Harm Reduction: A Lesson in Meeting People Where They Are
What is harm reduction?
At its core, harm reduction is about meeting a person where they are at in their journey towards self-improvement. Harm reduction looks to our standard definitions of “recovery” and “prevention” and instead suggests that we should view any positive movement in personal health as a success.
Where do we see harm reduction in daily life?
Harm reduction presents itself in American society in a myriad of ways even outside of drugs. Often when the term harm reduction is mentioned, our minds go to the current hot bed topics of needle exchanges and safe use sites. However, plenty of harm reduction techniques have been implemented into society with wide acceptance. Seat belts and car seats are both harm reduction measures in driving. Designated drivers are a harm reduction technique used in response to driving under the influence. Much of our current understanding of sexual health and education (condoms, birth control, PREP) are all forms of harm reduction in response to STIs, HIV/AIDS, and unwanted pregnancies.
In all these examples, public health response recognized that whilst abstinence may be the safest route, it isn’t the only route people will take, and just because a person took a less safe route doesn’t mean they don’t deserve care.
A little history check…
Harm reduction has a long history within America, but we really started to see the movement gain momentum during the AIDS crisis in the 1980s. Whilst media tended to focus on the impact on the queer community, they ignored one of the main groups impacted – injection users. Fortunately, a group of nurses, public health, and social workers took matters into their own hands and started a series of harm reduction campaigns that vastly changed the landscape of substance use and safety.
What started as educational campaigns on how to clean your needles with bleach turned into full blown clean needle exchanges. They faced a lot of pushbacks from the community, ranging from general protests to legal cases and jail time. The community of harm reductionists stayed strong in their belief that just because a person uses drugs does not mean they deserve to suffer. Besides, a person was much more likely to enter recovery and make personal health strides if they weren’t suffering from a terminal illness or a lifelong medical condition.
What’s happening now?
The most popularly accepted form of harm reduction in the substance world right now is a medication called naloxone. Naloxone is referred to in the pharmacology world as an “opioid antagonist” and is used to reverse an opioid (heroin, oxycontin, fentanyl etc.) overdose. Naloxone can do this as it has a stronger bond to opioid receptors than traditional opiates[1] which means that it will replace the opiates in the opioid receptors and continue to fill those receptors for 20-90 minutes therefore reversing the opioid induced overdose and preventing further overdoses for that allotted time. Harm reductionists are heavily encouraging that not only should medical professionals have access to this, but rather everyone should. In fact, many public health departments now have naloxone freely available for residents (visit here for a list of health districts who provide naloxone in Illinois).
Remember…
Harm reduction is not encouraging use. Harm reduction is about not viewing people who use drugs as a lost cause and meeting them where they are at. It’s about saying that recovery isn’t linear, and it isn’t all or nothing. Harm reduction is about empathy.
For more information on harm reduction, you can visit the following resources:
https://med.stanford.edu/halpern-felsher-reach-lab/preventions-interventions/Safety-First.html
For a detailed retelling of harm reduction history, we read:
Undoing Drugs: How Harm Reduction Is Changing the Future of Drugs and Addiction by Maia Szalavitz
[1] With the introduction of carfentanyl and fentanyl in the drug scene, the brand of naloxone commonly used, Narcan, may require several doses due to how much more potent these synthetic opiates are in comparison to common opiates used in the past. There are new forms of naloxone being produced (such as Kloxxado) which have more mg of naloxone in it that may be a good option for synthetic opioid overdose reversals.