Harm Reduction

Harm Reduction Principles

Key harm reduction principles include the following:

• Pragmatism. The elimination of mood-altering substance use is not an attainable goal in the foreseeable future. Addiction to, or dependence on, a substance may preclude cessation for some individuals, particularly if treatment is inaccessible; individuals may also choose to continue using a particular substance because of the perceived benefits it brings. A pragmatic approach to reducing vulnerability to drugrelated harms thus necessarily encompasses efforts to promote safer drug use practices among active substance users, as well as efforts to support individuals who wish to reduce or cease using particular substances.
• Prioritization of Goals. Harm reduction programs, policies, and collective user-initiated actions may prioritize their goals so that the most pressing needs of their target populations are addressed first. For example, efforts designed to reduce the spread of bloodborne infections via injection drug use may prioritize goals as follows: (1) reduce the likelihood that individuals will borrow used syringes; (2) minimize the risk that an individual will transition to injection [Page 454]drug use from another mode of drug administration, and reduce the duration of injecting among current injectors; and (3) facilitate access to appropriate treatment. Importantly, there is no single, optimal method of reducing drug-related harms for all individuals in a population. Rather, multiple possibilities should be available simultaneously, and the same individual may participate in different harm reduction efforts over the course of his or her life.
• Humanism. Individuals who use mood-altering substances can and do make rational choices that further their health and well-being, as well as that of their families and communities. The rights and dignity of all individuals who use mood-altering substances merit respect. Drug users are members of broader communities in which they fill multiple social roles, including those of parent, partner, child, and neighbor; furthering users’ health and well-being thus furthers community well-being. Users have been central to the development of harm reduction programs and policies, and their ongoing contributions to these efforts should be recognized, promoted, and respected.

These harm reduction principles guide a broad array of programs, policies, and collective userinitiated actions, including laws prohibiting driving while intoxicated and smoking in specified public spaces; syringe-exchange programs; and collective, user-initiated actions to protect promote users’ health and that of the broader communities in which they are embedded. Evidence regarding the effectiveness of some of these harm reduction policies, programs, and collective user-initiated actions is presented.

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