Skip to main content

Harm Reduction: A Lifesaving Approach

Acknowledging International Overdose Awareness Day

International Overdose Awareness Day, commemorated on August 31, began in 2001 in Melbourne, Australia. Observance of the day includes remembering those who have died and acknowledging the grief of loved ones left behind. The campaign also hopes to stimulate action on implementing evidence-based overdose prevention and drug policy.

Harm reduction is an important evidenced-based approach to prevent overdose deaths and reduce harmful effects of disordered drug use. Harm reduction provides immediate, lifesaving resources, and is part of the full continuum of prevention, treatment and recovery support interventions needed to ensure that pathways to health are available within communities.

What Do We Know About Harm Reduction?

Examples of general harm reduction tools that now have broad public support include sunscreen, seat belts, speed limits and cigarette filters. Harm reduction tools focused on drug use include naloxone to reverse overdose and safer use supplies to prevent infections. Harm reduction programs also provide education and typically offer linkage to resources such as social support services, medical care, and substance use treatment and recovery services.

Harm reduction effectiveness has been studied for decades. Harm reduction services across multiple studies are shown to reduce overdose death, infectious disease risk and drug use; facilitate access to health and social services, including treatment; and be cost-effective (relative to the costs of infectious disease). Concerns about syringe service programs increasing syringe litter or crime, or attracting non-resident people who use drugs have not been borne out by research.

Harm reduction also refers to a philosophical approach that includes:

  • Participant-driven goal setting, identifying immediate personal goals, breaking down goals into smaller steps
  • Nonjudgmental, non-abstinence-based engagement
  • Acknowledgement of incremental change
  • Emphasis on ways to stay safer and healthier and engagement in meaningful activities

As described by the U.S. Department of Veteran’s Affairs, “harm reduction embraces the concept of ‘any positive change’ and celebrates small steps moving towards healthier living. Often, taking smaller steps can be less intimidating and more realistic. In time, this can help a Veteran achieve bigger, more sustained change.”

How are Harm Reduction Principles Used in Substance Use Disorder Treatment?

Harm reduction principles are also increasingly recognized as a best practice in substance use disorder (SUD) treatment. Low-barrier treatment guided by harm reduction principles is effective in engaging and retaining marginalized patients and reducing overdose and drug use. Practices include:

  • No discharge for continued use (understanding that change can be gradual)
  • Recognize patients’ reduced use, reduced overdose risk, progress toward life stabilization, etc.
  • Eliminate requirement for counseling when prescribing medication treatment such as buprenorphine or methadone
  • Reduce “hoops” to gaining access to treatment
  • Create trauma-informed therapeutic environment

A recent study in Washington state randomized people who were experiencing houselessness and in treatment for alcohol use disorder to receive either harm reduction treatment (patients drive treatment goals) or usual care (treatment goal for all patients is reduced use or abstinence). Compared to usual care, harm reduction treatment participants reported significantly greater decreases in peak alcohol use, alcohol-related harm, alcohol use disorder symptoms and positive urine tests.

How Can We Support Efforts to Reduce Harm and Prevent Overdose?

Anyone who could be in a situation to witness an overdose (including as a community bystander) can carry naloxone. Many states have designated funds for distribution of naloxone to people most at risk for experiencing or witnessing an overdose. Everyone else can request a prescription from their primary care provider or request naloxone at the pharmacy (depending on state laws). Insurance typically covers a portion of the cost. The FDA recently approved over-the-counter sales of naloxone nasal spray, so this should be more available in the future.

Another way to support overdose prevention is to learn more about harm reduction, share information with others and speak up when you hear misinformation in your community. One example of straightforward talking points can be found in the Save Lives Oregon toolkit, which includes a one-page harm reduction overview and an “addressing common concerns” document.

Finally, we can renew our commitment to care for others, support for the safety and health of everyone in our community, and belief in each person’s agency to reduce the risks associated with drug use and make steps toward positive change. A cornerstone principle of harm reduction summarizes this ethos: Meet people where they are. And help them get where they want to be.

Learn More

Comagine Health studies harm reduction and its impacts on individuals and communities. Visit our Research and Evaluation page to learn more about this vital work.

Add new comment