Harm reduction is a set of strategies aimed at reducing the negative consequences associated with drug use. You may have heard of the term—especially in the context of treatment programs, syringe services programs (SSPs), or so-called “free crack pipes”—but you may be wondering what it actually means and why harm reduction programs are so vital to people with substance use disorder and their communities.
In 2009, Sheila Vakharia, PhD, deputy director of research and academic engagement at Drug Policy Alliance and author of the book “The Harm Reduction Gap,” was a social worker at an SSP. She had a client with substance use disorder who had been kicked out of a treatment program because he hadn’t been able to stop using alcohol.
He was unhoused and sometimes stood in line to get into a shelter for the night, but when the shelter ran out of space, he spent the night walking around.
“We would often talk about how, for him, drinking alcohol at night was a way to cope with being on the street,” Vakharia says. “And, when it was cold outside, he said drinking alcohol kept him warm.”
If he were in a traditional treatment program, Vakharia says he would be considered to be failing treatment because he was still drinking. But as a harm reductionist, she realized that he was homeless and that there was nowhere for him to go.
“Drinking is your coping mechanism, and until we can find a place for you to stay, how am I going to take away your one coping strategy while our whole system is failing you?” she thought.
Vakharia’s client’s story showcases why harm reduction is important, particularly amid the high rates of people with substance use disorder in the U.S.
Read on to learn more about harm reduction as we debunk some common myths and misconceptions.
Fact #1: Harm reduction helps reduce the negative effects associated with drug use
There are many misconceptions about harm reduction, but at its core, it is “a compassionate approach to working with people who engage in high-risk behaviors,” Vakharia explains. Several other organizations—including Harm Reduction International and the National Harm Reduction Coalition—define it as an evidence-based approach that’s been proven to save lives and as a social justice movement that centers and respects people who use drugs.
Instead of judging people who use drugs or requiring complete abstinence, harm reduction focuses on reducing the harm that substances can cause in a person—such as the risk of contracting HIV and other infectious diseases—and on keeping a person alive. “That can look like using less, using less frequently, using in less risky ways,” Vakharia says.
Harm reduction is a “movement that really considers how inequity and inequality is manifested in our society,” adds Tamara Oyola-Santiago, co-founder of the NYC-based harm reduction organization Bronx Móvil. It sees drug use “as a social determinant of health that is impacted by migration, poverty, inequity, inequality, and, if you’re part of the LGBTQ+ family, that also is impacted by transphobia and homophobia.”
Fact #2: Harm reduction encompasses many programs and approaches
Harm reduction includes a wide variety of health and social services and approaches. For instance, in the case of drinking alcohol, harm reduction tactics inform people about how to drink more safely, such as by eating before drinking, having a designated driver, counting the number of drinks, and not mixing alcohol with other substances.
“It can mean planning when you’re going to use and when you’re not going to use,” Vakharia adds. “It can mean making sure you’re not using [substances] alone or that when you are using, that someone is there to keep an eye on you with naloxone in case you have an overdose.”
Vakharia adds that at SSPs, professionals may check in on people who use drugs, give them tools like condoms, offer showers or a washing machine, and give them a referral to a treatment program or a doctor.
In a similar example, harm reduction can provide lifesaving supplies to folks who use drugs and are also unhoused, such as what Oyola-Santiago does through Bronx Móvil. The group walks around the Bronx delivering bottled water, bandages, drug test strips for fentanyl and xylazine, sterile syringes, food, socks, containers for the safe disposal of syringes, and other support for unhoused people.
“The problem is that our system makes people feel like failures when sometimes their substance use is the way that they’re surviving unlivable circumstances.”
Sheila Vakharia, PhD, deputy director of research and academic engagement at Drug Policy Alliance and author of the book “The Harm Reduction Gap.”
Fact #3: Harm reduction reduces drug use and makes communities safer
SSPs and similar programs make communities safer, despite common misconceptions alleging the opposite.
SSPs “collect used syringes, and then they dispose of them as medical hazardous waste, so we’re also getting syringes off the streets, out of people’s homes,” Vakharia says. “Used ones that might have blood in them, they might have bacteria, they might have viruses, [SSPs are] disposing of those.”
These programs also help reduce the risk of transmission of HIV and other diseases like hepatitis. Additionally, as studies have shown, SSPs can reduce crime (like break-ins and burglary) and make communities safer. Syringe disposal means safer public spaces like parks, as it prevents accidental needlestick injuries.
Fact #4: Harm reduction helps people’s recovery
Harm reduction programs connect people to drug treatment. Research has shown that people who access SSPs are five times more likely to enter drug treatment than those who don’t and three times more likely to stop using drugs than those who don’t access them. Even if someone isn’t ready to stop using drugs, harm reduction programs can help them avoid a fatal overdose in the interim by providing naloxone, a medication that reverses opioid overdoses.
Vakharia’s client, for example, went to an SSP to “sit in a chair and relax for a little bit,” but he also got mental health counseling and help getting into a housing program, she explains.
“To me, what was most important was that he was waking up in the morning and coming to see us, and he knew that even though the shelter didn’t have a place for him, he could come to us and talk to us,” Vakharia adds. “Because the problem is that our system makes people feel like failures when sometimes their substance use is the way that they’re surviving unlivable circumstances.”
If you or a loved one is worried about substance use, these resources from SAMSHA can help.