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What is the Harm Reduction Model?

Harm reduction is a public health approach to managing high-risk behaviors, including drug and alcohol addiction. It focuses on reducing the negative consequences of the action. The harm reduction model values abstinence, but abstinence is not exclusively the goal. 

The main priorities of harm reduction are to keep people alive and reduce suffering. This type of treatment meets the needs of patients “where they’re at” in their journey and recognizes that some people may not be willing or able to stop the risky or illegal behavior. 

Harm reduction focuses on providing judgment-free healthcare solutions that mitigate the health risks associated with these behaviors. Some of the methods used include safe access to drug paraphernalia, allowing drug intake in a controlled environment, and health education. The harm reduction model is gaining momentum worldwide, with over 200 syringe exchange programs operating in the United States.

Harm Reduction Approach & Strategies

According to the Harm Reduction Coalition, the principles of harm reduction are:

  • Acknowledging that drug use is an unavoidable part of society
  • Understanding that some methods of drug use are safer than others
  • Valuing quality of life over all else
  • Employing a non-judgemental approach and not forcing participation
  • Allowing drug users to be active participants and share their opinions
  • Empowering drug users to share information and support each other
  • Accepting that socioeconomic and racial issues contribute to drug use

Some of the more common harm reduction strategies include:

  • Impaired driving prevention programs, free taxi services, and designated driver programs to prevent driving under the influence of substances
  • Education on safer ways to use substances
  • Non-judgemental messaging to encourage people to seek support from medical professionals
  • Opioid substitution therapies, including methadone or suboxone, to lower the risk of overdose
  • Opioid antagonist therapies such as naloxone to rapidly reverse opioid overdose and reduce fatalities
  • Legal immunity for those who witness an overdose and call 911, to encourage others to seek support for drug users 
  • Supporting safe use of drugs through Supervised Consumption Services and injection facilities to help prevent overdose deaths and other harms of drug use 
  • Supply distribution and syringe exchange programs (SEPs), which provide access to clean needles and disposal options and reduce the spread of disease
  • Drug checking or adulterant screening to prevent harms associated with consuming contaminated substances 
  • Destigmatizing drug use to encourage users to seek support
  • Wound care to reduce infection and disease
  • Mental health and support programs to provide emotional support and promote overall well being 
  • Referrals to drug treatment programs to provide medical care and support safe detox and abstinence

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Harm Reduction Model: Pros

Research shows that harm reduction has many positive outcomes. The main positives of harm reduction include:

  • Increased referrals to support programs and health and social services
  • Increased access to health services
  • Reduced sharing of substance use equipment such as needles
  • The reduced spread of hepatitis C, HIV/AIDs, and other infectious diseases
  • Reduced overdoses and death rates among people who use substances
  • Increased knowledge of safer substance use
  • Increased knowledge of safer sex and sexual health
  • Reduced sexually transmitted infections and unwanted pregnancies
  • Increased condom use
  • Reduced needlestick injuries for law enforcement
  • Reduced number of contaminated syringes in circulation
  • Decreases the costs of emergency services and hospitalization
  • Prevents the need for expensive treatments for diseases like HIV and Hep C
  • Averted costs to the legal system

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What Are Some Criticisms of the Harm Reduction Model?

Harm reduction is not without its critics. The primary criticisms of harm reduction are:

  • It allows drug users to continue to use illicit drugs
  • It could potentially encourage new drug use
  • It promotes the legalization of illegal drugs

Some critics argue that medication-assisted treatment drugs like buprenorphine can be addictive and keep someone dependent on opioids.

Others believe that harm reduction condones or encourages drug use. The programs may make it easier for individuals to remain addicted and continue to commit crimes. People claim that the harm reduction model encourages substituting one drug for another.

Critics also argue that the drugs used in harm reduction can be diverted and sold on the black market. Furthermore, some people have suggested that needle exchange programs result in more dirty needles on the street and overdoses if the programs are not controlled. Despite this, some studies have not found any noticeable effects on overdose deaths or needle-sharing.

Similar claims have been made about regulated injection sites. A study also discovered that available research on the sites was not well-conducted.

Likewise, researchers who studied an injection site in Vancouver, Canada, discovered that it led to high increases in the number of people seeking methadone and other addiction treatments. However, other studies have found that injection sites improve users' health and do not heighten drug trafficking or crime.

Evidence shows that harm reduction does not encourage substance abuse, and harm reduction has shown great promise in treating patients. Patients who received therapy to control their drinking function better than patients who were treated with the goal of abstinence. Given its successes, harm reduction is the primary policy response to drug use in Europe. It is growing in popularity in the United States.

Harm Reduction Model For Substance Abuse

Harm reduction can be useful in treating alcohol and drug abuse. This treatment model recognizes that many drug users are either unable or unwilling to stop, do not need inpatient treatment, or are not ready for treatment. In these cases, harm reduction focuses on reducing harm due to dangerous drinking or drug use such as HIV transmission, viral hepatitis, and death from overdose. 

Harm reduction helps individuals slowly cut back on their drug or alcohol with the ultimate (though not exclusive) goal of complete abstinence. Harm reduction strategies for addiction focus on education, overdose prevention, and disease control.

Because harm reduction is a relatively new form of therapy for addiction treatment, there is limited data on its effectiveness. However, The National Institute on Alcohol Abuse and Alcoholism does not recommend a singular approach to treat everyone. It encourages controlled drinking and other harm reduction strategies.  

In 1988 the United States Secretary of Health and Human Services found that syringe exchange was “safe and effective.” Research shows that syringe and needle exchange programs lower HIV risk and hepatitis transmission, prevent overdose, and provide a gateway to drug users’ treatment.

While still in early research, other harm reduction strategies have shown promise, including heroin prescribing, depenalization, drug consumption rooms, and pill testing.

How Do You Find a Harm Reduction Program?

There are several ways to find a health reduction program. First is talking to your health care provider, an addiction counselor, or browsing the online listings offered by state from the Harm Reduction Coalition.

To find a suitable needle exchange program, you can search online listings from the North American Syringe Exchange Network.

You can find an authorized buprenorphine doctor by searching the Substance Abuse and Mental Health Administration’s database, according to state.

Lastly, you can also find methadone or opioid treatment programs by searching your location on the Behavioral Health Treatment Services Locator.

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Resources

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(1) Downing, Moher et al. “What's community got to do with it? Implementation models of syringe exchange programs.” AIDS education and prevention : official publication of the International Society for AIDS Education vol. 17,1 (2005): 68-78. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1510902/

(2) Frakt, Austin. “Politics Are Tricky but Science Is Clear: Needle Exchanges Work.” The New York Times, The New York Times, 5 Sept. 2016, www.nytimes.com/2016/09/05/upshot/politics-are-tricky-but-science-is-clear-needle-exchanges-work.html

(3) Harm Reduction Principles: National Harm Reduction Coalition. 31 Aug. 2020, https://harmreduction.org/about-us/principles-of-harm-reduction/

(4) “Harm Reduction.” Drug Policy Alliance, https://www.drugpolicy.org/issues/harm-reduction

(5) “Harm Reduction: An Approach to Reducing Risky Health Behaviours in Adolescents.” Paediatrics & Child Health, Pulsus Group Inc, Jan. 2008, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528824/

(6) “Harm Reduction: Evidence, Impacts, and Challenges.” Edited by Tim Rhodes and Dagmar Hedrich, NCJRS Abstract - National Criminal Justice Reference Service, European Monitoring Centre for Drugs and Drug Addiction, 2010, https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=252863

(7) “Reducing the Harm of Drug Use and Dependence.” TreatNet, United Nations Office on Drug Use and Crime, https://www.unodc.org/ddt-training/treatment/VOLUME%20D/Topic%204/1.VolD_Topic4_Harm_Reduction.pdf

(8) Marlatt, G. A. (1983). The controlled-drinking controversy: A commentary. American Psychologist, 38(10), 1097–1110. https://psycnet.apa.org/record/1984-13214-001

(9) Marlatt, G. Alan, and Katie Witkiewitz. “Harm Reduction Approaches to Alcohol Use: Health Promotion, Prevention, and Treatment.” DoctorDecuca.com, Alexander DeLuca, M.D., 2002, http://www.doctordeluca.com/Library/AbstinenceHR/HRforAlcProbs02.pdf

(10) National Research Council (US) and Institute of Medicine (US) Panel on Needle Exchange and Bleach Distribution Programs; Normand J, Vlahov D, Moses LE, editors. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington (DC): National Academies Press (US); 1995. 7, The Effects of Needle Exchange Programs. https://www.ncbi.nlm.nih.gov/books/NBK232343/

(11) Prest, Lauren. “Harm Reduction.” University of Utah Health, University of Utah, 2018, https://physicians.utah.edu/echo/pdfs/harm-reduction.pdf

(12) Single, Eric. “Harm Reduction as an Alcohol-Prevention Strategy.” Alcohol health and research world vol. 20,4 (1996): 239-243. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876518/

(13) Stockings, Emily, et al. “Prevention, early intervention, harm reduction, and treatment of substance use in young people” Lancet Psychiatry 2016; 3: 280–96 Published Online February 18, 2016 http://dx.doi.org/10.1016/ S2215-0366(16)00002-X https://natap.org/2016/HIV/PIIS221503661600002X.pdf

(14) Szott, Kelly. “Contingencies of the Will: Uses of Harm Reduction and the Disease Model of Addiction among Health Care Practitioners.” Health (London, England : 1997), U.S. National Library of Medicine, Sept. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430440/

(15) “Understanding Harm Reduction: Substance Use.” HealthLink BC, 1 Apr. 2020, https://www.healthlinkbc.ca/healthlinkbc-files/substance-use-harm-reduction

(16) “What Is Harm Reduction?” What Is Harm Reduction? " North Carolina Harm Reduction Coalition, http://www.nchrc.org/harm-reduction/what-is-harm-reduction/

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