|The term “harm reduction” refers to policies, programmes and projects which aim to reduce the health, social and economic harms associated with the use of psychoactive substances. It is an evidence-based and cost-effective approach – bringing benefits to the individual, community and society.
Harm reduction is a targeted approach that focuses on specific harms. It requires that politicians, policymakers, communities, researchers and frontline workers ask two questions:
1. What specifically are the harms associated with different psychoactive drugs?
2. What can be done to reduce the risk of those harms occurring?
• People who inject drugs are vulnerable to contracting blood borne infections such as HIV and hepatitis B and C. Providing sterile needles and syringes helps reduce the risk of infection.
• People dependent on illicit opiate drugs (such as heroin) are at particular risks from impure drugs, overdose, and having to engage in acquisitive crime in order to purchase their drugs. The medical provision of substitute drugs such as methadone and buprenorphine reduces these risks.
• People who become drunk in bars and pubs may cause harm to themselves or others. Training bar staff in responsible serving may help reduce the risk of intoxication and give staff the skills to prevent incidents.
• People who drink and then drive motor vehicles may hurt themselves or others. Drink driving laws, the provision of public transport, and designated driver programmes reduce risks of injury and fatality by separating drinking from driving.
• People who smoke tobacco are likely to suffer serious illness and premature death. Helping them to switch to non-smokable forms of nicotine vastly reduces their risks.
Harm reduction can work alongside approaches that aim for reductions in drug, alcohol and tobacco consumption. However, harm reduction is often a more realistic approach: it recognises that many people throughout the world use psychoactive substances, and that society is unlikely to ever be drug-, drink- or nicotine-free. Harm reduction does not exclude abstinence as a goal for individuals who are dependent but, rather, provides people with more pragmatic choices such as limiting their intake. Harm reduction helps to engage people and motivate them make contact with treatment providers when they are ready. However, as good treatment and help is unavailable to many people around the world, and many psychoactive substance users may not be ready to engage with treatment services, it is essential from a public health perspective to do what can be done now to reduce harm – waiting for a drug free society or for people to achieve abstinence is not an option.
There are two main pillars that guide harm reduction. One is a pragmatic public health approach, and the other is based within a human rights approach. Both share an ethos that changing human behaviour must be a facilitative and cooperative process which respects the dignity of the individual. Harm reduction avoids moralistic, stigmatizing and judgmental statements about substance use and users. It avoids value laden language (such as ‘drug abuse’ and ‘addict’). Harm reduction approaches also seek to identify and advocate for changes in laws, regulations and policies that increase harms, or which hinder the introduction of harm reduction interventions.
The evidence clearly demonstrates that harm reduction reduces the impact of substance use for the individual and society, and helps keep people alive and well. Harm reduction saves lives.