Harm Reduction Definition
“Harm reduction refers to policies, programs and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal drugs without necessarily reducing drug consumption.”
Harm reduction acknowledges that the world is not drug-free and if people are going to use drugs, then it’s better to use them in a safer environment in order to minimize the number of overdose deaths that occur.
Methadone clinics (like Symetria) are usually considered harm reduction because methadone overdose is possible when mixed with other drugs, though around 10x less likely than other opioids.
Goals of Harm Reduction
- Keep people alive and encourage positive change: Protect the health of people who misuse substances and keep them alive. Positive changes in a person's life should be reinforced, no matter how small or incremental that change may be. (Examples: needle exchanges or Narcan distribution for overdose).
- Reduce the harms of drug laws and policy: Change laws, policies and law enforcement practices to improve the health and well-being of people who use substances. Often, current policies create and exacerbate the potential risk and harms of substance use. (Example: eliminating criminalization of drug or paraphernalia possession).
- Offer alternatives to approaches that seek to prevent or end substance use: Provide individuals who use substances access to high quality, evidenced-based treatment programs. Harm reduction approaches believe that entry into substance use treatment should be voluntary; additional treatment options other than abstinence-based treatment should be available.
Harm Reduction in Treatment
Healthcare providers that use a harm reduction model meet patients where they are and encourage them to be as healthy as possible. The tone is non-judgmental and non-coercive.
Even if a patient doesn’t follow the recommended treatment plan, providers teach them skills to:
- improve their quality of life
- minimize their risk of harm (like acquiring a new disease, job loss, heroin abscess or overdose)
The ultimate goal of harm reduction practice is to empower individuals who misuse substances to make their own decisions and define recovery in their own terms. This approach values collaboration between provider and patient.
- Although most often associated with substance use, providers also use harm reduction to manage medical conditions such as obesity and heart disease.
6 Principles of Harm Reduction in Treatment
Applying these six principles of harm reduction helps improve the quality of the provider-patient relationship, which may also improve clinical care outcomes and treatment adherence.
- Humanism: Providers value, care for, respect and dignify patients as individuals. Providers accept patients’ choices and seek to understand the balance between how substance use harms and benefits the patient.
- Pragmatism: Providers recognize that no one, including themselves, will ever achieve perfect health behaviors. They understand that expecting patients to make healthy choices every time and in every situation is an unrealistic expectation. Providers offer patients a range of supportive approaches based on the goal of the patient.
- Individualism: Each patient has unique needs, strengths and harmful behaviors. Patients should be offered an array of treatment options and interventions tailored for their needs and strengths.
- Autonomy: While providers should educate patients on healthy behaviors and treatment options, patients ultimately make their own choices about their medication, treatment and health behaviors.
- Incrementalism: Positive change by the patient is a step towards improved health. Each positive movement by the patient should be celebrated by the provider, serving as a method of positive reinforcement. Celebrate improvements rather than punish regression. This is beneficial to the patient and the provider-patient relationship.
- Accountability without termination: Providers view patients as being responsible for their behaviors and health choices. While patients have the right to make harmful health decisions, the provider should not terminate patients for doing so. Providers can help patients understand the consequences of their decisions.
Harm Reduction Examples
Harm reduction can be a specific initiative, but it can also be a mindset to how people struggling with substances are treated — by society, within the laws, by law enforcement, by families or by healthcare professionals, for example.
Harm Reduction Advice
- Check drug potency with testing kits (and avoid or use less if stronger than usual)
- Have naloxone (Narcan) on-hand
- Don't use alone
- Buy from trusted sources (ie. someone that uses the same drugs or tests prior to distributing)
- Use sterile injection practices (ie. use clean needles, don't lick needles, use sterile water, use fresh cotton and don't share needles)
- Smoke or ingest rather than inject
- Reduce amounts when returning after any period of abstinence
- Access contraception
Harm Reduction Programs
Harm reduction began as a grass-roots movement in the 1980s during the HIV crisis. It started with needle exchange programs to ensure that if someone was injecting drugs, such as heroin, they were doing it safely and not spreading the disease.
Today, organized harm reduction groups still provide needle exchanges as well as safe injection sites which go a step further to provide 24/7 supervision and connection to mental health resources.
Additionally, harm reduction groups like The Harm Reduction Coalition (HRC) advocate for the decriminalization of drugs and for Good Samaritan laws that offer legal protection to those seeking medical care for themselves or others during an overdose.
Another important initiative of harm reduction groups is to distribute and educate on how to use naloxone, the anti-overdose drug. Naloxone (Narcan) training can be geared toward families of those using, the general public, healthcare providers or police forces.
Medication-Assisted Treatment (MAT) programs that include the use of Suboxone or methadone are also considered harm reduction in contrast to the traditional abstinence-only programs.
Getting Harm Reduction Treatment
"If treatment is on a linear continuum with abstinence-based and harm reduction on opposite ends, Symetria is much close to the harm reduction side. The goal here is to help patients stop using as soon as possible. However, we don't kick someone out of treatment for lapsing, even multiple times. We let patients drive their own treatment. Working together with care and respect and on a patient-by-patient basis to help them meet the goals they set for themselves."
Harm Reduction Addiction Treatment