by Luisa Lasalle (Fall 2016) & Uravadee Chamchansang (Spring 2015)
Harm reduction is a collection of ideas, strategies and interventions aimed at reducing the negative consequences associated with drug use and other behaviors (1). Harm reduction meets people “where they are at” instead of demanding sobriety by highlighting the prevention of harm, instead of the prevention of drug use itself (1). It focuses on strategies such as safer use, needle exchange programs, and peer support groups. In addition to facilitating intervention, harm reduction is also a movement for social justice emphasizing the rights and dignity of people who use drugs and engage in other risky behaviors (1). Ultimately, by accepting that licit and illicit drug use as an unavoidable part of our society, harm reduction strategies chose to minimize the harmful effects rather than ignore or condemn people who use drugs (1).
Harm reduction was originally used as a risk-elimination framework to reduce drug dependency, specifically to slow the spread of HIV/AIDS via intravenous drug use. Harm Reduction first emerged in the 1980s to tackle the growing problem of Hepatitis B (2). Needle exchange programs were implemented between people who used drugs and city officials (2). In the late 1980s, the UK National Health Service adopted a similar network for syringe exchange as seen in the Dutch harm-reduction program (2). This development led to even wider implementation of the harm reduction strategies in Western Europe, Canada, Australia, and The United States (2). Today, harm reduction interventions go beyond needle exchange programs through interventions such as using naloxone, a drug used to counter the effects of opioid overdose (1).
From the beginning, harm reduction services have taken a special interest in high risk groups, such as people who use drugs who are also involved in prostitution or street gangs (3). Research shows that these high risk populations are at the greatest risk of HIV/AIDS, and therefore benefit the most from harm reduction services (3). In 1990, the 1st International Conference on Reduction of Drug Related Harm was held in Liverpool, England, one of the first cities to have open needle exchanges (4). The success of the conference led to the establishment of the International Harm Reduction Association (IHRA) in 1996, the world’s largest global harm-reduction association (4). In 2011, IHRA changed its name to Harm Reduction International, one of the leading international sources for research, legal analysis, and advocacy on harm reduction and drug-policy reform (4).
The most well-known harm reduction intervention is syringe access programs (SAPs). SAPs, also called needle exchange programs, offer an approach to drug use that promotes and honors the competence of the person using drugs to protect themselves, their loved ones, and the community they live in, by giving people the right to respect, health, and life-saving sterile injection equipment (5). Evidence shows that SAPs reduce the spread of blood-borne infections such as HIV, and supports the overall health and well-being of people who drugs by linking them to drug treatment, medical care, housing, and other social services (5). At least 77 countries today provide some form of sterile syringe and/or needle distribution, pointing to a successful global health intervention given appropriate resources and funding. (6).
While drug use has historically been the focus of harm reduction strategies, in recent years, harm reduction approaches have been expanded to other behaviors and situations such as sex work, homelessness, distracted driving, and alcohol use (7).
Global, national, and local drug policies present many barriers to implementing harm-reduction programs. International drug conventions influence national legislation, creating an environment in which harm reduction strategies cannot be fully deployed (8). A public dialogue is needed to discuss potential compromises and future legislation that will increase control and regulation of the world’s drug supply. Furthermore, many policies and practices intentionally or unintentionally create and exacerbate risks to people who use drugs. These include the criminalization of drug use, discrimination, abusive and corrupt policing practices, restrictive and punitive laws and policies, the denial of life-saving medical care and harm-reduction services, and social inequities (8).
Some countries oppose harm reduction programs. For example, Thailand and Russia have needle exchange programs but political leadership has ignored other harm reduction recommendations and resisted the implementation of evidence-based programs such as the us of methadone, which has led to devastating consequences. In Russia, approximately one in one hundred adults is infected with HIV (9). In contrast, Australia has embraced harm reduction strategies and newly diagnosed HIV infections have been nearly eliminated among people who use drugs (9).
As early as 1997, a global survey showed that the presence of HIV within blood taken from used syringes increased 6% annually in cities without clean needle distribution, and decreased 6% in cities with needle exchange (9).
(1) Addiction Info. Harm reduction history and definitions [Internet]. 2015 [cited 2015 Mar 16]. Available from http://www.addictioninfo.org/articles/256/1/Harm-Reduction-History-and-Definitions/Page1.html
(2) Greig A, Kershnar S. Harm reduction in the USA: A movement toward social justice [Internet]. 2015 [cited 2015 Mar 16]. Available from http://n6106group.files.wordpress.com/2012/02/harm-reduction-in-the-usa.pdf
(3) Ashton JR, Seymour H. Public health and the origins of the Mersey Model of Harm Reduction. Int J Drug Policy. 2010; 21(2):94–6. doi: 10.1016/j.drugpo.2010.01.004.
(4) International Harm Reduction Association. History [Internet]. 2015 [cited 2015 Mar 16]. Available from http://www.ihra.net/history
(5) Guide to Developing and Managing Syringe Access Programs [Internet]. 2010. [cited 2016 Oct 24]. Available from: http://harmreduction.org/wp-content/uploads/2011/12/SAP.pdf
(6) Syringe exchange programs around the world: The global context [Internet]. 2009. [cited 2016 Oct 24]. Available from: http://www.gmhc.org/files/editor/file/gmhc_intl_seps.pdf
(7) Harm reduction: An approach to reducing risky health behaviours in adolescents [Intenet]. 2008. [Cited 2016 Oct 24]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528824/
(8) Democratic Underground. Harm reduction: Not really a manifesto but a goal. 2014 [updated 2014 Jan 1; cited 2015 Mar 16]. Available from: http://www.democraticunderground.com/10024262548
(9) The Global Commission on Drug Policy. The War on Drugs and HIV/AIDS How the Criminalization of Drug Use Fuels the Global Pandemic [internet]. [cited 2015 April 24]. Available from: http://globalcommissionondrugs.org/wp-content/themes/gcdp_v1/pdf/GCDP_HIV-AIDS_2012_REFERENCE.pdf (accessed 24 October 2016).
Useful Resources for Further Research
Videos: Harm Reduction Coalition YouTube Channel
Harm Reduction Coalition is a national advocacy and capacity-building organization that promotes the health and dignity of individuals and communities impacted by drug use
“Harm reduction: An approach to reducing risky health behaviours in adolescents”
Overview of Harm Reduction including recommendations from The Canadian Pediatric Society for HCPs working with adolescents
Guide to Developing and Managing Syringe Access Programs
Free online manual made by the Harm Reduction Coalition, designed to outline the process of developing and starting a Syringe Access Program (SAP).