Harm Reduction

For people with drug and alcohol problems, is complete abstinence the only way forward?

Well, it’s a great option for some, but it doesn’t work for everyone – at least not right now, so for those that can’t or won’t stop abusing drugs or alcohol, we have harm reduction. With harm reduction, people find ways to make positive changes and improve quality of life, whether they reduce drug or alcohol use or not.

There are many possible reasons why a person uses drugs or alcohol or feels as though they can’t stop at this point in time, but whether you or someone you love chooses to try for abstinence or not, harm reduction interventions can help improve quality of life – no matter where you’re at.

• Harm reduction programs can give you the support, education, skills and resources you need to make positive changes and live a healthier and happier life.
• By making positive changes, you increase your self confidence and your belief in the possibility of further positive changes.¹

Here’s a brief overview of the guiding principles behind harm reduction, some examples of typical community harm reduction programs and some examples of harm reduction initiatives you can adopt at the personal level.

15 Principles of Harm Reduction

Harm reduction takes a pragmatic view of reality:

• Whether you like it or not, and no matter what you try to do about it, people in your community will continue to use and abuse drugs and alcohol. Though you cannot force abstinence, you can help people take better care of themselves and in doing so, the community at large also benefits

There’s no single accepted definition for harm reduction, but at its core:

Harm Reduction = Any program or policy designed to reduce drug-related harm without requiring the cessation of drug use.²

Here are 15 of harm reduction’s guiding principles:^{3 4}

1. Harm reduction advocates know that drug and alcohol abuse can have tragic consequences, but they accept that drug and alcohol abuse is a reality that’s not going away anytime soon.
   
2. Harm reduction interventions are evidence-based, pragmatic and non-judgemental.
3. Harm reduction works to meet people where they are currently at (so, for example, you wouldn’t have to get sober to start off with harm reduction, you could continue to drink while making incremental changes.)
4. Harm reduction helps you deal with your most immediate goals. For example, if you are getting evicted, you might see finding a safe place to stay as more important than long-term abstinence.
5. Drug and alcohol use problems occur across a spectrum of severity. Abstinence is not the only path of progress – people can take steps to reduce use and reduce harms while still using drugs or alcohol.
6. Everyone has the right to decide how they want to live, and this includes self-determination on the use of drugs and alcohol.
7. There are some methods of drug and alcohol use that are safer and less harmful than others.
8. Though harm reduction programs are often controversial, these programs help the community. The community benefits more when many people make small improvements than when a few people make life-changing improvements.
9. There is no one intervention or treatment approach that works for everyone. When people have access to a range of options, they do better.
10. People normally accomplish major life changes through an incremental process of small changes and steps. Harm reduction programs help people make small beneficial changes that can eventually add up to something substantial.
11. Through a lens of harm reduction all people are viewed as worthy of the same tolerance, respect and compassion, no matter what their current state. Service providers should not judge those in the community.
12. All people have the same basic human rights – whether they use drugs or not, particularly the right to freedom from arbitrary detention, degrading practices and inhumane treatments.
13. People are more likely to make use of and benefit from services they choose voluntarily (rather than get forced into). People are very capable of responsible self-directed change when given information and support.
14. Harm reduction interventions are considered successful if they improve individual or community health or well being or community. A harm reduction intervention does not need to reduce drug or alcohol use to be qualified a success.
15. People from the targeted community (drug or alcohol abusers) are involved in the planning and implementation of harm reduction programs.

Does Harm Reduction Encourage Drug Use?

Critics object to harm reduction on the grounds that it seems to promote drug use and may encourage people to start using drugs or increase their use.

Research has shown, however, that harm reduction programs do not encourage drug use initiation and that rather than leading people to greater use, harm reduction programs often provide an initial entry point to social services and actually increase a person’s likelihood of getting addiction treatment.⁵

Community Harm Reduction Examples

Examples of common harm reduction programs include:⁶

• Needle exchange programs.
• Overdose prevention programs – such as providing naloxone to people at high risk to witness an opioid overdose.
• Supplying disposable crack pipes, push sticks, screens or mouthpieces.
• Safer sex programs which supply free condoms.
• Methadone maintenance treatment programs.
• Pill testing – testing illicit pills for adulterants.
• Supervised injection/consumption facilities.
• Prescribed heroin.
• Wet houses for homeless alcoholics (supervised living environments where previously homeless alcoholics get a safe place to live and regular small doses of alcohol).
• Education and outreach programs for high-risk communities.
• Community prevention campaigns against impaired driving.
• Peer support programs – for example, support groups where drug and alcohol abusers share support and information.

Individual Harm Reduction Examples

If you use or abuse drugs or alcohol, there are likely ways to live better and stay healthier. Some examples of individual harm reduction techniques you can practice include:

• If you inject drugs, use a new syringe and sterile water and cotton each time.
• If you inject drugs, consider moving to safer modes of administration, like smoking or snorting.
• Practice safer sex.
• Get a health check-up. Be honest with your doctor and ask how your drug use is affecting your health. Get a tetanus shot and a hepatitis B vaccine.
• Learn CPR and know what to do in the event of an overdose. If you are at increased risk to witness an O.D., consider carrying naloxone.
• Don’t use drugs alone and if possible, buy from someone you know.
• If you smoke marijuana, crack or other drugs, don’t hold the smoke in your lungs (holding does not increase drug absorption but it does increase lung irritation and damage.)
• Take steps to reduce your consumption.
• Consider medication management programs, like with methadone or buprenorphine.
• If you drink heavily, take preemptive measures to offset nutritional deficiencies, such as with thiamine, that are commonplace among heavy drinkers (a daily vitamin or two or an occasional b vitamin shot at the doctor’s office might save your life.)
• If you snort drugs, especially cocaine, make sure to insert the straw high into your nostril and then rinse out your nasal cavity after snorting (this protects you from septum damage.)
• Be cautious with mixing drugs. Many opioid overdoses occur after the co-consumption of an opioid and another sedative, like a benzodiazepine.

Does Harm Reduction Work?

At the community level, we see that harm reduction programs get big results for small financial outlays. Research shows that harm reduction programs can:

• Reduce HIV, hepatitis C and other infectious disease transmission (by reducing needle sharing, reducing injection frequency and by promoting safer sex.)
• Reduce the rate of accidental and early death among active drug users - by reducing overdose incidences and by improving overall health.
• Reduce injection drug use in public place.
• Reduce the numbers of syringes and other forms of drug paraphernalia left on the streets.
• Reduce disability and disease rates by helping I.V. drug users develop and maintain safer injection practices.
• Reduce crime (people given methadone or prescribed heroin do not have as much need to commit crimes).
• Increase social engagement – by getting drug and alcohol abusers more involved with social support services many are able to increase their participation in mainstream society.

Harm Reduction Works

People in the community will use and abuse drugs and alcohol today and they’ll use them tomorrow as well...

This isn’t going to change any time soon; abstinence only policies won’t stop all substance abuse, so to exert the most benefit, we have to help people achieve the small changes they’re willing to make. Fortunately, at the community level, helping many people make small positive changes helps society more than convincing a few people to make dramatic changes, but harm reduction makes sense at the individual level as well, since people usually improve themselves through small incremental steps that can eventually add up to something great.