Harm reduction
Harm reduction is an approach aimed at minimizing the negative consequences associated with drug and alcohol use, particularly for individuals with substance use disorders. Rather than focusing solely on abstinence, harm reduction strategies seek to reduce the health risks and emotional damage linked to substance misuse. This pragmatic methodology addresses behaviors such as risky drug use, sharing needles, and unsafe sexual practices, which can lead to severe health issues like overdoses and the transmission of diseases such as HIV and Hepatitis C.
While often controversial, advocates argue that harm reduction policies can effectively mitigate the dangers of drug use and encourage individuals to seek treatment. For example, needle exchange programs, which allow users to swap used needles for clean ones, have been shown to lower the risk of blood-borne infections and increase the likelihood of individuals pursuing drug treatment options. Despite resistance, especially in the United States, some countries have embraced harm reduction initiatives, including safe injection sites and substance use education programs. The ongoing debate around these strategies reflects broader discussions about drug policy, public health, and compassion for those affected by addiction.
Subject Terms
Harm reduction
DEFINITION: Harm reduction in the context of addiction and substance use disorder includes policies and practices that aim to reduce the level of physical and emotional damage as well as the mortality rate that are consequences of chronic drug and alcohol use.
Background
Harm reduction focuses on behavior and practices that jeopardize a person’s health and well-being. Such behaviors and practices include risky sexual practices, over-use of drugs and alcohol to the point of becoming unconscious or overdosing, using drugs alone and in seclusion, and sharing needles during intravenous drug use that can result in spreading diseases such as Hepatitis C and HIV. Harm reduction is based in pragmatism, or realism, rather than in the idealism reflected in abstinence-only drug policies. Harm reduction methodology does not aim to stop a person from misusing drugs and alcohol, but rather to reduce the individual's level of harm and risk often associated with such behavior.
Harm reduction practices are often controversial in that opponents view them as promoting unhealthy, immoral, and sometimes illegal behavior. Advocates of harm reduction policies believe that prohibitionist drug policies can increase the risk and danger to users beyond those risks already associated with a drug. Focusing on reducing the levels of potential harm that results from drug and alcohol use while still maintaining a compassionate and nonjudgmental stance when working with individuals suffering from substance use disorder has been shown to have a greater impact on whether or not the afflicted choose to enter treatment and rehabilitation for their disease. Advocates believe that state and federal drug policies that are based on the prohibition of drugs will not eradicate drug use: people will still break laws and use drugs regardless of the laws in place. Drug policies, they argue, should seek to reduce the harm caused by drug use. Harm reduction policies regarding illegal substances are the most contentious in terms of public support.
Types of Programs
In the United States, harm reduction policies surrounding the use of heroin are among the most controversial yet the most prevalent as well. Canada and many European nations have embraced harm reduction policies. Needle exchange programs (also referred to as syringe services programs, or SSPs), in which addicts exchange a used needle for a clean one, are among the most disputed harm reduction programs. Controversy exists even though research consistently shows needle exchange programs minimize the risk of contracting blood-borne diseases such as those caused by the human immunodeficiency and hepatitis viruses. The Centers for Disease Control and Prevention (CDC) maintains that SSPs are "proven and effective community-based prevention programs" that "do not increase illegal drug use or crime, and play an important role in reducing the transmission of viral hepatitis, HIV and other infections." Further, research showed that Individuals who start using SSPs are five times more likely to seek drug treatment and approximately three times more likely to quit using drugs compared to those who do not participate in these programs, according to the CDC. Such programs became especially important amid the opioid crisis of the 2010s and 2020s, during which rates of misuse of opioid pain relievers, heroin, and fentanyl soared in the US, resulting in increased use of injection drugs, as well as overdose deaths and viral hepatitis infections. Many SSPs also provide naloxone, a medication that can reverse drug overdoses, to people who inject drugs.
The US Congress banned federal funding for needle exchange programs in the late 1980s but lifted the ban in 2009. Two years later, however, Congress reimposed the ban. The Consolidated Appropriations Act of 2018 once again allowed the use of federal funds to support SSPs under certain circumstances. The funds, provided by the Department of Health and Human Services, cannot be used to purchase needs or syringes, and programs that use federal funding for the operation of SSPs must follow federal, state, and local laws and regulations. In the early 2020s, about four hundred SSPs were operating throughout the US according to the Kaiser Family Foundation, though the number of programs offered in each state varied greatly, with some states, such as Alabama and Nebraska, not having any SSPs.
Safe injection rooms, another form of harm reduction for intravenous drug users that exist in some European nations, provide medical personnel and sterile equipment and make referrals to treatment programs. Drug zones have also been implemented in some European cities to contain the spread of drug use into other areas. Additional harm reduction strategies include distributing condoms to prevent the spread of sexually transmitted diseases, providing methadone or naloxone to opiate addicts, promoting moderate and thoughtful drinking practices over abstinence for recovering alcoholics, and conducting responsible drinking campaigns on college campuses.
US Drug Policy
Despite a slight shift in thought and perception surrounding illicit drug use, substance use disorder, and opiate addiction in particular, the US drug policy continues to be shaped around punitive actions that promote zero-tolerance for drug use and heavy prison sentences for possession and distribution of drugs. The federal government continues to wage a war on drugs that seeks to eradicate drug use. US drug policy has created significant barriers to implementing harm reduction strategies.
Bibliography
Hulse, Carl. "Surge in Cases of HIV Tests US Policy on Needle Exchanges." New York Times, 16 May 2015, www.nytimes.com/2015/05/17/us/surge-in-cases-of-hiv-tests-us-policy-on-needle-exchanges.html. Accessed 5 Dec. 2024.
Inciardi, James, and Lana D. Harrison, editors. Harm Reduction: National and International Perspectives. Sage, 2000.
Levengood, Timothy W., et al. "Supervised Injection Facilities as Harm Reduction: A Systematic Review." American Journal of Preventive Medicine, vol. 61, no. 5, Nov. 2021, pp. 738–749, DOI: 10.1016/j.amepre.2021.04.017. Accessed 1 Dec. 2022.
Marlatt, G. Alan, editor. Harm Reduction: Pragmatic Strategies for Managing High Risk Behavior. Guilford, 1998.
McCann, Eugene, and Cristina Temenos. "Mobilizing Drug Consumption Rooms: Inter-place Networks and Harm Reduction Drug Policy." Health and Place, vol. 31, 2015, pp. 216–23.
Nadelmann, Ethan A. “Common Sense Drug Policy.” Foreign Affairs, vol. 77, no. 1, 1998, pp. 111–26.
"Safety and Effectiveness of Syringe Services Programs." Centers for Disease Control and Prevention, 8 Feb. 2024, www.cdc.gov/syringe-services-programs/php/safety-effectiveness.html. Accessed 5 Dec. 2024.
"Sterile Syringe Exchange Programs." Kaiser Family Foundation, 2022, www.kff.org/hivaids/state-indicator/syringe-exchange-programs/. Accessed 5 Dec. 2024.