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Understanding the Harm Reduction Model

May 4, 2022

Table of Contents

Harm reduction is a supportive and personalized way to help people transition from active substance misuse to living a life that is no longer focused on getting and staying under the influence of any substance.

What Is Harm Reduction?

Harm reduction is a philosophy on care that aims to reduce the harms of a risky behavior instead of denouncing the behavior altogether. It is a “meet the person where they live” approach to managing harmful use of drugs and alcohol. For example, a needle exchange facility that gives a patient clean needles to inject their drugs is using a “harm reduction model” because instead of denouncing drug use altogether, they are helping to reduce any harm that comes from the dangerous behavior of injecting drugs. Another example might be medications for opioid use disorder: Instead of denouncing the use of any and all opioids like methadone or suboxone, we instead use them in place of full opioids because they are generally considered safer. The goal of “harm reduction”is to reduce the harm caused by substance misuse rather than enforce a “cold turkey” or “complete abstinence” detox approach..[1]

The Philosophy of Harm Reduction 

Harm reduction aims to reduce the damage caused by substance misuse and substance use disorder (SUD). The goal isn’t to wholly eliminate substance misuse but rather to lessen the risks to the individual engaging in the behavior. 

The idea behind this philosophy is to remove the pressure of an abrupt transition from active addiction to sobriety. 

Harm reduction provides a method of creating a tailored plan for the individual to go at their own pace as they move out of their old life, way of thinking, and response to stressors (usually with substance use) and begin to learn new habits.[1] If a person is not ready or able to be completely abstinent from substances, there are still things we can do to prevent harm to them while they are continuing to use. This is what the harm reduction model advocates. 

Harm Reduction for Heroin & Other Opioids

When an individual is using heroin or other opioids,  treatment with Suboxone, a combination of buprenorphine and naloxone, is a harm reduction strategy that has been shown time and time again to be highly effective.[2]

Some schools of thought view MAT (Medication for Addiction Treatment) as a harm reduction model” in the sense that it still allows individuals to use opioids (methadone and Suboxone) but it permits them access to legal, much safer opioids that have many fewer risks than illicit opioids.[3] 

Suboxone can help a person stop injecting heroin, which reduces the risk of infection and bacteria that come with needles. Suboxone also contains naloxone, which helps deter the person from overdosing. 

Other harm reduction measures for opioids include the following:

  • Marking needles to avoid accidental sharing with other people
  • Cutting back on the dose taken each day or per use
  • Stopping the use of needles
  • Using clean needles

Needle exchange programs, which provide clean, free needles, are a popular harm reduction approach.[4] Needle injection sites, which are safe places where injection drug users can inject drugs with medical supervision on site, are another harm reduction tactic. 

Harm Reduction for Alcohol Misuse

A slow tapering of alcohol can help someone with an alcohol use disorder (AUD) decrease the risks of heavy drinking. A reduction in drinking can lower the risk for heart disease, cancer, injuries, and accidents.[5]

Naltrexone is a medication that lessens the pleasurable effects of drinking and decreases cravings. 

These are other forms of harm reduction for alcohol:

  • Making sure never to drive after drinking
  • Using apps or other devices to help monitor consumption
  • Cutting back on the number of days spent drinking or the number of drinks per session
  • Focusing on eating healthfully and drinking water before and during alcohol use sessions 

Harm Reduction for Stimulants

There is no medication option to aid in stimulant detox, but harm reduction for stimulants can help to mitigate the harm related to stimulant misuse. 

For example, some harm reduction options for stimulants may include the following:[6]

  • Avoiding use of needles or participating in needle exchange programs
  • Proper dental care to address the harm done by stimulant use on the teeth
  • Nutrition counseling to address malnourishment and disordered eating that may result from or drive continued stimulant use 
  • Using safe sex practices to avoid accidental pregnancy and/or disease transmission 

Harm Reduction for Marijuana

The risks of heavy or frequent marijuana use include damage to physical health, increased risk of injury, and mental health issues.[7]

To address marijuana use from a harm reduction perspective, these are some options: 

  • Cutting back on the frequency of use or the amount used per session
  • Avoiding driving after use of marijuana
  • Choosing not to drink or use other drugs while using marijuana
  • Opting to avoid high-potency forms of marijuana

Effectiveness of Harm Reduction

There have been a number of studies that have looked into the value of harm reduction measures. Harm reduction strategies have consistently been found to work when it comes to addiction, especially when it comes to the support for the use of clean needles and supervised injection sites.[8,9]

There are ample studies that demonstrate the efficacy of Suboxone to treat people with long-term, high dose opioid addiction to avoid relapse and overdose.[2]

Criticism of Harm Reduction

Not everyone understands the value of a harm reduction model. Some view harm reduction - the idea that it is ok to not be abstinent from substances - as enabling people to continue using drugs and alcohol, normalizing a behavior.[10]

Others, including many people in the 12-step community, believe that the use of medications like Suboxone is simply replacing the drug of choice and therefore any use constitutes a lack of “real” sobriety.[11]

The truth is that for many millions of people, total abstinence is not and will never be an option. 

For these people, a harm reduction model allows them to continue to use while still receiving support and options to help keep them as safe as possible while actively using. At Bicycle health, we believe that harm reduction meets people “where they are at” in their addiction journey instead of forcing them to be ready for abstinence when they are not.  

Where to Get Help

If you would like to learn more about harm reduction options near you, you can check in with the Harm Reduction Coalition.[12]

You can also find the closest clean needle exchange site through the North American Syringe Exchange Network.[13]

If you would like to learn more about Suboxone and Medication for Addiction Treatment, contact us at Bicycle Health for more information and to set up a personal consultation. 

What if Harm Reduction Doesn't Work?

If you feel that harm reduction is not the best option for you, it’s not your only option for recovery. 

While medications are often needed in the initial phase of recovery from opioid use disorder (OUD), you can work with your treatment team to taper off these medications if that is your ultimate goal. Reach out to a medical professional to learn more. 

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. What Is Harm Reduction? Harm Reduction International. https://www.hri.global/what-is-harm-reduction. 2022. Accessed March 2022.
  2. Suboxone: Rationale Science, Misconceptions. The Ochsner Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855417/. 2018. Accessed March 2022.
  3. Opioid Maintenance Treatment as a Harm Reduction Tool for Opioid-Dependent Individuals in NYC: The Need to Expand Access to Buprenorphine in Marginalized Populations. Journal of Addictive Diseases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3620719/. April 2013. Accessed April 2022.
  4. The Significance of Harm Reduction as a Social and Health Care Intervention for Injecting Drug Users: An Exploratory Study of a Needle Exchange Program in Fresno, California. Social Work in Public Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129746/. August–September 2016. Accessed April 2022.
  5. Alcohol Management as Harm Reduction. Substance Abuse and Mental Health Service Administration. https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/alcohol-management-harm-reduction. March 2022. Accessed March 2022.
  6. Harm Reduction Strategies for Stimulant Use. Massachusetts Department of Public Health. https://www.mass.gov/doc/bsas-overview-of-harm-reduction-strategies-for-stimulant-use/download. February 2022. Accessed March 2022.
  7. Harm Reduction. Substance Abuse and Mental Health Association. https://www.samhsa.gov/find-help/harm-reduction. February 2022. Accessed March 2022.
  8. Politicians Need to Get Over Their Squeamishness About Needle Exchange Programs. The Washington Post. https://www.washingtonpost.com/news/wonk/wp/2015/03/31/politicians-need-to-get-over-their-squeamishness-about-needle-exchange-programs/?noredirect=on. March 2015. Accessed March 2022.
  9. What’s the Evidence That Supervised Drug Injection Sites Save Lives? NPR. https://www.npr.org/sections/health-shots/2018/09/07/645609248/whats-the-evidence-that-supervised-drug-injection-sites-save-lives. 2018. Accessed March 2022. 
  10. Public Health Officials Applaud Needle-Exchange Programs, but Critics Remain. Indianapolis Business Journal. https://www.ibj.com/articles/69145-public-health-officials-applaud-needle-exchange-programs-but-critics-remain. 2018. Accessed March 2022.
  11. Buprenorphine Treatment and 12-Step Meeting Attendance: Conflicts, Compatibilities, and Patient Outcomes. Journal of Substance Abuse Treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560966/. May 2015. Accessed March 2022. 
  12. Find Harm Reduction Resources Near You. Harm Reduction Coalition. https://harmreduction.org/resource-center/harm-reduction-near-you/. Accessed March 2022. 
  13. Syringe Services Program finder. North American Syringe Exchange Network. https://nasen.org/map/. January 2022. Accessed March 2022.

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