MSU Extension Food & Health

Traditional approaches to discouraging substance use are often fear based, attempting to scare people away from using substances and stigmatizing those who do. These approaches focus on abstinence, without considering the lived experiences of people who choose to use substances for pleasure or to reduce pain. Everyone’s experience with substance use and recovery is different – but recovery is possible and harm reduction aids recovery.

Harm reduction is a realistic and compassionate alternative to typical substance use recovery programs and policies that emphasize 100% sobriety. Harm reduction is an assortment of judgment-free approaches that can help reduce the negative consequences of substance use. Without harm reduction approaches, individuals face a greater risk of contracting a chronic infectious disease like Hepatitis C, overdose, and even death.

Dr. Vitka Eisen, a person in recovery and board member for the National Council for Mental Wellbeing, writes that “the goal of harm reduction is to move people to the place where they are most realized, healthy and safe. For some, that place is abstinence, but for others it’s not, because abstinence from drug use is not an actual requirement for full participation in society.”

Harm reduction recognizes that complete abstinence from substances is not more important than someone’s life. In fact, harm reduction emphasizes the need to weigh an individual’s or a community’s health, social and economic outcomes more heavily than they weigh total drug consumption.

There are two main qualities of harm reduction approaches:

1. All life activities carry risk, so harm reduction is already an essential part of our everyday lives.

Driving or riding in a car carries a potential risk of being hurt or killed in an accident or collision, but we reduce the potential harm by wearing seatbelts, use of airbags and requiring education about driving before allowing people to drive. Similarly, the COVID-19 virus poses a threat to our health and we use masks, socially distance, and wash our hands frequently to limit transmission risks. We also use parachutes, child car seats, fences for our pets, bike helmets, all as a way to minimize the harm of daily or occupational activities. We know that many of our daily activities require us to risk a certain amount of safety. Harm reduction is something we accept as a normal part of life.

2. The elimination of drug use is not necessarily attainable or desirable.

Not everyone has the same ability to change, and not everyone experiences the same negative consequences from substance use. Some individuals may be interested in reducing, but not eliminating their substance use. They are excluded from abstinence-only programs and services. Harm reduction approaches acknowledge differences among people who choose to use substances. They affirm the humanity, dignity and respect of people who use substances.

Examples of harm reduction for substance use disorder and problematic or chaotic substance use may include:

• Naloxone/Narcan, opioid overdose reversal medication.
• Syringe/needle exchange programs.
• Medically supervised safe consumption sites and facilities.
• Fentanyl testing.
• Testing for sexually transmitted diseases.
• Family planning.
• Access to various community resources.
• Access to medications like PrEP, which helps reduce the risk of HIV transmission.
• Referrals to substance use disorder treatment.

One of the biggest myths about harm reduction is that it provides a "free pass" and will encourage criminalized drug use. The research on harm reduction shows that this is not true. Most research studies show that harm reduction decreases illicit drug use, overdose, and overdose-related deaths. Additionally, rates of other bloodborne diseases like Hepatitis C and HIV have significantly decreased in places with strong harm reduction policies and programs.

Notably, harm reduction programs provide more opportunities to invite a person to join treatment or recovery services, and it increases retention in treatment and recovery programs. For example, according to the CDC, people who begin using safe syringe programs are five times more likely to enter drug treatment and three times more likely to stop using drugs, compared to those who don’t use the programs. Harm reduction helps those who are using substances to remain connected to their communities and their families, regardless of their sobriety status. These connections are essential for treatment and recovery with substance use disorder.

Harm reduction alone does not always address structural problems that lead to substance use disorder or chaotic substance use. Some harm reduction approaches are still plagued by the stigma of substance use as a moral failure and are further stigmatized by racism, gender and sexuality oppression, and other types of discrimination. Public acceptance of harm reduction programs and policies varies because of the stigma. Adopting harm reduction programs or practices in your community is an opportunity to eliminate that stigma. It is an opening to address structural barriers that create the stressful, traumatic living conditions that often prompt chaotic substance use.

Each person’s experience with recovery is unique, depending on their age, race, class, gender, sexual orientation, ability, class and so many more characteristics. But recovery IS possible. Some actions you can take include:

• Knowing the signs of opioid overdose.
• Getting trained to use naloxone so that you feel confident using it in an overdose situation.
• Ordering and carrying a free naloxone kit, courtesy of the Michigan Department of Health and Human Services. 
• Advocating for continued funding of safe syringe programs and new programs to be added in your area.
• Talking to your friends and family about harm reduction; there are many resources to help you start the conversation. 
• Requesting that your local, regional and state lawmakers become educated on the benefits of harm reduction. Find state and federal lawmakers here. Local lawmakers can be found at city/town council meetings or mayor offices.
• Learn more about opioid misuse prevention through MSU Extension’s MiSUPER initiative; you can attend a community event or request a presentation.
• Watch MSU Extension’s Stories of Hope to hear inspiring stories of recovery, of loving people with substance use disorder, and experiences with harm reduction.