdose Prevention & Education (DOPE) Project in San Francisco is the largest single-city naloxone distribution program in the country. The DOPE Project offers basic and comprehensive training on overdose to staff members of businesses, bars, and festivals as well as to individuals who are likely to be by-standers in an overdose event.
Community Members are Trained
To date, the project has trained over 13,000 community members in the city on how to use naloxone. The DOPE Project partners with programs in the city that provide services to people who use drugs, such as syringe access (needle exchange) programs and Jail Health Services. These programs ensure naloxone gets distributed quickly to those who need it most.
Project DOPE Saves Over 1,000 Lives Every Year
Since its inception in 2001, naloxone distributed by the DOPE Project has reversed, on average, 1,500 overdoses each year. According to the Centers for Disease Control, organizations that provide naloxone kits to laypersons have increased considerably since 2010. There was a 243 percent increase in the number of local sites providing naloxone. There was also a 187 percent increase in the number of people given naloxone kits and a 160 percent increase in the number of reversals reported.3
Drug Education and Testing Programs
Fentanyl is a powerful opioid responsible for a large share of overdose deaths. Fentanyl is often found in heroin, and it can be present in cocaine, MDMA, ketamine, and other drugs. An effective harm reduction practice is testing drugs for fentanyl before taking them. Fentanyl testing strips were originally designed for urine tests, but they’re being used to test whether fentanyl is present in many types of drugs.
Fentanyl testing was pioneered at Vancouver, British Columbia’s Insite Safe Injection Facility. Over one month, 86 percent of all drugs tested by the program were positive for fentanyl. Johns Hopkins Bloomberg School of Public Health recently completed a study about fentanyl. Participants said that if they knew their drugs contained fentanyl, they would modify their behavior to reduce the risk.
The risk avoidance included:
Not using the drugs
Using drugs more slowly
Using drugs in the presence of someone with access to naloxone
Buying their drugs from another dealer.4
DanceSafe is an American 501(c)(3) organization that promotes health and safety within the electronic music and nightlife communities. Founded in San Francisco in 1998, DanceSafe now has chapters in cities across North America. Its overarching goals are harm reduction and peer-based education. Using a non-judgmental perspective, DanceSafe provides:
Drug-testing services to prevent overdose
Safe spaces to engage in conversations about drug use and personal safety
Free water and electrolytes to prevent heatstroke and dehydration
Free earplugs to protect hearing
Unbiased and fact-based information on drugs and potential harms so that people can make informed decisions
Through the DanceSafe website, the public can purchase drug testing kits, get safety tips, and learn about the potentially harmful effects of different drugs.
A similar organization is Nightlife Empowerment, a European harm-reduction group that promotes safe drug use in nightlife settings across the EU. Its objectives include:
Promoting safer nightlife policies through partnerships with nightlife professionals, peers, harm reduction NGOs, the scientific community, and public institutions.
Exchanging information and tools to improve interventions and develop new responses to challenges in harm reduction while also promoting health and safety within party scenes.
Influencing nightlife policies through advocacy and conferences.
Housing First Programs
Housing First is a harm reduction approach to addressing homelessness. Other approaches to combating homelessness require individuals to complete a series of programs or seek substance abuse treatment before obtaining housing. A growing body of research shows that by providing people with housing first, people are often in a better position to address secondary problems like mental health issues, substance use disorders, and unemployment.
According to the National Alliance to End Homelessness, studies show that between 75 and 91 percent of people housed with a Housing First model remain in housing a year after moving in. Other research shows that permanent housing through a Housing First program saves communities an average of $31,545 per person in emergency services, including hospitals, jails, and emergency shelters.
Sex Education and Condom Distribution
In addition to protecting against the negative consequences of drug abuse, harm reduction strategies can be used to protect against the negative consequences of unprotected sex. Sex education programs and free condom distribution for both adolescents and adults help reduce unwanted pregnancies and stem the spread of sexually transmitted diseases, including HIV. Research shows that arming teens with information and condoms doesn’t promote sexual activity, but it does provide protection from unintended consequences when they choose to become sexually active. These programs are especially important today, as a new report from the CDC shows that cases of syphilis, gonorrhea, and chlamydia reached an all-time high in 2018.
Needle Exchange Program
Providing access to clean syringes is an essential component of a harm reduction program in communities where drug injection is an issue. Needle exchange programs help prevent the transmission of infectious diseases like HIV and hepatitis as well as skin and soft tissue infections that can lead to hospital stays.
Another benefit of needle exchange programs is that they serve as a contact point and resource. People in need can get medical or mental health care, housing, drug treatment, and other social services. They also help challenge the stigma and misinformation associated with drug abuse while prioritizing the dignity and rights of people with substance use disorders.
Needle Exchanges are Controversial
Needle exchange programs are very controversial. However, the National Institute on Drug Abuse (NIDA) points out that study after study shows that, despite what the critics say, these programs do not increase or promote drug use.5 They’re also not a public endorsement of drug abuse. The vast majority of people who inject drugs have a substance use disorder, which the NIDA reminds us, is a medical problem and not a moral failing. Without treatment, an intravenous drug user will likely not be able to stop on their own. Until proper help is offered, needle exchange programs can reduce the risk of HIV and hepatitis and slow the spread of the disease within the community.
Safe Injection Facilities
Safe injection facilities (SIFs) are also known as drug consumption rooms (DCRs) or safer consumption spaces (SCS). These are spaces where people can use drugs in a supervised setting. SIFs are quite controversial in the U.S., but the research backs up the benefits for harm reduction.
According to an article published in the journal Canadian Family Physician, evidence suggests that SIFs:
Reduce overdose deaths by 88% per 100,000 person-years.
Reduce ambulance calls to overdose emergencies by 63%.
Drastically reduce HIV infections.6
SIFs serve the purpose of reducing overdose deaths, but they also help connect people who abuse drugs to services like treatment, medical or mental health care, and housing. Research shows that people with substance use disorders who take advantage of SIFs engage in better self-care, reduce or stop their needle sharing, use drugs more safely, and reduce overall drug use.
Misconceptions About Harm Reduction
Misconceptions about harm reduction are plenty, but the research is clear: harm reduction works. It may not always lead to abstinence, but harm reduction can prevent disease and help reduce overdose deaths, criminal activity, violence, and homelessness. Here are some common misconceptions about harm reduction, along with the truth.
Myth: Harm Reduction Practices Condone Drug Abuse
Harm reduction operates under the reality-based assumption that people are going to use drugs regardless of others who “condone” their use. Since some individuals either can’t or won’t quit, the next best thing is to reduce the negative effects of drug abuse by making it as safe as possible. This protects both the individual and the community from the health and social consequences of drug use.
Myth: Harm Reduction Keeps People Using Drugs
Harm reduction is aimed at the large population of people who have not yet chosen abstinence. Far from perpetuating drug abuse, harm reduction practices like needle exchange programs and safe injection sites actually provide a pathway to recovery for those who want to stop. These programs provide information and resources to help people find treatment, housing, medical or mental health care, and other services needed for people to quit or reduce their use. Harm reduction proponents know that abstinence is ideal, but they also know that the reality is that not everyone is going to quit using drugs.
Myth: Equipping Police Officers With Naloxone to Reverse Overdoses is a Waste of Resources.
Opponents of arming police officers with naloxone say that police are charged with maintaining law and order–not saving “addicts.” But police are also charged with protecting and serving their communities. Police are often the first responders on the scene of an opioid overdose and may be the only thing standing between someone’s life and their death. According to the U.S. Attorney General, equipping officers with naloxone not only saves lives but also improves community relations, enhances information-gathering abilities, strengthens cross-agency communication; and creates a united front in the fight against opioid overdose.
The bottom line on harm reduction is that a large body of research is clear: Harm reduction prevents and reduces the spread of disease, reduces criminal activity, and reduces hospital costs associated with drug abuse.
Applying Harm Reduction to Daily Life
Harm reduction principles can be applied to any type of drug use, including drinking, smoking marijuana, or injecting heroin. They can be applied by casual drug users and people with a substance use addiction to reduce the risks of using. Here are some tips for lowering your risk of overdose, disease and other consequences of drug abuse.
Buy less. Buying a large amount of drugs makes it easy to end up using more than you planned. It may be more expensive to buy in smaller amounts, but it could also be safer, in the long run, to do so.
Set a time limit. If you’re headed out for a night of drinking or you plan to use drugs, choose a time to stop, then stick to it.
Reduce dosage or frequency. Take smaller doses of drugs, and dose less frequently than you normally would.
Eat before you start. Eating can help reduce the effects of alcohol and some drugs. Before you head out, eat a healthy meal and drink plenty of water.
Choose the safest method of use. Since injecting carries more risk than smoking, snorting, or swallowing the drug, avoid injecting whenever possible.
Choose your own pace. Don’t try to keep up with others when you’re out drinking or using drugs. Use at your own speed.
Cut back your use. If you drink or use drugs every day, try instituting one or more drug-free days each week.
Harm reduction helps protect individuals and communities against the ravages of unchecked drug abuse. It’s unlikely that drug abuse will disappear anytime soon, and doing everything possible to improve safety and promote access to treatment is the fundamental purpose of harm reduction. Harm reduction practices reduce overdose deaths, HIV and unintended pregnancies. They provide support in the right direction if and when people choose to quit.
If you are ready to reduce or end your substance use, but find that you need help, Laguna Shores Recovery can help.