Harm Reduction
A Deep Dive into the Movement
Evidence Basis for Harm Reduction
A Quick History
Early Beginnings (1920s-1960s)
One of the earliest influences of a harm reduction approach was the British approach to heroin use in the 1920s-1950s.
Unlike the more punitive models in the U.S., British doctors were allowed to prescribe heroin and other narcotics to individuals with addictions, focusing on managing the addiction rather than criminalizing the user.
In the 1950s and 60s, alcohol education programs in the UK and U.S. began focusing on “controlled drinking” rather than complete abstinence.
Development of Needle Exchange Programs (1980s)
Needle and syringe exchange programs (NSPs) were developed in the Netherlands, the UK, and Australia. These programs provided sterile needles and syringes to prevent the spread of infectious diseases.
In 1984, the first formal needle exchange program opened in Amsterdam, Netherlands. The approach was controversial at the time because it was perceived by some as enabling drug use. However, it quickly proved to be effective in reducing HIV transmission.
8 Key Harm Reduction Principles
Reduction of substance-related harm
Drug use is a complex.
Quality of life and well-being
Non-judgmental
Voice in programs
PWUD are the primary agents
Social inequities
Real and tragic harm and danger
Common Misunderstandings
Condones drug use
People can’t make changes as long as they continue to use
Engaging with people who are intoxicated is pointless
Working with unmotivated people is hard!
What Works for You, is What is Right for You...
Expansion of Harm Reduction Principles (1990s)
By the 1990s, the harm reduction philosophy expanded globally. In addition to needle exchange, other strategies became popular, especially in Europe and Canada:
- Supervised consumption rooms (safe injection sites)
- Methadone maintenance treatment (for opioid dependency)
- Drug-checking services (to test for contaminants in drugs)
During this period, International Harm Reduction Conferences began to take place, bringing together public health officials, researchers, activists, and people who use drugs to discuss best practices.
Harm reduction principles were further developed to include social justice and the rights of people who use drugs.
Harm Reduction in the U.S. (1990s-Present)
For much of the 1980s and 1990s, American drug policy was heavily influenced by the “War on Drugs” rhetoric, favoring criminalization over public health approaches.
However, by the late 1990s, harm reduction programs, particularly needle exchanges, started to emerge in cities like New York and San Francisco.
By the early 2000s, harm reduction organizations in the U.S. such as the Harm Reduction Coalition began advocating more effectively for policies like syringe exchanges and overdose prevention.
The rise of the opioid epidemic in the 2010s led to an expansion of harm reduction programs, especially around the use of naloxone (an overdose reversal drug).
