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What is “harm reduction”?

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The most basic definition of harm reduction seems pretty simple, reading something like, “reducing harm to another person or persons through actions and behaviors”. Now, expand harm reduction to the substance abuse community and the answer becomes somewhat more complicated, much of which is driven my misunderstanding and stigma.

At its’ core, harm reduction in the substance use community begins by  extending a fundamental attitude of compassion and respect to those within the orbit of substance use, encompassing not only the substance user, but their families and communities, as well.  While it certainly doesn’t mean condoning self-destructive behaviors, it does mean that we acknowledge that basic human rights are not surrendered because of this behavior and improving someone’s quality of life isn’t an all or nothing proposition.

High Level Principles of Harm Reduction

Beyond the basics, a commitment to an evidence-supported intervention strategy is important.  There is an abundance of knowledge that indicates that harm reduction intervention is a practical, inexpensive and effective tool in addressing substance abuse. These interventions successfully cross social, cultural and economic barriers in their effectiveness.

A commitment to social justice for drug users may be one of the more challenging principles of harm reduction. For many, the concept of ensuring that needed health and social service access is available to everyone who requires it may run counter to political, religious, cultural or philosophical beliefs. However, for the concept of harm reduction to have maximum impact, support must be extended to all who need it, without discrimination or excess regulation.

Finally, acceptance is crucial. Reaching out to provide support, treatment, counseling, security or anything else needed must be done without judgement. The use of labels or phrases that promote stigmatizing individuals can create a wall between those who need help, and those who can offer it.

The Practical Application of Harm Reduction Principles

Essentially, harm reduction is a reality based approach to substance use treatment that acknowledges that people will use drugs, not everyone will want to stop using drugs and that total abstinence is not a realistic or positive outcome for all individuals. By approaching substance use disorders as a multi-tiered challenge, with a variety of potential outcomes, treatment and cure successes can be better monitored.

The goals of a harm reduction approach to abuse treatments are first and foremost to keep people alive. Second to this goal is guiding users toward a positive change in their lives through a process of support and positive reinforcement.  The celebration of a small victory in an individual’s journey is to be celebrated and built upon as a stepping stone to further successes.

This is exemplified best in medication-assisted treatment (MAT) for opioid use disorder. Methadone has been proven in countless studies over the last 60 years to be the gold standard of care for individuals struggling with opioid addiction. However, because methadone itself is an opioid, methadone maintenance treatment is stigmatized as just “replacing one drug with another”. While on the surface that may be true, the effectiveness of methadone treatment, and more recently buprenorphine (Suboxone®) and naltrexone (Vivitrol®), is so well-documented that it cannot be disputed it is a life-saving option for those struggling to overcome the use of opioids. Many individuals feel that anything other than total abstinence is not “real recovery” but MAT is a part of a recovery journey that offers a real chance at life after opioid use.

The strict, black and white approach to drug laws and accompanying consequences are a target of harm reduction advocates who understand most individuals aren’t helped by being punished for their addictions. Placing the health of drug users above the push for incarceration is critical in moving beyond the often negative approach to simply locking up an abuser. With access to treatment and support, the long-term outlook for many substance misusers can be very promising.  Other policies in place throughout the country may also bear examination:

  • Limitations on the availability of Naloxone (Narcan), as well as restrictions regarding who can dispense and administer it. Current restrictions may cost lives unnecessarily.
  • The availability of controversial safe-injection sites, with medical professional supervision, offering drug users a location, free from criminal victimization and with the security of a medical presence, should an overdose situation occur.
  • Discrimination based upon current or previous drug use, which can seriously handicap an individuals efforts at moving beyond their substance abuse issues, and back into a role as a productive member of society.

Those who would continue to question the effectiveness of a harm reduction approach, need only look at the success demonstrated by the use of this methodology in addressing the spread of AIDS.  Due to the prevalence of AIDS in the substance use treatment environment, there is a substantial degree of overlap with respect to many harm reduction initiatives.

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