Harm Reduction Guide

What Is Harm Reduction?

Harm reduction is a set of policies and practices intended to reduce the negative effects of drug and alcohol use.

Harm reduction programs exist for several types of drugs, including opioids, alcohol, stimulants, Ecstasy, and marijuana. They range from needle exchange sites to managed alcohol programs to drug-testing kits at music festivals. Studies have found many of these methods to be effective. But critics see the programs as encouraging drug use and keeping people addicted to drugs.

Below is information on common programs, tips for safe use, and links to more resources. 

American Addiction Centers offers free and confidential guidance to those suffering from addiction. Call our addiction helpline today if you or someone you know may be struggling with an addiction problem. 

Harm Reduction

Harm reduction is a broad term that applies to policies, programs, and practices that aim to minimize the health, social, and economic consequences of substance abuse.¹ The idea behind harm reduction is not to necessarily eliminate substance abuse but to diminish its harmful effects.

Harm reduction acknowledges that many people will continue to abuse drugs and engage in other dangerous behaviors despite prevention efforts. It also accepts that many people are unwilling or unable to seek treatment. But while some people who use substances may not necessarily require treatment, it is helpful for them to be aware of resources that can help minimize harm from their drug use.¹

Heroin and Other Opioids

Harm reduction for heroin and other opioids is designed to reduce the risk of overdose and decrease the transmission of blood borne viruses associated with needle drug use. It also includes referring heroin and opioid users for addiction treatment and medical care.²

The medications used in MAT are:⁷

• Methadone: This is one of the most widely used medications for treating opioid addiction. It is available in several different forms, but many patients take it orally as a liquid. It is a long-acting drug that alleviates cravings and withdrawal symptoms. Methadone is only available at certified OTPs. It is an effective tool in managing heroin and other types of opioid dependence, but can cause some unpleasant side effects (e.g., nausea, constipation, sedation)
• Buprenorphine: This is a medication taken daily as an orally disintegrating tablet or film or an implant that slowly releases the medication over 6 months. Physicians who have completed a training and certification process can dispense buprenorphine, so you can receive it at a doctor’s office or at an OTP. As a partial opioid agonist, the risk of overdose is lower than with methadone, and withdrawal symptoms may be somewhat less severe. Buprenorphine is sometimes combined with naloxone (trade name: Suboxone), a drug that helps discourage misuse of this treatment medication should it dissolved and injected
• Naltrexone: This medication blocks the effects of opioids to minimize the high if you use. By reducing the rewarding effects of opioids, it may be easier for you to stop using. Naltrexone does not help with withdrawal symptoms, and you cannot begin taking it until 7-10 days after your last opioid use because it can cause the onset of or worsen withdrawal. It is also available in an extended-release injectable formulation that lasts for 30 days
• Naloxone: This FDA-approved opioid antagonist medication is used to quickly reverse an overdose. Naloxone blocks opioid receptor sites and helps to restore breathing. It is available as an injectable (which requires professional training), a nasal spray, and an auto-injectable. Naloxone is a prescription drug in many states, but it can be obtained in a pharmacy without a prescription in some parts of the country. People (and their families) who use heroin or other opioids might want to consider keeping naloxone in their homes in case of overdose.⁸

Alcohol

Harm reduction for alcohol aims to minimize harm due to alcohol use and abuse which, in addition to potentially developing an alcohol use disorder, includes increased risk for cancer, heart disease, liver cirrhosis, stomach problems, mental health issues, and injuries and accidents.⁹

Tips for safer drinking include:¹⁰

• Giving car keys to someone before you start drinking
• Eating before drinking and stay hydrated when drinking
• Taking vitamins to replace those lost through drinking
• Going out with a friend who can monitor your behavior and consumption
• Bringing condoms when you go out drinking. Scheduling at least one abstinence day a week
• Reducing the number of days you drink per week or month

Stimulants

As with harm reduction for other substances, stimulant harm reduction efforts are aimed at meeting users where they are, proving education on drug use, and preventing harm associated with stimulant use, including dental problems, STDs, psychosis, and poor hygiene.¹⁵

Ecstasy

The aim of Ecstasy (MDMA) harm reduction is to prevent harms associated with Ecstasy use, which can include anxiety, trouble concentrating, fatigue, insomnia, depressed mood, hypersomnia, difficulty concentrating, decreased appetite, and dizziness.¹⁷

DanceSafe is a similar organization that provides education about Ecstasy and other drugs in the electronic music scene, as well as on-site pill purity testing at events. Other on-site services include ear plugs, free water, and safe sex tools.

Tips to reduce the harm caused by Ecstasy use include:¹⁸

• Avoiding taking Ecstasy with other substances
• Staying hydrated, but being careful not to drink too much because you can develop hyponatremia, a condition caused from overconsumption of water that can be fatal.¹⁷
• Having a friend to talk to if you feel anxious, depressed, or other negative emotions
• Reducing the amount of Ecstasy you consume in one session
• Using a test kit or consulting an online drug checking database to determine the purity of your Ecstasy

Marijuana

Harm reduction for marijuana is designed to promote safety, health and well-being, and informed decision-making regarding use.¹⁹

In anticipation of Canada’s legalization of marijuana, the Canadian Nurses Association published a harm reduction guide for marijuana use.

How Effective Is Harm Reduction?

A number of studies on harm reduction for specific substances have demonstrated its effectiveness.

In the video below, American Addiction Centers’ national medical director, Dr. Calarco, addresses the effectiveness of harm reduction.

@americanaddictioncenters Is harm reduction effective? #harmreduction #addiction #addictionhelp #addictionrecovery ♬ Spooky, quiet, scary atmosphere piano songs – Skittlegirl Sound

Criticisms

Critics argue that medication-assisted treatment drugs such as buprenorphine can themselves be addictive and are essentially keeping the person dependent on opioids (substituting one drug for another). They also point out that the drugs can be diverted and sold on the black market.²²

Further, some have suggested that needle exchange programs lead to more dirty needles on the street and overdoses if the programs are not properly controlled.²³ Another common criticism is that they encourage drug use and make it easier for addicts to remain addicted and continue to commit crimes.²⁴

Similar claims have been made about supervised injection sites. And a recent study found that the available research on the sites was not well-conducted. The quality studies did not find any noticeable effect on overdose deaths or needle-sharing.²⁵

Still, researchers who studied an injection site in Vancouver, Canada found that it led to significant increases in the number of people who sought methadone and other addiction treatments. Other reviews have found that injection sites improve health in users and do not increase drug trafficking or crime. The question is whether sites that open in other cities, like in the U.S., will see these same results.^4,25

• You may be able to find a harm reduction program by talking to your health care provider, an addiction counselor, or searching the online listings (available by state) from the Harm Reduction Coalition
• To find a needle exchange program, you can browse online listings from the North American Syringe Exchange Network
• To find a designated driver program, you can search for a program by state on the website of the National Directory of Designated Driver Services
• To find an authorized buprenorphine doctor, you can search the Substance Abuse and Mental Health Administration’s database, available by state
• To find a methadone or opioid treatment program, enter your location on the Behavioral Health Treatment Services Locator to enter your location and then use the drop-down menu on the right-hand side of the map. Make sure that you check “substance abuse.”