Harm reduction refers to policies, programs and practices that aim to minimize the negative health, social and legal impacts associated with drug use, drug policies and drug laws.
Harm reduction is grounded in justice and human rights. It focuses on positive change and on working with people without judgement, coercion, discrimination, or requiring that people stop using drugs as a precondition of support. (Harm Reduction International)
Goals
Principles
While the goals and principles of harm reduction are clear, there can be disagreement as to whether any particular practice is a harm reduction practice and, if so, if it is consistent with all of the principles of harm reduction.
Take, for example, the prescribing of medications (called opioid agonist therapy (OAT)) to treat opioid addiction. OAT is considered the most effective treatment for those with an opioid addiction. It provides long-acting regulated opioids that minimize cravings and withdrawal, allowing people to stabilize. There is no disagreement over OAT, even though there may be disagreement over whether it is a harm reduction practice. Many consider OAT to be one form of harm reduction because the use of drugs (albeit as prescribed treatment) continues. Given the extensive evidence over decades for OAT as treatment, others view it as treatment rather than harm reduction. It depends on whether one views treatment that seeks to prevent or end drug use as harm reduction.
Responding to overdoses and using Naloxone to reverse opioid overdoses are key components of harm reduction and are discussed in the Overdose and Naloxone section of this website.
The provision of clean needles/pipes prevents the spread of blood-borne diseases like HIV or Hepatitis C. While it may not slow down or prevent drug use, it is a tool to prevent other illnesses which not only adversely affect PWUD but also their families and the general public.
Safer ways to use drugs can be found on the CATIE website.
Prescribed alternatives (previously referred to as safer supply) refers to programs introduced in Canada starting in 2019 whereby healthcare providers prescribe regulated drugs to those struggling with addiction as an alternative to the toxic drug supply that is readily available on the street. The most common program is one whereby hydromorphone (Dilaudid) is prescribed to someone addicted to opioids. It is the most controversial of all harm reduction programs.
While some argue that hydromorphone as a prescribed alternative is similar to providing OAT, there are significant differences:
While any prescribed narcotic can be diverted, there is evidence that hydromorphone as a prescribed alternative has resulted in international, national and provincial trafficking. The Canadian government is defending a lawsuit brought by parents who allege that their children were harmed by hydromorphone prescribed to others as part of the prescribed alternatives programs.
The Substance Use Health Network (previously the National Safer Supply Community of Practice) is a Canadian website with comprehensive resources on all issues related to harm reduction, including supervised consumption sites/overdose prevention sites and the provision of prescribed alternatives.
Addiction Medicine Canada is an advocacy group of Canadian healthcare providers who have concerns and recommendations to avoid the diversion and unsupervised injection of hydromorphone as part of prescribed alternatives programs.
Do evidence-based and rights-based policies and practices mean that no one should ever be mandated to treatment? In certain circumstances the goals/principles of harm reduction can conflict. In those circumstances, mandated treatment may be the best or even the only way to reduce harms.
For example, severe substance use disorder (SSUD) is known to adversely affect a person’s ability to make choices (capacity and autonomy). If they refuse treatment due to SSUD and they are at serious risk of harm to themselves or others, it is inconsistent with the goals and principles of harm reduction to allow them to die when they don’t want to die, or to allow them to harm others and then suffer the harms of incarceration.
To view mandated treatment as always in opposition to harm reduction is a wrong either/or choice (false dichotomy). Many who support harm reduction also support the need for mandated treatment where the harms of not intervening are expected to greatly exceed the harms of intervening. For a more detailed discussion, see the Involuntary Treatment section of this website.
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