Understanding the Harm Reduction Model

Harm reduction is a supportive and personalized way to help people transition from active substance misuse to living a life that is no longer focused on getting and staying under the influence of any substance.

What Is Harm Reduction?

“Harm reduction” is a philosophy on care that aims to reduce the harms of a risky behavior instead of denouncing the behavior altogether. It is a “meet the person where they live” approach to managing harmful use of drugs and alcohol. 

For example, a needle exchange facility that gives a patient clean needles to inject their drugs is using a “harm reduction model” because instead of denouncing drug use altogether, they are helping to reduce any harm that comes from the dangerous behavior of injecting drugs. 

Another example would be when treatment centers reward people for clean urine samples but do not punish people if they have had a lapse and returned to misusing substances. Even if people occasionally misuse drugs,  by keeping them in treatment it reduces the overall harm that the person would experience if they were otherwise not in treatment and more regularly misusing drugs.

The goal of “harm reduction” is to reduce the harm caused by substance misuse rather than enforce a “cold turkey” or “complete abstinence” detox approach. [1]

Understanding the Harm Reduction Model 

The four principles of harm reduction are as follows:[1]

1. People who use drugs are entitled to treatment. OUD is a medical condition that has evidence based treatments. Medical providers should treat their patients with both compassion and dignity. Each person who uses drugs is entitled to treatment as they would be for any medical condition. 
2. Evidence is crucial. Therapies come backed by plenty of studies proving they are practical, effective, safe, and cost-effective in plenty of communities. 
3. Social justice and collaboration are prioritized. Harm reduction aims to reduce discrimination and ensure people of all communities get the help and services they need. 
4. Stigma has no place in treating patients with OUD. People should be met where they are, including if they use drugs currently. All language and terminology should convey respect.

The Philosophy of Harm Reduction 

Harm reduction aims to reduce the damage caused by substance misuse and substance use disorder (SUD). The goal isn’t to wholly eliminate substance misuse but rather to lessen the risks to the individual engaging in the behavior. 

If a person is not ready or able to be completely abstinent from substances, there are still things we can do to prevent harm to them while they are continuing to use. This is what the harm reduction model advocates.

Harm Reduction for Heroin & Other Opioids

Harm reduction measures for opioids include the following[2,3]:

• Marking needles to avoid accidental sharing with other people
• Cutting back on the dose taken each day or per use
• Naloxone distribution programs
• Wrap around healthcare services 
• Using clean needles

Needle exchange programs, which provide clean, free needles, are another harm reduction approach for OUD.[4] 

Harm Reduction for Alcohol Misuse

With alcohol use disorder (AUD), total abstinence might be ideal, but may not be realistic. Even a reduction in the amount of drinking can lower the risk for heart disease, cancer, injuries, and accidents.[5] 

These are other forms of harm reduction for AUD:

• Making sure never to drive after drinking
• Using apps or other devices to help monitor consumption
• Cutting back on the number of days spent drinking or the number of drinks per session
• Focusing on eating healthfully and drinking water before and during alcohol use

Harm Reduction for Stimulants

There is no medication option to aid in stimulant detox, but harm reduction for stimulants can help to mitigate the harm related to stimulant misuse. 

For example, some harm reduction options for stimulants may include the following:[6]

• Avoiding use of needles or participating in needle exchange programs
• Proper dental care to address the harm done by stimulant use on the teeth
• Nutrition counseling to address malnourishment and disordered eating that may result from or drive continued stimulant use 
• Using safe sex practices while under the influence to avoid accidental pregnancy and/or disease transmission

Harm Reduction for Marijuana

The risks of heavy or frequent marijuana use include damage to physical health, increased risk of injury, and mental health issues.[7]

To address marijuana use from a harm reduction perspective, these are some options: 

• Cutting back on the frequency of use or the amount used per session
• Avoiding driving after use of marijuana
• Choosing not to drink or use other drugs while using marijuana
• Opting to avoid high-potency forms of marijuana
• Using edible forms instead of inhaled forms to prevent lung damage

Effectiveness of Harm Reduction

Many studies have examined the value of harm reduction measures. While each policy works a little differently, research suggests that many of these policies can be helpful for people dealing with very difficult issues.

Harm reduction services studied include the following:

• Needle exchange programs: Syringe services programs have been studied for more than 30 years, and the National Institute on Drug Abuse (NIDA) says they are safe, cost-effective, and helpful in preventing HIV and high-risk injection behaviors in people who use needles for drugs. The programs also aren’t associated with increased drug use or crime, NIDA says.[8]
• Safe injection sites: Researchers say supervised injection facilities are closely tied to reductions in overdose deaths, and they can improve access to addiction treatment programs too.[9]
• Phone apps for drinking: Phone applications that provide self-control tips are more helpful than those that try to motivate people to quit drinking, researchers say.[16]

Criticism of Harm Reduction

Not everyone understands the value of a harm reduction model. Some view harm reduction – the idea that it is ok to not be entirely abstinent from substances – as enabling people to continue using drugs and alcohol, normalizing a behavior.[10]

Others, including many people in the 12-step community, believe problematically that the use of medications like Suboxone, one of the primary treatments for opioid use disorder, is simply replacing the drug of choice and therefore any use constitutes a lack of “real” sobriety.[11]

The truth is that for many millions of people, total abstinence is not and will never be an option. For these people, a harm reduction model allows them to continue to use while still receiving support and options to help keep them as safe as possible while actively using. 

At Bicycle Health, we believe that harm reduction meets people “where they are at” in their addiction journey instead of forcing them to be ready for abstinence when they are not.  

Harm Reduction vs. Abstinence

Researchers highlight an ongoing debate between harm reduction and abstinence-based therapies. Sometimes, experts discuss the two models as polar opposites, forcing patients and providers to choose between one and the other. 

Sometimes, however, experts consider harm reduction and abstinence as a continuum. The long-term goal of both approaches is to help people live a healthy life—no matter what they might need to do to get there.[17]

Doctors working with at-risk populations seem particularly open to using harm reduction principles, especially if they’ve worked in abstinence-only facilities in the past. Doctors working with homeless populations, for example, told researchers that harm reduction allowed their patients to be open about their substance misuse, so they could have an open dialogue about how drugs might harm their lives.[18]

The Substance Abuse and Mental Health Services Administration (SAMHSA) has embraced harm reduction, saying the approach allows for incremental change. People using these services can make choices that enable healthy, self-directed and purpose-filled lives.[19] At some point, these people might choose abstinence. If not, they’re still trying to avoid some of the most serious consequences of ongoing use.

Researchers say that some providers view total abstinence as the best option for people using substances other than alcohol or marijuana. These doctors also say that harm reduction should also be used as an intermediate goal, with sobriety as the desired final outcome.[20] As long as some doctors view hard drugs as inherently unsafe, sobriety-only programs are likely to remain.

Where to Get Help

If you would like to learn more about harm reduction options near you, you can check in with the Harm Reduction Coalition.[12]

You can also find the closest clean needle exchange site through the North American Syringe Exchange Network.[13]

If you would like to learn more about Suboxone and MAT, contact us at Bicycle Health for more information and to set up a personal consultation. 

Harm Reduction FAQs