Acknowledge the Reality of Drug Use

Harm reduction accepts that drug use is part of our society and works to minimize its harmful effects rather than simply ignoring or condemning them. This perspective acknowledges that some methods of drug use are less risky than others, promoting safer practices to mitigate the harms associated with drug use (National Harm Reduction Coalition, 2024).

Understand Drug Use is Complex

Drug use encompasses a continuum of behaviors from abstinence/no use to chaotic use (Calltime Mental Health, 2022). Not everyone who falls on this continuum (see Figure 1) wants or needs treatment for substance use disorder; for example, someone may recreationally use cocaine in certain environments. Some of these individuals may not meet the diagnostic criteria for substance use disorder (SUD). However, harm reduction interventions such as drug testing strips (ex. Fentanyl and xylazine strips), might be beneficial to minimize associated risks. Harm reduction strategies help people who use drugs (PWUD) stay safe and make informed decisions about their substance use, while also opening the door for many people to receive treatment if and when they are interested (National Harm Reduction Coalition, 2024).

Figure 1

(May, 2020)

Prioritize Quality of Life

The primary criterion for successful harm reduction interventions and policies is the enhancement of individual and community quality of life and well-being, rather than the cessation of drug use or engagement in treatment (National Harm Reduction Coalition, 2024). This approach values health, dignity, and human rights, seeking to create supportive environments that enable people to make positive changes with or without abstaining from drug use.

Non-Judgmental and Non-Coercive Care

Harm reduction calls for the provision of non-judgmental, non-coercive services and resources for PWUD and the communities they live in (National Harm Reduction Coalition, 2024). This approach respects the autonomy and choices of individuals, offering support that assists them in reducing the harm associated with their drug use without imposing abstinence. For example, some treatment organizations may require abstinence from a substance for up to 2 weeks before the client can access services offered, which is a barrier for many folks seeking care. A non-coercive approach to harm reduction helps build rapport and trust with the community being served, as well as offer a welcoming and positive environment for PWUD.

Include People Who Use Drugs

Another primary focus of harm reduction is ensuring that PWUD and those with a history of drug use have a meaningful voice in the creation of programs and policies designed to serve them. PWUD have always been at the forefront of harm reduction movements, which has contributed to their impact and success. One of the main slogans used when discussing harm reduction is “Nothing about us without us”, meaning harm reduction policies and programs should be run with the full participation of PWUD and people with lived experience with substance use (National Harm Reduction Coalition, 2024).

Frame PWUD as the Primary Agents of Reducing Harm

This principle affirms PWUD as the primary agents of reducing the harms of their drug use and empowers them to share information, build community, and support each other in developing strategies that meet their needs. Unfortunately, people with SUD often experience blame, shame, and stigma when seeking treatment and resources. When organizations engage PWUD as the primary decision-makers in their health, they are supporting the individual’s autonomy and empowerment. This can lead to improved retention in treatment and more effective continuity of care.

Address Social Inequalities

Harm reduction recognizes that factors such as poverty, class, racism, social isolation, past trauma, and sex-based discrimination significantly affect individuals’ vulnerability to and capacity for effectively dealing with drug-related harm. These social inequalities must be addressed to create equitable and effective harm reduction strategies and programs (National Harm Reduction Coalition, 2024).

Acknowledge the Harms of Drug Use

Harm reduction does not seek to minimize or ignore the real harm and danger associated with substance use. Instead, it works to provide realistic and compassionate solutions to address the needs of PWUD (National Harm Reduction Coalition, 2024). This approach acknowledges the consequences of drug use while working to reduce these harms through practical and evidence-based interventions. For example, it is important when counseling someone with stimulant use disorder to educate on the risks of fentanyl contaminating their supply and how to use fentanyl test strips, rather than just trying to link them to treatment and pushing an abstinence-only approach. This acknowledges the reality that not every person who uses drugs wants or needs treatment, and  provides education and tools to make informed decisions about substance use.