Harm Reduction as a Life Strategy
By Cele Fichter-DeSando, MPM (She Her, Hers)
Harm reduction, formalized in the 1980s, is an approach for reducing risk and preventing death for individuals who use substances. However, harm reduction as a life strategy has long been part of a mainstream public health approach used by health professionals, parents, and teachers. Whenever you apply sunscreen before going out into the sun, buckle a seatbelt before starting your car, read a food label before making a supermarket purchase, or put a helmet on before riding a bicycle you are employing a harm reduction strategy.
Prevention professionals have included harm reduction strategies in school and community education programs for many years. Programs that teach parents, children, and youth about medication safety, peer refusal skills, and calling for a ride before getting into a car with someone who has been drinking or using substances are all examples of harm reduction strategies.
In recent years, in addition to use with risky substance use, harm reduction has been successfully applied to sexual health education in an attempt to reduce both teen pregnancies and sexually transmitted diseases, including HIV. Specific harm reduction strategies are applied according to the target population and the specific harm to be addressed (Pediatrics and Child Health, 2008).
Harm Reduction as a Prevention Strategy
Understanding harm reduction more fully will assist prevention practitioners in incorporating and expanding harm reduction approaches into a comprehensive prevention program. The following organizations provide definitions, explanations, research findings, and resources for further understanding harm reduction.
Applied Prevention Science International
Applied Prevention Science International (APSI) was established in 2013 to expand the availability of effective and efficient prevention services in communities in the U.S. and around the world. ASPI outlines the importance of harm reduction for prevention professionals who address a range of community needs and prevent the onset of the use of psychoactive substances. If substance use is initiated, prevention professionals have as their goal to prevent the negative consequences associated with substance use. Preventing the negative consequences associated with substance use is part of harm reduction (APSI, 2022).
The Substance Use and Mental Health Services Administration
The Substance Abuse and Mental Health Services Administration (SAMHSA) describes harm reduction as a comprehensive part of the continuum of care that emphasizes engaging directly with people who use drugs to prevent overdose and infectious disease transmission. Harm reduction approaches improve the physical, mental, and social wellbeing of those served, and offer non-judgmental opportunities for accessing substance use disorder treatment and other health care services. SAMHSA provides information, harm reduction resources, and links for collaboration (SAMHSA, 2022).
Harm Reduction International
Harm Reduction International (HRI) describes harm reduction as being made up of policies and practices informed by a strong body of evidence that shows interventions to be practical, effective, safe and cost-effective in diverse social, cultural, and economic settings. HRI posits that most harm reduction interventions are easy to implement and inexpensive, and all have a strong positive impact on individual and community health (HRI, 2022).
A Framework for Harm Reduction
As prevention practitioners it is useful to have a conceptual framework for understanding harm reduction and its application in community settings. Researchers at the University of Pittsburgh Medical Center have proposed a framework for expanding harm reduction principles to healthcare settings (Hawk et.al, 2017). The authors propose extending the harm reduction philosophy to include other health risk behaviors and have outlined six principles to be used in a broad-based harm reduction approach. The harm reduction principles of humanism, pragmatism, individualism, autonomy, incrementalism, and accountability without termination are outlined in the table below.
The six principles affirm the dignity, value, and autonomy of each person to make choices about their health behavior. Health care professionals are companions and guides that can provide harm reduction approaches that can be used as a universal precaution and applied to all individuals regardless of their disclosure of negative health behaviors. (Hawk et al 2017). These principles can be used as a foundation for prevention and other professionals when interacting with individuals and when designing programs.
Technical Assistance for Planning and Providing Harm Reduction Services
Developing a foundation and understanding of harm reduction principles is one of the first steps in planning and providing harm reduction programs and expanding prevention services to include harm reduction. There are resources available to prevention and other behavioral healthcare professionals and organizations to assist with the next steps of developing and implementing harm reduction services and programs.
The National Harm Reduction Technical Assistance Center
National Harm Reduction Technical Assistance Center (NHRTAC), delivered in partnership with the Centers for Disease Control (CDC) and SAMHSA, provides free help to anyone in the country providing (or planning to provide) harm reduction services to their community. CDC established and expanded the NHRTAC in collaboration with SAMHSA to ensure comprehensive support for the integration of harm reduction strategies and principles across diverse community settings and within a treatment and community framework. Services may include syringe services programs, health departments, and programs providing substance use disorder prevention, treatment, and recovery programs (NHRTAC, 2022).
NHRTAC has partnered with technical assistance providers to connect programs with resources and experts to implement harm reduction services and other activities in support of the health and wellness of people who use drugs. The technical assistance providers listed on the NHRTAC website include:
A non-profit representing public health officials who administer HIV and hepatitis programs, including harm reduction services
A nationwide advocate and ally for people who use drugs that works to bring harm reduction strategies to scale
UW and NYU collaboration with harm reduction expertise in data collection, analysis, and monitoring and evaluation for SSPs
Supports approaches to strengthen community assets and resources to prevent substance misuse and support long-term recovery
Builds the capacity of mental health and substance use treatment organizations
Specializes in behavioral health program design and implementation, including overdose response in diverse settings
Works at intersection of harm reduction and recovery, integrates peers into continuum of services, and recovery anti-stigma
Promotes evidence-based and promising treatment, recovery-oriented and substance use prevention practices and services
Harm Reduction Toolkit
The National Drug and Alcohol Research Centre, University of New South Wales (NDARC) Access Quality International developed a toolkit “Opening Doors” Enhancing Youth-Friendly Harm Reduction” to provide practical training and guidance on effective harm reduction services for young people. The toolkit developed in 2011 includes important and honest conversations around drug use amongst young people.
Prevention Technology Transfer Center
The Prevention Technology Transfer Center provides Harm Reduction Prevention Resources, fact sheets, webinars, and other materials to assist prevention professionals in harm reduction programming.
Conclusion: The National Harm Reduction Coalition defines harm reduction as a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs. Harm reduction does not require abstinence from any risky behaviors (HRC, 2020). As human beings, we all have the right to health, well-being, and access to evidence-based health care services. Programs and services that employ a harm reduction approach are effective, doable, and improve health outcomes for everyone. Harm reduction utilized as a universal life strategy decreases disparities and increases the quality of life for us all.
Author's Contact Info:
Cele Fichter-DeSando, MPM (She, Her, Hers)
7069 Highland Creek Drive
Bridgeville PA, 15017
Applied Prevention Science International. 2022. Prevention, Treatment and Harm Reduction: How Are These Defined in Today’s Prevention Work? Blog Post. Jan 24, 2022, Updated May 20, 2022. https://www.apsintl.org/post/prv-
Harm reduction: An approach to reducing risky health behaviours in adolescents. (2008). Paediatrics & child health, 13(1), 53–60. https://doi.org/10.1093/pch/13.1.53
Harm Reduction International 2022. What is Harm Reduction? https://www.hri.global/what-is-harm-reduction
Hawk, M., Coulter, R.W.S., Egan, J.E. et al. Harm reduction principles for healthcare settings. Harm Reduct J 14, 70 (2017). https://doi.org/10.1186/s12954-017-0196-4
National Harm Reduction Coalition 2020. https://harmreduction.org/
National Harm Reduction Technical Assistance Center 2022. https://harmreductionhelp.cdc.gov/s/
Substance Abuse and Mental Health Services Administration (SAMHSA) 2022. Harm Reduction Page. Retrieved June 23, 2022. https://www.samhsa.gov/find-help/harm-reduction