Expand Harm Reduction Practices

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Introductory Paragraph

The term harm reduction has involved reducing all types of harm. Preventing death through reversing overdose, preventing infection and disease transmission through needle exchange programs, preventing overdose through the use of testing strips, and supporting public awareness campaigns in support of harm reduction strategies are just some of the ways harm reduction is put into practice.

One important aspect of harm reduction is that it supports interventions aimed at reducing the negative effects of health behaviors without necessarily extinguishing potentially harmful behaviors completely. In a substance use disorder setting, harm reduction seeks to keep individuals and communities alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover.

Definition

The Harm Reduction Journal defines harm reduction as 'policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use  without necessarily reducing drug consumption.  Exact definitions from other organizations vary slightly in their wording but are overall consistent. [1]

Principles

The principles set out by the National Harm Reduction Coalition include[2]:

  • Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them
  • Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them
  • Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies that meet their actual conditions of use
  • Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm
  • Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm
  • Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use
  • Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others
  • Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies 

Key Information

The resource pages under Harm Reduction explore many of the main strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the below list is not a complete inventory of strategies, it includes practices and strategies that despite researched effectiveness are often impeded by stigma targeted at people who use drugs. Some of the most widely adopted and well-researched harm reduction practices include:

Naloxone Training and Distribution Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies.

Expansion of Needle Exchange Programs

The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public - many of whom in the latter group see these programs as enabling harmful or immoral behaviors.

Syringe Services Programs (SSPs), also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. Having people participate in needle exchange programs provides another opportunity to connect with others and be connected to services if willing [3] .

The impact of SSPs in relation to being 1-for-1 syringe exchanges or not.


Overdose Prevention Sites

Different Names. Supervised Injection [4]

Fentanyl Test Strips and Safer Use Supplies [5]

Medications Opioid & Alcohol Use Disorder Medications

Technology-Assisted Awareness and Safety Never use alone hotlines “Hot batch” alerts Overdose Response reporting

Harm Reduction in Special Settings

The resources pages also focus on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

Relevant Research

Science/Research-Based Education Similar to the movement away from abstinence-only sex education, the role of developmentally appropriate substance use education for people who use drugs, and for individuals who may use drugs, is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate awareness and the sharing of available knowledge regarding substance use, allowing people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

https://harmreduction.org/resource-center/ - A lot of resources and information here.

https://drugpolicy.org/resources/drug-education-resources - Resources for younger age groups too

Impactful Federal, State, and Local Policies

  • Recent lift on Fentanyl Testing Strip purchases
  • State Bystander Intervention Policies
  • Naloxone Bulk Funds
  • Naloxone Standing Order
  • Safe Injection Site bans/laws
  • Syringe Access and Paraphernalia Laws

Available Tools and Resources

The resource pages under Harm Reduction explore many of the main strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practicioners.  Some of the most widely adopted include:

Naloxone Training and Distribution

Saving a life provides the opportunity to find recovery.  A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication.  Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

Expansion of Needle Exchange Programs

The use of "dirty" needles can lead to infection, spread disease, and creates a tremendous increase in health care related costs.  The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars.  As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public - many of whom in the latter group see these programs as enabling harmful behaviors.  Having people participate in needle exchange programs provides another opportunity to connect with others and be connected to services if willing.

Harm Reduction in Special Settings

The resources pages also focus on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth.  In both cases numerous strategies have been developed to improve harm reduction for all effected. 

 

Promising Practices

National Harm Reduction Coalition:

Harm Reduction Coalition

National Harm Reduction Journal:

https://harmreductionjournal.biomedcentral.com
 

 

Sources