1. Section Editor(s): Dubois, Timothy M. RN, BSN, PHN

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Psychoactive substance use is prevalent in our society. It does not discriminate and shows no mercy. Throughout history, we have proven time and time again that abstinence is not plausible. You only have to turn the pages back to the prohibition era for an example. The current war on drugs has further stigmatized and criminalized substance use to a point where our society sees only deviance. As a nation, we are starting to see a shift in the perception of drug use and even drug abuse. There is, however, much ground to cover, and we can start by expanding our current definition of harm reduction and including it in our medical practices.


Harm reduction is a practice that is beneficial to us all. It helps the drug user community to be safer and helps society as a whole by reducing death, hospitalizations, and the tremendous subsequent cost (Stancliff, 2015). The ads on the television telling people to ensure a sober ride after a night out is harm reduction. There are many examples including methadone maintenance treatment programs, Suboxone programs, needle exchanges, and even medically supervised injection facilities along with naloxone distribution programs that function as harm reduction methods (Hadland, 2014). These programs and facilities are all providing a service of immeasurable value. These programs exist to give people a fighting chance to better their lives. However, a better life looks different to different people. Methadone and Suboxone programs will give you a chance to change your habit (Harris, 2013). Injection facilities and needle exchanges will make it easier to acquire the items needed and alter your practices to be safer. Anything that decreases the mortality and morbidity surrounding drug use is successful harm reduction.


There is an organization in Seattle, the People's Harm Reduction Alliance (PHRA), which is a community-run operation. Because they are managed by the community that they serve, there are many drug users involved from the street level outreach to the boardroom; they are able to practice with more fluidity than their government-run counterparts. PHRA provides their community with needles, crack pipes, and various sundries necessary to more safely inject or smoke drugs. With that comes educational material on safe injecting practices, communicable diseases, and even sex work. In 2015, PHRA began handing out meth pipes to reduce the likelihood that individuals would choose to inject the drug because of lack of access to a pipe. Many public health officials cite the lack of evidence in suggesting that a lack of a pipe leads to injecting behavior. However, this community organization does it anyway, and they do it to start a conversation, to open their doors, and to make their community more inclusive. They now have access to a portion of the population that has been inaccessible, and that population has a place to ask questions, to learn, and to feel safe.


Throughout the country, we need to incorporate a more vast understanding of harm reduction. We, as healthcare professionals, need to educate ourselves and our students about the benefits of creating an environment that is supportive of the many behaviors that people exhibit. When alcoholism, drug addiction, sex work, and the million of other potentially dangerous actions that are hidden, performed in secrecy or shrouded in shame, are normalized and brought to light, then we can all start to have a discussion. We can reduce the harm that comes from behaviors that are actually very normal.




Hadland S. E., DeBeck K., Kerr T., Nguyen P., Simo A., Montaner J. S., Wood E. (2014). Use of a medically supervised injection facility among street youth. Journal of Adolescent Health, 55, 684-689. [Context Link]


Harris M., Rhodes T. (2013). Methadone diversion as a protective strategy: The harm reduction potential of "generous constraints." International Journal of Drug Policy, 24, 43-50. [Context Link]


Stancliff S., Phillips B., Maghsoudi N., Herman J. (2015). Harm reduction: Front line public health. Journal of Addictive Diseases, 34, 206-219. doi:10.1080/10550887.2015.1059651 [Context Link]