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Harm Reduction for Beginners Part One: What is Harm Reduction?

Harm reduction focuses on improving the overall health and well being of the person using substances, without focusing solely on abstinence as an indicator of success.
Written by
Dr. Amanda Reiman
April 28, 2023

Remember the “Drug Free America” rhetoric of the 1980’s and 90’s? The idea that we can completely stop humans from using psychoactive substances is naive and dangerous. There is a lot we can do to make these practices safer for the consumer and for greater society.

The phrase “harm reduction” has been popping up a lot lately. Debates about how to address substance misuse are often between those who believe that abstinence is the only route and those who believe in harm reduction (which also includes abstinence). This can be confusing. What is “harm reduction”, and how does this relate to cannabis? In this three part series from Personal Plants, we will go over the basics of harm reduction, how to reduce the potential harms from using cannabis, and how to use cannabis itself as a harm reduction tool! To start, here is a short explainer about the concept of harm reduction, the values underneath it,  and what it means for those who use intoxicating substances. 

What is “harm reduction”?

Harm reduction focuses on improving the overall health and well being of the person using substances, without focusing solely on abstinence as an indicator of success. And while harm reduction also includes abstinence, it supports that the decision to be abstinent should be in the hands of the user, and not the law or other agents of authority. Now, you may be asking, if we leave the choice to be abstinent to the user, will any user ever make that choice? The answer is, yes. Many people who experience drug dependence make the decision to be abstinent. However, they may not make that decision right away, and they may never decide that abstinence is the right path for them. Harm reduction believes that there are ways to support and help people reduce the harms that substance use may present in their lives EVEN IF they are not currently abstaining from substances. Furthermore, it supports the voices of those who are using substances in the conversations about drug policy and programs. Opponents of harm reduction state that allowing people to access services like housing and employment while they are actively using is enabling their addiction, and that people who are actively using cannot advocate for themselves or make good decisions about how to take care of themselves. However, people, even in active addiction, can make healthy choices and that they can also advocate on their own behalf. You can learn more about that here.

Does harm reduction include other things besides drugs?

Harm reduction does not only apply to drug use. Seat belts, bike helmets and condoms are all examples of harm reduction. We acknowledge that driving, riding a bike and having sex all come with the potential for harm. We don’t outlaw these activities, instead we develop ways to make them safer and reduce the chance of harm. For substance use, harm reduction can be in the form of access to Naloxone, clean syringes, and a safe place to consume substances. Speaking of safe places to consume substances, alcohol bars and cannabis lounges are also forms of harm reduction as they provide safe places for people to potentially be intoxicated, and include access to help if needed. So, what are the values that drive the concept of harm reduction?

The Harm Reduction Coalition

The Harm Reduction Coalition (HRC) has been around since 1993 and, like medical cannabis, was a product of the HIV/AIDS crisis in San Francisco. Seeing judgment and inaction on the part of traditional health care services and leaders, HRC formed to support the people deemed unworthy of help. They also partner with these folks to both acknowledge them as human beings and to help them get their needs met, regardless of whether they are actively using substances. HRC provides vital community resources and education to help people reduce the potential harms from substance use and sexual activity. Their work is framed by the eight values of harm reduction.

The Values of Harm Reduction

I am a social worker, and one of the things that drew me to the profession was the tenets of what social work is. Social justice, competence, the dignity and worth of each person, meeting people where they are at, and the importance of human relationships are the currents that run through this work, and the values of harm reduction fit with the values of social work. Here are the eight principles of harm reduction.

  1. Acceptance that legal and illegal substance use will continue to exist and there are things we can do to minimize the harm associated with use rather than just condemn it or wish it away. Remember the “Drug Free America” rhetoric of the 1980’s and 90’s?

The idea that we can completely stop humans from using psychoactive substances is naive and dangerous. There is a lot we can do to make these practices safer for the consumer and for greater society.

2. Recognition that substance use is complex and makes up a variety of behaviors that can change throughout one’s lifetime. These can range from problematic use to complete abstinence. And, that not all drugs or ways of consuming drugs hold the same level of risk. We can educate people on how to minimize that risk and make their use safer. 

3. Complete abstinence is not the only measure of whether someone is improving. Stable housing, employment, better interpersonal relationships, and better managed physical and psychological health can all improve the overall quality of someone’s life…even if they are still engaging in substance use. Furthermore, people are more likely to want to change the behaviors that are not serving them when they feel they have a chance at a stable existence.

4. Services provided to people who are using substances should be non-coercive and non-judgemental. Our current approach to substance use is very paternalistic in nature. We as a society have decided that people who use drugs (alcohol not included of course) cannot make rational decisions about their lives. Furthermore, we seem to think that shaming them or assigning them the label of “addict” somehow compels people to change their behaviors. This is not the case for most people.

5. Includes people who actively use drugs or who have used in the past in the conversation about how people who use drugs should be treated. I know that when rules about cannabis are made with no input from consumers, there is a huge backlash. Why should cannabis be different from other substances? Where are the voices of the consumers?

6. The recognition that people who use drugs are the best ones to actively reduce the harm associated with use, and to educate others on how to reduce harm. Even when experiencing active dependence, people who use drugs are capable of rational thought and decision making. Empower people to make healthy decisions.

7. Understanding the role of the greater system. Racism, economic inequality, sexual discrimination and past trauma all contribute to the complexities of hazardous substance use. It is important to recognize this and to work to change the system as well as reduce harm. Active trauma can be a barrier to healthy living.

8. This one is important, and one that is often overlooked by those who reject harm reduction. Harm reduction recognizes that substance use can be very harmful. This includes both the psychoactive, biological and societal impacts of use, as well as the harms that stem from prohibition (such as tainted supply, criminal justice involvement, and unsafe consumption environments). Harm reduction is NOT pro drug use, harm reduction is pro people.

The harm reduction approach, while practiced in certain states and communities, is still a far cry from the “Just Say No’ rhetoric that dominates the national discourse. The thing is, because the visible number of people who use illicit substances is small, and those who use these substances non-problematically are usually hidden, many people feel that this is not an issue they can relate to or comment on. However, as cannabis consumers feel more comfortable talking about their cannabis use, it is an opportunity to better understand harm reduction in a context we are comfortable and familiar with. In part 2 of the series, we will talk about harm reduction as it applies to cannabis. Nothing is completely without harm, and knowing how to apply harm reduction principles to cannabis use can increase the chances of long term, healthy plant relationships.

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