Harm Reduction

Partnership to End Addiction supports the use of harm reduction strategies and interventions for people who use substances, including alcohol, marijuana, nicotine, opioids, and stimulants, among others.

Harm reduction is a compassionate and practical approach that aims to reduce the risks and negative consequences associated with substance use and improve quality of life by promoting health and safety. Harm reduction is an essential component of the comprehensive public health approach needed to effectively address our nation’s addiction crisis. Our definition of harm reduction is informed by our work supporting families concerned about a loved one’s substance use and encompasses the following set of principles:

1. Respect for the individual. An approach grounded in dignity and compassion, harm reduction promotes self-efficacy by including and respecting the goals of the individual who uses substances. It recognizes that individuals may not want to or be able to stop using substances yet or engage in treatment and that there are many different pathways to health and well-being. In this way, harm reduction “meets people where they are” rather than forcing them to conform to the goals of a treatment program, their family or another entity.
2. Prioritize safety. Simply, the goal of harm reduction is to keep people who use substances safe. There are many practical ways to support behavior change to reduce the risks associated with substance use and prevent negative consequences such as disease, injury, illness, overdose and death. We support interventions/strategies that are evidence-based and contribute to safety and reduced harm, while encouraging additional research on harm reduction strategies that do not yet have sufficient supportive evidence.
3. Reduce stigma. Harm reduction is widely used as a public health strategy to address health risks that are not associated with substance use. For example, sunscreen, seatbelts and helmets are widely accepted harm reduction strategies. Many people use designated drivers as an accepted harm reduction strategy with respect to alcohol use. With this exception, harm reduction for substance use is highly stigmatized because of the deep and pervasive stigma against people who use substances. A widespread misunderstanding among the public that addiction is a choice or moral failing and a societal preference for abstinence-only treatment and recovery have led to an incorrect belief that harm reduction promotes or encourages substance use. Further, stigma often causes individuals to hide their substance use, use alone or in risky ways, and avoid seeking help or treatment. Harm reduction helps to destigmatize substance use by promoting compassion, hope and healing, rather than seeking to punish and shame people who use substances. Reducing stigma is especially important for marginalized populations who have been disproportionately harmed by the criminalization of substance use and punitive War on Drugs policies.

Despite the long-standing debate about the relative merits of a pure abstinence versus a harm reduction approach to addiction care, we do not believe that a “one-size-fits-all” approach allows for the broad reach needed to solve the addiction crisis. As such, we embrace any strategy that is based in the research evidence and that stands to improve the health, safety and well-being of individuals and families at-risk for or struggling with addiction.

We encourage the adoption and promotion of harm reduction strategies by families, by treatment providers and in policies.

Recommendations for families:

We encourage families to talk to loved ones about their goals and respect their decisions about treatment engagement. Families should feel empowered to encourage (or promote) harm reduction strategies when these are appropriate, and not feel judged, shamed or afraid they are “enabling.” Harm reduction is not “enabling” because it changes a person’s behavior in a positive direction by increasing safety. Families can use communication skills to help their loved one set goals and can utilize educational resources to learn about various harm reduction strategies.

Recommendations for treatment providers:

Treatment providers should utilize evidence-based interventions for substance use disorders, including behavioral therapies, FDA-approved medications and recovery support services. Treatment providers should utilize harm reduction principles and strategies as part of the treatment continuum. Care should be patient-centered and based on goals developed collaboratively among the patient, provider and patient’s family rather than on a “one-size-fits-all” approach, which typically involves promoting abstinence only. Treatment providers should also be compassionate and supportive to patients who may continue to use substances during their course of treatment and avoid the use of punitive practices including discharging patients for substance use – the very reason they are in treatment.

Recommendations for policymakers:

Moralistic and stigmatizing polices impede the adoption and implementation of harm reduction practices. Policymakers should ensure that policies regarding harm reduction are rooted in evidence and are free from stigma. They should also remove polices that inhibit research on harm reduction interventions. Research shows that harm reduction interventions, such as naloxone and syringe services programs, are cost effective because they reduce costs associated with overdose, disease, infection and other health care expenses. Policymakers should invest in harm reduction and eliminate funding barriers for the implementation of harm reduction strategies. To promote racial equity, harm reduction strategies should be widely accessible to diverse communities, and funding should support harm reduction organizations and programs serving marginalized communities.