Harm reduction is a proactive and practical approach to reducing the negative personal and public health consequences associated with “unpopular” behavior by improving policies, programs, inventions, and practices. When applied to substance use, harm reduction acknowledges that completely abstaining from drugs is not a realistic solution for everyone. Its primary goal is to save lives and protect the health of both the people who use drugs and their communities. It can be as simple as a syringe service program (SSP) that hands out clean needles to avoid the spread of diseases such as hepatitis, HIV, and other infectious conditions, or it can be as high-tech as harm reduction vending machines on busy street corners that distribute naloxone, a medication known to reverse opioid overdoses.
If you’re finding the concept of harm reduction for substance use a little hard to swallow, you’re not alone. For decades, American policy has promoted prevention, enforcement, and abstinence as the best ways to handle our war on drugs. Whatever form they must take to ease the burdens of drug abuse for both users and society, harm reduction efforts require a certain school of thought that might not be popular with some. With all the caveats and stipulations, we tend to apply to our daily lives, it’s easy to consider that some of our population does not deserve safety or dignity due to “bad decisions” or engagement in “immoral activities.” However, with that policy, we’ve only seen usage rates rise, culminating in more than 100,000 people dying from drug overdoses over the past year, alone – that’s 29% more than the year before, and 250% more since 1999.
Travis Rieder, Ph.D., M.A. is a researcher at the Johns Hopkins Berman Institute of Bioethics. He addresses the misconceptions. “Opponents sometimes argue that giving people sterile syringes, clean pipes, naloxone, a safe space to use drugs under supervision, etc. incentivizes or leads to drug use. But, people are going to use drugs whether they have these resources or not, and so, withholding them doesn’t prevent that use; it just makes it more dangerous. Making an activity more dangerous doesn’t stop people who are committed to engaging in that activity; it just hurts and kills more of them.”
Concept of Harm Reduction
Despite the hurdles, the concept of harm reduction is slowly starting to catch on in the US – primarily because statistics point in that direction. We have almost 40 years of research since the first overdose prevention site opened in Switzerland, and it’s provided lots of insight into how harm reduction can help us with our fight against substance use disorder (SUD) and its related illnesses. So far, we have learned the following about overdose protection sites and SSPs:
- They save lives. There have been no reported overdose deaths, ever, at an overdose prevention site. A 2011 study published in The Lancet found that fatal overdoses dropped 30% in a Vancouver, Canada, neighborhood served by such a facility. Studies have found that cities with needle and syringe programs have an average annual decrease in HIV prevalence of 18.6%, compared with an annual average increase of 8.1% in cities without these programs. These programs have been estimated to have prevented more than 32,000 new HIV infections in Australia between 2000 and 2009.
- They save money. A Baltimore-focused, 2017 study led by Susan Sherman, PhD, MPH, a professor in Health, Behavior and Society at Johns Hopkins University, estimated that a $1.8 million annual investment in an overdose prevention site would save the health care system $7.8 million each year through reductions in ambulance calls, emergency department visits, hospitalizations, and infections such as HIV and hepatitis C.
- They will be used. A study led by Bloomberg School researchers published last summer in the Journal of Urban Health found that around 77% of participants who use drugs expressed a willingness to use such facilities.
- They help people enter treatment. A health care provider in Vancouver found that in a single year, more than 400 people who used the city’s overdose prevention site also enrolled in an adjoining inpatient treatment program.
In spite of the numbers, harm reduction strategy remains controversial in America. The U.S. Department of Justice has warned that overdose prevention sites would violate the so-called “crack house statute,” which makes it a felony to “maintain any place” for using controlled substances. Despite this warning, many states remain determined to provide this lifesaving intervention. However, according to the Harm Reduction Coalition, many of the states that haven’t prohibited SSPs still offer no protection against prosecution for drug residue found on returned syringes.
We are, however, starting to see some progress politically. In 2009, the Obama administration lifted a 21-year ban on federal funding for needle exchange programs. Still, these programs are available only in certain regions and are heavily affected by local laws.
President Biden has also introduced legislation to address the overdose epidemic. His American Rescue Plan Act of 2021 funds a harm reduction grant program through the Substance Abuse and Mental Health Services Administration (SAMHSA) that is expected to award $30 million in harm reduction grants to support those working to make substance use safer.
Preventing overdoses and the spread of disease are only two of the ways harm reduction is making an impact on American society. Other types of harm reduction programs are using technology to exist around the laws and social stigmas. They can include testing strips to ensure that drugs are not laced with fentanyl and naloxone kit distribution to cut down on overdose deaths, just to name a few.
Another hi-tech harm reduction program that’s taking hold in America is KnowDrugs.app. Started by former social worker, Philipp Kreicarek, the app gives users the power to determine the content purity of their substances. Simply by checking the catalog on the app, one can tell the difference between real and fake substances. Kreicarek believes that objective and unbiased information on drugs is a fundamental right, and he set up the KnowDrugs app so users can minimize risks and consume drugs more responsibly. In addition to gaining information about certain drugs, those who use KnowDrugs can access information about how certain drugs work, practicing safer use, and finding confidential advice.
Yet another effective harm reduction strategy is widespread distribution of and education on how to use Naloxone kits to reverse the symptoms of opioid overdose. Current legislation calls for more kits to be distributed among populations that use drugs and to those who could likely find people suffering from overdoses. Naloxone kits are available without a prescription at many pharmacies across the country, but each pharmacy may individually decide whether to distribute the kits. And, if you’re lucky enough to locate a participating pharmacy, insurance may not cover the cost (which can be more than $100 in some places).
To help with distributing naloxone and other harm reduction kits, companies like Dispension Industries are manufacturing self-service kiosks and smart lockers equipped with biometrics, making restricted products available via safe, secure, and convenient transactions. These special vending machines are located in busy areas where substance use is known to happen. That way, medicine will be available 24/7, encounters will be somewhat private, and people will be less likely to be turned away when they try to acquire kits.
Even though they’ve already taken the world by storm, some harm reduction methods are still illegal in the US or very highly regulated to the point of potentially negating the good they’re trying to bring to our neighborhoods. Although SUDs are chronic and treatable medical conditions, studies show people suffering from these disorders still face discrimination and stigma that can impact their health and well-being in numerous ways. The truth is that, while SUDs are easily treatable, stigma often factors into the reasons why people who need help do not seek care. Harm reduction services can minimize that stigma by being readily available; easy-to-use; and, in some cases, anonymous.
Crossroads offers harm reduction services in the form of medication-assisted treatment (MAT), using medication to comfortably control withdrawal symptoms. With more than 120 locations across 10 states, we combine methadone, buprenorphine, and other medicines with counseling and behavioral therapies to give our patients the best possible outcomes in their recovery. The medication stabilizes brain chemistry and eases cravings while the therapy teaches techniques to resist relapses and lead healthier lives. Methadone maintenance programs have been shown to be very effective at reducing heroin use, crime, and risk behaviors for HIV.
 Leslie, K.M. (2008). Harm reduction: An approach to reducing risky health behaviors in adolescents. Paediatric and Child Health, 13, 53-60.
 Ashton, M., Lenton, S., Mitcheson, L., Nelles, B., and Stimson, G. A review of the evidence-base for harm reduction approaches to drug use. Forward Thinking on Drugs.