Harm Reduction Strategies to Improve Safety for People Who Use Substances

An official website of the Department of Health & Human Services

Salisbury-Afshar E, Gale B, Mossburg S. Harm Reduction Strategies to Improve Safety for People Who Use Substances . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2024.

Salisbury-Afshar E, Gale B, Mossburg S. Harm Reduction Strategies to Improve Safety for People Who Use Substances . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2024.

The non-medical use of prescription opioids and benzodiazepines, as well as the use of illegal substances such as cocaine and fentanyl, poses immediate and long-term risks to individuals and the community at large. In 2023, 48.5 million people (17.1% of the population) were estimated to have a substance use disorder (SUD), which is defined as a pattern of behaviors in which patients continue to use a substance despite experiencing significant problems related to its use.1,2 This prevalence rate is a 17% increase since the data was first collected in 2020.3 People who use substances (PWUS) may be at acute risk of harm, such as death from overdose or contracting an injection-related infection. Overdose deaths have increased dramatically in the past decade, to over 100,000 deaths in 2023, in large part due to the rise of synthetic opioids such as fentanyl.4 People who inject drugs can be at risk for injection site infections that can lead to bacteremia and other life-threatening issues. Those who share injection equipment are also at risk of HIV and hepatitis C virus (HCV) transmission.5 Beyond these acute threats, long-term substance use can lead to the development of SUD and severe physical health issues, such as organ damage with some substances, and can contribute to mental health disorders that often compound problems associated with substance use. Socially and economically, PWUS face stigma and marginalization, which further exacerbate their struggles and limit their access to essential services.

Treating SUD is a complex task. Some individuals with substance use disorder are reluctant to seek help or engage in treatment, partly due to the stigma associated with substance use and partly because treatment approaches historically have focused solely on achieving total abstinence. This one-size-fits-all approach can be alienating, especially for individuals who are not ready or able to commit to complete abstinence. As a result, only around one-in-10 people with a substance use disorder have received treatment,6 and many continue to use substances without engaging in any health supports, missing opportunities for intervention that could mitigate harm.

Harm reduction offers a promising, evidence-based alternative to address these challenges. Unlike methods that focus solely on achieving total abstinence, harm reduction strategies prioritize the health and well-being of individuals, even if they continue to use substances. By addressing the immediate risks and reducing the long-term harms associated with substance use, harm reduction provides practical solutions that meet people where they are, helping to protect their health and dignity while offering a path toward improved health and well-being.

Respect for individuals’ autonomy, with a focus on engagement, collaboration, and empowerment, is central to the harm reduction philosophy. It acknowledges that people choose for various reasons to engage in activities that may cause harm. Instead of taking away their deciding power and forcing them to abstain from the activity, harm reduction focuses on providing people with information and tools to reduce the risks posed by the activity as much as possible. In this sense, efforts like seatbelts, bike helmets, and speed limits are examples of harm reduction strategies because they reduce the risks of driving or riding a bike without attempting to force people to abstain from those activities. In relation to PWUS, harm reduction recognizes that complete abstinence from substances may not be a realistic or immediate goal for everyone and acknowledges that there are many ways to reduce the risks associated with substance use.

With a non-judgmental and non-stigmatizing approach, harm reduction strategies provide essential services to people who use substances. The services often include access to naloxone for overdose prevention, screening and treatment for injection-related infections, drug-checking services, and in some places, syringe service programs (SSPs) and safe consumption spaces (also known as overdose prevention sites). Harm reduction services may also link people to a variety of social and health-related resources, including peer support programs, medications for opioid use disorder, mental health treatment, and substance use disorder treatment programs.