Harm Reduction Meaning

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KEY TAKEAWAYS

Harm reduction is an approach that aims to reduce the damage caused by drug and alcohol use, without expectations of abstinence.

Harm reduction is a person-centred approach that promotes the health and safety of substance users who are not able or willing to abstain from drugs totally [1].

What Is Harm Reduction?

Harm-reduction strategies minimise the negative risks of substance use, such as infectious diseases and the potential to overdose [2].

Harm reduction promotes the rights of drug users [3].

Harm reduction advocates extol its non-judgmental and dignified approach to care for substance users [4].

How The Meaning Of Harm Reduction Changes According To Setting

Outpatient Clinic/ In The Community

Overdose-related knowledge increases by 24% with naloxone administration training in the community [5].

Only 1 in 5 naloxone prescriptions are fulfilled, indicating a need for ‘take-home’ naloxone programs; naloxone reverses heroin overdose in 82% of patients [6] [7].

Skin and needle cleaning practices improve by 18.4% after community outreach programs teach skin and needle cleaning skills, reducing bacterial infections [8].

Drug testing facilities allow users to check the purity of substances but also enable drug dealers to test products [9].

Effective harm reduction therapy is more family and community-oriented for ethnic minority clients, where individualism is secondary to communal culture [10].

A 2004 survey of 436 British substance abuse services found that 40% offered needle exchange services, and 3% provided safe places for ingestion [11].

Rehab Clinic

Abstinence-focused drug and alcohol services risk the perception of failure in harm-reduction users [12].

Hospital

Substance use disorder patients who leave hospital against medical advice stay 65% longer in hospitals with harm reduction programs, receiving more necessary medical treatment [13].

38% of emergency care staff have an unfavourable attitude towards drug addicts who overdose, while 5% have an unfavourable attitude towards accidental poisonings, suggesting the need for staff training to reduce stigmatisation of drug abusers [14] [15].

Academic Papers

Some academic papers argue that harm-reduction strategies are not a durable solution to substance misuse [16].

Overdose rates are rising by 23.7% per year in Vancouver despite the widespread adoption of safe injection sites (SIFs) since 2013; SIFs proponents claim SIFs reduce overdose mortality [17] [18].

Meaning Of Harm Reduction In Different Geographical Locations

Syringe service programs and possession and distribution of fentanyl testing strips are illegal in 11 US states [19].

(Click here to read about fentanyl rehab.)

There is a 57% HIV prevalence among injecting substance users in Dar es Salaam, Tanzania [20].

Drug testing services in the Netherlands have raised public awareness, such as the 2014 Red Alert campaign on the Pink Superman pill; while other countries reported fatalities, no adverse health incidents were reported in the Netherlands [21].

Groups That Change The Meaning Of Harm Reduction Initiatives

Sex Workers

Female sex workers:

Have a 13.5% higher risk of HIV infection than non-sex workers
Consuming drugs intravenously increases the risk of HIV by 0.63% to 2.4%
Reduce needle sharing by 95% after injection risk interventions [22]

Promotion of condoms reduces the incidence of HIV by 93% in sex workers and their clients in low-and middle-income countries [23].

Long-Term Intravenous Drug Users

63.7% of intravenous drug users have had an injection-associated infection [24].

Intravenous drug users usually learn how to inject through trial and error; being taught how to inject safely reduces risks such as swollen limbs and painful missed shots [25].

Homeless Individuals

Safe consumption sites where homeless people can inject in Vancouver resulted in a 35% reduction in the number of fatal opioid overdoses [26].

Managed alcohol programs reduce emergency service use by 93% in homeless people [27].

Homeless women with drinking problems eat 33% healthier diets after nutritional awareness programs [28].

LGBT+ Individuals

41% of men who have sex with men report sexualised drug use, increasing their risk of HIV through condomless sex [29].

58% of LGBT+ identifying adolescents report that experiences of homophobia increase their use of alcohol and drugs [30].

Drug use is 69.95% higher in LGBT clubs than in straight or mixed venues [31].

LGBT activism has been interconnected with drug policy, notably in campaigns to legalise medical marijuana to alleviate symptoms during the AIDS crisis, which heavily impacted gay men [32].

How Has Harm Reduction Changed Drug And Alcohol Legislation?

A Manchester University student education program to reduce the harm of drug use was awarded part of a £5 million government grant [33].

Low-and middle-income countries receive 5% of the estimated amount of funding needed for intravenous drug harm reduction services [34].

The UK government’s 10-year drugs plan pledges to expand and improve evidence-based drug harm reduction services:

Provide naloxone to staff in prisons
Expand naloxone provision across the UK
Expand needle and syringe programs [35]

Safe drug consumption services have shut down due to a lack of funding in Canada [36].

Harm Reduction Is Often Confused With

Harm reduction is confused with drug legalisation because it calls for an empathetic approach to drug use rather than criminalising it, but harm reduction favours regulatory approaches [37] [38].

Harm reduction is confused with full recovery programmes, but it encompasses small, achievable steps that align with healthcare goals rather than replacing a full recovery program [38].

Harm reduction is confused with enabling drug use, as critics believe abstinence should be the primary goal, but harm reduction strategies are designed for those whom total abstinence is not an appropriate approach [39] [40].

References

[1] Substance Abuse and Mental Health Services Administration. “Harm Reduction.” SAMHSA Gov, Substance Abuse and Mental Health Services Administration, 29 Oct. 2024. “Harm reduction is a practical and transformative approach that incorporates community-driven public health strategies — including prevention, risk reduction, and health promotion — to empower people who use drugs (and their families) with the choice to live healthy, self-directed, and purpose-filled lives.”
[2] Kimmel, Simeon D., et al. “Principles of Harm Reduction for Young People Who Use Drugs.” Pediatrics, vol. 147, no. Supplement 2, Jan. 2021, pp. S240–48. Accessed 7 Mar. 2021. “The first is that harm reduction services are critical to keeping young adults alive and healthy and can offer opportunities for future engagement in treatment. Such services therefore should be offered at every opportunity, regardless of an individual’s interest or ability to minimize use of substances. The second is that all evidence-based harm reduction strategies available to older adults should be available to young adults and that whenever possible, harm reduction programs should be tailored to young adults and be developmentally appropriate.”
[3] Kimmel, Simeon D., et al. “Principles of Harm Reduction for Young People Who Use Drugs.” Pediatrics, vol. 147, no. Supplement 2, Jan. 2021, pp. S240–48. “Harm reduction services are critical to keeping young adults alive and healthy and can offer opportunities for future engagement in treatment. Such services therefore should be offered at every opportunity, regardless of an individual’s interest or ability to minimize use of substances.”
[4] Kimmel, Simeon D., et al. “Principles of Harm Reduction for Young People Who Use Drugs.” Pediatrics, vol. 147, no. Supplement 2, Jan. 2021, pp. S240–48. “Such services therefore should be offered at every opportunity, regardless of an individual’s interest or ability to minimize use of substances.”
[5] Williams, Anna V., et al. “Training Family Members to Manage Heroin Overdose and Administer Naloxone: Randomized Trial of Effects on Knowledge and Attitudes.” Addiction, vol. 109, no. 2, Oct. 2013, pp. 250–59. “At follow-up, study participants who had received THN training reported greater overdose-related knowledge relative to those receiving basic information only [OOKS mean difference, 4.08 (95% confidence interval, 2.10–6.06; P < 0.001); Cohen’s d = 0.74 (0.37–1.10)]. There were also more positive opioid overdose-related attitudes among the trained group at follow-up [OOAS mean difference, 7.47 (3.13–11.82); P = 0.001; d = 0.61 (0.25–0.97)]. At the individual level 35 and 54%, respectively, of the experimental group increased their knowledge and attitudes compared with 11 and 30% of the control group. During follow-up, 13 participants witnessed an overdose with naloxone administered on eight occasions: five among the THN-trained group and three among the controls.”
[6] Vidya Eswaran, et al. Take-Home Naloxone Program Implementation: Lessons Learned from Seven Chicago-Area Hospitals. no. 3, Mar. 2020, pp. 318–27. Accessed 30 May 2023. “Furthermore, only 1 in 5 naloxone prescriptions from the ED is actually filled,14 and despite the implementation of standing orders authorizing naloxone dispensing without a prescription, many retail pharmacies do not readily dispense naloxone without a direct physician prescription or attributable encounter.17-19 These barriers to pharmacy dispensing point to a critical need to dispense naloxone directly to the public in the form of ‘take-home naloxone’ programs.”
[7] Kerr, Debra, et al. “Randomized Controlled Trial Comparing the Effectiveness and Safety of Intranasal and Intramuscular Naloxone for the Treatment of Suspected Heroin Overdose.” Addiction, vol. 104, no. 12, Dec. 2009, pp. 2067–74. “Naloxone reversed heroin overdose successfully in 82% of patients.”
[8] Phillips, Kristina T., et al. “Skin and Needle Hygiene Intervention for Injection Drug Users: Results from a Randomized, Controlled Stage I Pilot Trial.” Journal of Substance Abuse Treatment, vol. 43, no. 3, Oct. 2012, pp. 313–21. Accessed 18 Sept. 2020. “These analyses represent an 18.4% improvement among intervention participants from baseline to the 6-month follow-up compared with a worsening of 2.8% among assessment-only participants.”
[9] Centre for Alcohol and Drug Research (CRF) at the University of Aarhus, and Danish Health Authority. "Literature Review of Drug Checking in Nightlife -Methods, Services, and Effects." 2019.
[10] Blume, Arthur W., and Laura V. Lovato. “Empowering the Disempowered: Harm Reduction with Racial/Ethnic Minority Clients.” Journal of Clinical Psychology, vol. 66, no. 2, 2009. “For example, harm-reduction therapists understand the importance of increasing client self-efficacy, but with ethnic minority clients, it is often critically important to increase collective efficacy in the context of the community.”
[11] Rosenberg, Harold, et al. “Nonpharmacological Harm-Reduction Interventions in British Substance-Misuse Services.” Addictive Behaviors, vol. 29, no. 6, Aug. 2004, pp. 1225–29. Accessed 4 Dec. 2019. “Table 1.”
[12] Koutroulis, Glenda. “‘That Original Tension.’” Journal of Substance Abuse Treatment, vol. 19, no. 1, July 2000, pp. 89–98. Accessed 17 Dec. 2020. "Withdrawal treatment services, as with most drug and alcohol services, have developed within a framework of abstinence as the ideal treatment outcome. Treatment services, therefore, have been oriented toward facilitating individuals to achieve abstinence from drug use with outcome measures reflecting this goal. When the individual continues to use drugs he or she tends to be constructed as having ‘failed’ in some way.”
[13] Lisa, et al. “Using a Harm Reduction Approach to Treat Inpatients with Substance Use Disorders.” Journal of Nursing Administration, vol. 53, no. 3, Lippincott Williams & Wilkins, Mar. 2023, pp. 138–45. “Of the 1780 unique visits for patients with a diagnosis of SUD, 311 patients (17.5%) left our hospital AMA or eloped. The average length of stay for all patients evaluated by the HR team was 6.6 days compared with 4.0 days for those who left AMA.”
[14] Ghodse, A. H. “The Attitudes of Casualty Staff and Ambulance Personnel towards Patients Who Take Drug Overdoses.” Social Science & Medicine, vol. 12, no. 5A, Sept. 1978, pp. 341–46. “Table 1.”
[15] Sharma, Malika, et al. “Harm Reduction in Hospitals.” Harm Reduction Journal, vol. 14, no. 1, June 2017. “De-stigmatizing interventions starts with educational programs for all health care providers.”
[16] Oh, Jay J. “Revisiting Harm Reduction Strategy: Is Harm Reduction Harmful?” Ethics & Medics, vol. 48, no. 10, 2023, pp. 1–4. Accessed 8 Jan. 2025. “Some argue that this encourages dangerous behavior when the best approach would be to encourage abstinence.”
[17] Husock, Howard. “‘Harm Reduction’ Is No Solution.” City Journal, 16 Nov. 2023. “Safe-injection sites have legally operated in Vancouver since 2003, yet overdose deaths there are soaring. In July, CBC News reported that British Columbia had set a dubious new record, with 1,455 overdose deaths in the first seven months of the year.”
[18] Semaan, Salaam, et al. “Potential Role of Safer Injection Facilities in Reducing HIV and Hepatitis c Infections and Overdose Mortality in the United States.” Drug and Alcohol Dependence, vol. 118, no. 2-3, Nov. 2011, pp. 100–10. Accessed 1 Jan. 2020. “SIFs provide positive health benefits (reducing transmission of HIV and viral hepatitis, bacterial infections, and overdose mortality.”
[19] Claborn, Kasey, et al. “‘We Do It Ourselves’: Strengths and Opportunities for Improving the Practice of Harm Reduction.” Harm Reduction Journal, vol. 20, no. 1, BioMed Central, June 2023. “For example, Texas is one of 11 states in which syringe service programs are illegal [9] and drug paraphernalia law prohibits the possession and distribution of fentanyl testing strips [10].”
[20] Reid, Savanna R. “Injection Drug Use, Unsafe Medical Injections, and HIV in Africa: A Systematic Review.” Harm Reduction Journal, vol. 6, no. 1, 2009, p. 24. “In Dar es Salaam the HIV prevalence among IDU varied from 0–90% across neighborhoods in 2006, averaging 57%.”
[21] Smit‐Rigter, Laura Alexandra, and Daan Van der Gouwe. “The Neglected Benefits of Drug Checking for Harm Reduction.” Internal Medicine Journal, vol. 50, no. 8, Aug. 2020, pp. 1024–24. Accessed 23 Sept. 2020. “In 2014, a Red Alert warning campaign for a Pink Superman pill containing 173 mg of the substance paramethoxymethamphetamine, a stimulant drug that is closely related to MDMA but regarded as being more toxic, made the pill unsellable in The Netherlands; no adverse health incidents were reported linked to this pill. However, in other countries, the use of this pill, with exactly the same features, led to several fatal and nonfatal incidents.”
[22] Strathdee, Steffanie A., et al. “Reductions in HIV/STI Incidence and Sharing of Injection Equipment among Female Sex Workers Who Inject Drugs: Results from a Randomized Controlled Trial.” PLoS ONE, edited by Eduard J. Beck, vol. 8, no. 6, June 2013, p. e65812. Accessed 15 Dec. 2019. “In Tijuana, receptive needle sharing declined by 95%.”
[23] Wariki, Windy MV, et al. “Behavioral Interventions to Reduce the Transmission of HIV Infection among Sex Workers and Their Clients in Low- and Middle-Income Countries.” Cochrane Database of Systematic Reviews, Feb. 2012. Accessed 26 July 2020. “A total of 13 trials with 8,698 participants were included. Primary outcomes (HIV and STI prevalence and incidence) were reported in seven trials. Of these, HIV incidence was reported in only three trials. After a 6‐month follow‐up assessment, there was no evidence that social cognitive behavioral intervention was effective in reducing HIV incidence (RR 0.12, 95% CI 0.01 to 2.22). However, there was a reduction in HIV incidence at 3‐month follow‐up assessment of promotion of female and male condom (RR 0.07, 95% CI 0.00 to 1.38). Social cognitive interventions and promotion of female and male condom use were significantly reduced STIs incidence (RR 0.57, 95% CI 0.34 to 0.96) and (RR 0.63, 95% CI 0.45 to 0.88), respectively. Secondary outcomes were identified in 13 trials. Meta‐analyses showed evidence that interventions to promote the use of female and male condoms do reduce non‐condom use (RR 0.83, 95% CI 0.65 to 1.05) compared to promotion of male condoms alone, and that social cognitive interventions reduced drug use among sex workers (RR 0.65, 95% CI 0.36 to 1.16) compared to standard care.”
[24] Marks, Laura R., et al. “Drug Preparation, Injection-Related Infections, and Harm Reduction Practices among a National Sample of Individuals Entering Treatment for Opioid Use Disorder.” Harm Reduction Journal, vol. 21, no. 1, Jan. 2024, pp. 1–10. “Injection-associated infections had affected 63.4% of participants who had ever used injection drugs.”
[25] Harm Reduction Org. “Getting off Right.” National Harm Reduction Coalition, 1998. “Most of us taught ourselves how to inject through a process of trial- and-error that undoubtedly included lost shots, painful misses, swollen limbs, and a great deal of frustration. This manual is intended to help minimize these problems.”
[26] Magwood, Olivia, et al. “The Effectiveness of Substance Use Interventions for Homeless and Vulnerably Housed Persons: A Systematic Review of Systematic Reviews on Supervised Consumption Facilities, Managed Alcohol Programs, and Pharmacological Agents for Opioid Use Disorder.” PLOS ONE, edited by Bernard Le Foll, vol. 15, no. 1, Jan. 2020, p. e0227298. “The establishment of INSITE in Vancouver led to a 35% decrease in the number of fatal opioid overdoses.”
[27] Magwood, Olivia, et al. “The Effectiveness of Substance Use Interventions for Homeless and Vulnerably Housed Persons: A Systematic Review of Systematic Reviews on Supervised Consumption Facilities, Managed Alcohol Programs, and Pharmacological Agents for Opioid Use Disorder.” PLOS ONE, edited by Bernard Le Foll, vol. 15, no. 1, Jan. 2020, p. e0227298. “Individuals participating in MAPs demonstrated fewer hospital admissions and a 93% reduction in emergency service contacts.”
[28] Ijaz, Sharea, et al. “Interventions for Preventing or Treating Malnutrition in Homeless Problem-Drinkers: A Systematic Review.” International Journal for Equity in Health, vol. 17, no. 1, Jan. 2018. “Table 2: Eating right skill score- food frequency data (Mean change) / ‘One third higher than pre test scores’ / Educating shelter living women in healthy eating improved nutritional intake.”
[29] Hibbert, Matthew. "Sexualised drug use among LGBT people: a mixed methods study of reasons for engagement and associations with physical and psychological wellbeing." 2020. "Table 4."
[30] Kelly, John, et al. “Substance Use by Same Sex Attracted Young People: Prevalence, Perceptions and Homophobia.” Drug and Alcohol Review, vol. 34, no. 4, June 2014, pp. 358–65. Accessed 16 Aug. 2019. “With 58% reporting homophobia has had an impact on their AOD use (see Table 2).”
[31] Lea, Toby, et al. “Alcohol and Club Drug Use among Same-Sex Attracted Young People: Associations with Frequenting the Lesbian and Gay Scene and Other Bars and Nightclubs.” Substance Use & Misuse, vol. 48, no. 1-2, Nov. 2012, pp. 129–36. Accessed 10 Jan. 2020. “Table 2.”
[32] Rukus, Joseph, et al. “LGBT Novel Drug Use as Contextualized through Control, Strain, and Learning Theories*.” Social Science Quarterly, vol. 98, no. 5, Sept. 2016, pp. 1711–30. “The activism of the last few decades has, in some instances, intertwined drug policy, gay rights, and civil rights in such a way that they have become deeply connected... Reeling from the high rate at which gay men were dying, activists made medicinal marijuana advocacy part of a broader fight for overall recognition.”
[33] University of Manchester. “Student Drug Harm Reduction Project Awarded Part of £5m Government Fund.” Student Drug Harm Reduction Project Awarded Part of £5m Government Fund , University of Manchester, 3 Apr. 2023. Accessed 28 May 2025. “The Staying Safe Programme (TSSP) is a documentary-style video education project which has been designed to reduce demand for drugs by deterring or delaying the onset of their use, preventing the transition to heavy or problematic use, and equipping students with the knowledge required to reduce the harms associated with the use of recreational drugs.”
[34] Harm Reduction International. “The Global State of Harm Reduction 2022.” Harm Reduction International, 2022. “Funding for harm reduction is only 5% of the level needed to meet the estimated service needs for people who inject drugs by 2025.”
[35] UK Gov. "Policy paper: From harm to hope: A 10-year drugs plan to cut crime and save lives." 2019. "We will support local areas to expand and improve the quality of a full range of evidence-based harm reduction and treatment interventions."
[36] Wilson, Carla. “Controversial Drug-Consumption Site Shuts down in Nanaimo.” Vancouver Sun, Vancouver Sun, 4 Feb. 2023. Accessed 28 May 2025. “NANDU has run out of money, but Livingston hopes to receive additional funding in April. The consumption site was operated largely with $80,000 in provincial funding.”
[37] DuPont, Robert L. “Drug Legalization, Harm Reduction, and Drug Policy.” Annals of Internal Medicine, vol. 123, no. 6, Sept. 1995, p. 461. “Although reducing the harm caused by drug use is a universal goal of all drug policies, policy proposals called ‘harm reduction’ proposals include a creative renaming of the dismantling of legal restrictions against the use and sale of drugs. The essential components of legalization policies are couched within this concept. Much of the driving force behind the harm reduction movement also centers on personal choice and ‘safe’ habits for drug use.”
[38] Erickson, Patricia. “Harm Reduction: What It Is and Is Not.” Drug and Alcohol Review, vol. 14, no. 3, Jan. 1995, pp. 283–85. “The meaning of the term ‘harm reduction’ has changed over the decades of its existence but it is now increasingly being aligned with public health approaches. An agreed meaning for the term would be helpful and should be sought. Antecedents are easy to find. Emphasis on small achievable steps is an important element; neither inherently supportive of prohibition nor of legalization, harm reduction is essentially pragmatic and tends to favour regulatory approaches.”
[39] Hawk, Mary, et al. “Harm Reduction Principles for Healthcare Settings.” Harm Reduction Journal, vol. 14, no. 1, Oct. 2017. “Critics advocate for abstinence-only programs, arguing that anything less enables and encourages continued drug use and produces greater harm to the community.”
[40] MacMaster, S. A. “Harm Reduction: A New Perspective on Substance Abuse Services.” Social Work, vol. 49, no. 3, July 2004, pp. 356–63. Accessed 4 Dec. 2019. “He proposes using harm reduction strategies for individuals for whom the abstinence perspective may not be appropriate. Together, the traditional abstinence and harm reduction perspectives provide a basis for a more comprehensive continuum of care for individuals experiencing problems related to their substance use.”

About the author

Harriet Garfoot

Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health, and is a member of the Burney Society. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: May 28, 2025