Harm reduction

Harm reduction is used to describe a range of measures and supports that aim to reduce the risk and harm associated with substance use. Harm reduction evolved from the practice of people who were using drugs who sought to reduce the harms to themselves and others caused by their drug use. Peer education and peer support have been and are crucial to the development of harm reduction.

Harm reduction measures eventually became embedded in mainstream service provision. Sometimes this was regarded as controversial, despite the considerable and sometimes overwhelming evidence of effectiveness. Evidence for harm reduction interventions has been established from widespread research and is a basis for the further development and implementation of this approach.

There has been sustained controversy around harm reduction approaches since the 1980s when the provision of basic harm reduction services began and was opposed usually on ideological grounds and in ways that stigmatised people with a drug problem and sometimes also those who wanted to support and help them including families and service providers. (See stigma; see pro- and anti-drug)

Since then, in Scotland, there has been slow but significant progress in the development and delivery of harm reduction measures often in the face of continuing opposition.

Scotland has a good coverage of injecting equipment provision services and extensive, though under-developed, opiate substitution treatment services which were first developed in response to the HIV outbreaks of the 1980s. However the quality of these services and their integration with other mainstream services is affected by the perception of them as ‘controversial’ or ‘peripheral’ and the stigmatising of people in who use drugs, people who have a drug problem and people who use drug services. (See stigma)

More recently, Scotland has developed a national take-home naloxone programme in response to the high rate of opiate overdose deaths. However, Scotland still lacks drug consumption rooms and drug checking services. The development and provision of drug-related information with a harm reduction perspective is still stymied by the notion that this is controversial (see pro and anti-drugs).

Harm reduction is sometimes portayed as promoting drug use. Given the evidence for the social and personal roots of problem drug use (see poverty; see self-medicating; see adverse childhood experiences; see trauma) the issue does not lie in the provision of harm reduction services and this approach. In Scotland harm reduction focus largely on people whose drug use is linked to a range of issues they face and sometimes an overwhelming experience.

A harm reduction approach does not ‘normalise’ substance use but normalises society’s response to a potentially hazardous activity in that harm reduction is how we approach all other behaviours – driving, cycling, participating in dangerous sports – taking an informed decision to minimise risk and avoid possible harms.

Harm reduction is sometimes regarded as ‘lacking ambition’. Harm reduction measures can eliminate harm and risk or significantly reduce harm and risk. This is sometimes downplayed or disparaged as an aim or an achievement. It can be uncomfortable for some people to consider that drug use may cause no or little harm and yet, of course, non-problem use is the norm.

Harm reduction is sometimes portrayed as countering or opposing recovery or abstinence. However, people who regard themselves as being in recovery have often used harm reduction services and practiced harm reduction. The harms they may have experienced as a consequence of their use of substances have been reduced or eliminated. Therefore, the range and extent of the harms they have to recover from is reduced. Also, their ambitions and what they aspire to ‘recover to’ are not limited by harms they experienced during their problem substance use. And of course, the ultimate harm is death and people need to survive a period of problem substance use to move on and make progress in their lives. An argument that sets harm reduction and recovery in opposition is difficult to sustain. It is worth noting how much of the development of harm reduction involves input from people with personal experience of problem substance use including people who regard themselves as in recovery.