Harm reduction is a philosophy and a way of approaching life. It informs policies, programs, and practices that aim to mitigate the harms of inherently or potentially dangerous activities. Harm reduction should be evidence-based, stigma-free, and social justice-oriented. Public health professionals and academic institutions across the globe support harm reduction strategies.
Most US drug laws – particularly those written in the late ’80s and early ’90s – were written with the intent of improving public health but were not based on compassion or any evidence. These laws are fraught with stigma and reinforce social inequities that fall hardest on people living in poverty and people of color. Lawmakers thought punitive retribution would deter drug use, but harsh punishments for illegal drug possession, poor regulations on legal drugs, and a disregard for science have contributed to the tragic outcomes affecting nearly every American today. We are home to 4% of the global population and 27% of the world’s drug overdoses. We have an opioid overdose death rate more than twice that of any other country.
What constitutes as harm reduction for drug users varies based on the type(s) of drugs being consumed, the settings in which those drugs are used, how they are ingested, and by whom. Risk is, of course, also present in the selling/purchasing context, so harm reduction should also be informed by how drugs are purchased, packaged or re-packaged, and sold.
For example, people who inject heroin/fentanyl can benefit from syringe access programs (SAPs), which provide sterile syringes and injection education to participants. Without proper disposal, syringes are more likely to be discarded in public spaces, increasing the risk of disease exposure for people who do not use drugs. SAP participants are five times as likely to enter treatment than their non-participant peers.
Ideal harm reduction for psychedelic drugs often involves peer support. One such program, called Zendo, provides trained peer support services to people at festivals and events. Overwhelmed with sensory input, psychedelics can cause anxiety, disorientation, and erratic behavior. In extreme cases, the person may appear to be having a mental health crisis. A safe place to cool down and talk to someone who understands non-ordinary states of consciousness is usually sufficient to de-escalate overstimulation and help the person have a more positive learning experience. When situations escalate into medical emergencies, their proximity to medical services allows quick transfer into the appropriate care.
Some drugs, including cocaine and ketamine, are commonly consumed by snorting a powder form of the substance into the nose (“insufflating”). Sinuses are extremely sensitive, so if a powder isn’t completely crushed, users can experience painful cuts. Because the nose is a mucous membrane, sharing a snorting utensil (such as a straw) can allow hepatitis and other infections to pass from one person with an open wound to another. Infectious particles may be present on a straw even if it can’t be seen with our eyes. Regardless of whether a person shares their snorting device, open sinus wounds increase users’ risk of simply catching a cold. Insufflating drug users can reduce their risk of disease transmission and sinus infections by always using a clean snorting utensil and never sharing them. Rinsing with saline mist before and after every use can also reduce sinus injury and illness.
In the purchasing/selling context, people who sell drugs can reduce harm to their customers by testing each batch of every purchase with an adulterant screening kit and informing their customers of the results of those tests. If a seller has a trusting relationship with their supplier, they may also bring a kit with them to test every batch before making a purchase. Refusing to purchase adulterated or incorrect products could have a beneficial impact on the supply line by creating a financial incentive for every link in that chain to do the same due diligence. Drug checking is especially important as fentanyl has started to appear in drugs other than opioids, causing death in unsuspecting consumers. Illegal marketplaces can be extremely dangerous for purchasers at every stage, so this is not always possible or safe, depending on the selling network.
If you’re not a drug user, harm reduction might be more familiar to you in other environments or activities. Here are a few examples:
– Seat belts and seat belt laws
– Car seats for toddlers
– Helmets, knee pads, and elbow pads
– Condoms & hormonal birth control
– Smoke alarms & sprinkler systems
– Fire escape plans
– Emergency exit doors
– Protective eyewear
– Steel-toed boots and hard hats
– Hand sanitizer & antibacterial soap (and policies requiring employees to wash or sanitize hands)
– Health warnings on tobacco packaging
– Laws that punish and deter drunk driving
Harm reduction programs and educators have fought against drug prohibition while also fighting for the right to provide basic health education and services to vulnerable populations. Drug Education Consulting works to improve the health of drug-using populations under any system of drug laws.
Read more about the principles and goals of harm reduction here.