What is harm reduction?

Harm reduction refers to policies and practices that try to reduce the harm that people do to themselves or others from their drug use. It can be contrasted with primary prevention which tries to prevent people using drugs in the first place, or to stop them using once they’ve started.

Harm reduction first became a widely used term in the UK in the 1980s in response to the increasing number of cases of HIV among drug injectors and the development of syringe exchange schemes. Since then it has been developed in a number of ways including ‘safer dancing’ and drug testing.

Harm reduction focuses on ‘safer’ drug use and has also been developed as a way of educating young people about drug use, rather than telling them to ‘Just Say No’.

There have been arguments over the morality of harm reduction. Some people say that it condones or promotes drug use, but people who support it say it is realistic, helps keep drug users safe and respects individual choices and freedoms. See the Position Statement from Harm Reduction International for more on this.

Harm reduction initiatives

There are a wide range of different harm reduction initiatives in place. These include:

• Needle exchange schemes – providing clean and sterile needles for people who inject drugs, thereby reducing the transmission of blood borne diseases such as hepatitis and HIV and enabling the safe disposal of syringes.
• Drug Consumption Rooms –  places where illicit drugs can be taken under the supervision of trained staff, thereby reducing the chances of overdose, disease transmission and drug related litter.
• Drug testing in Clubs – The Loop conducts forensic testing of drugs at UK festivals and nightclubs and provides associated welfare support.
• Providing information on safer drug use – see the guidelines below

Harm reduction guidelines

• If you are going to use drugs, do not use them alone and always tell someone else what it is you have taken.
• Always use clean needles and do not share injecting equipment.
• Begin by using a small amount e.g. a quarter of a pill and wait a couple of hours before taking more. Or Crush, Dab, Wait – i.e. crush up any pills, dab in a wet finger to taste and then wait an hour or two. This is particular important advice now that ecstasy tablets are being found that are much stronger than they used to be. See more on this here.
• Don’t mix drugs with other drugs including alcohol or prescription medications.
• When dancing, be sure to take breaks to cool down and drink small sips of water – but don’t drink more than a pint an hour.
• Think about your surroundings and do not use in an unsafe place.
• Never drive or use machinery after taking drugs.
• Always get help if you are worried about a friend and give the medical professionals as much information as possible about the drug or drugs that were taken.
• Place sleeping or unconscious friends in the recovery position

• Practice safe sex

Further reading

Harm reduction research:

High time for harm reduction (1987)
Impelled by the injecting-related AIDS crisis, Merseyside was where harm reduction in the UK first took root. From there in 1987 came this ground-breaking call for a turn away from what was seen as a failed attempt to prevent use to mitigating the harm. Expressed modestly as a “prudent” suggestion, with Russell Newcombe’s essay, “harm reduction” had come of age. You can also see the original Druglink article (PDF).

Time for safer injecting spaces in Britain? (2020)
Drug consumption rooms are a particularly contentious form of harm reduction, viewed on one hand as a practical, humane, life-saving approach to dangerous drug use, and on the other, as an endorsement of drugtaking and a dereliction of the duty to treat people dependent on drugs.

Harm reduction: what’s it for? (2016)
‘Hot topics’ offer background and analysis on important issues which sometimes generate heated debate. Opposing agendas have led to a shifting balance between seeing harm-reduction as acceptable only in the service of the greater good of reducing or eliminating drug use, versus seeing it as the overriding objective, one which should never be sacrificed to an anti-drugs agenda.

Drug safety testing, disposals and dealing in an English field: Exploring the operational and behavioural outcomes of the UK’s first onsite ‘drug checking’ service (2019)
In a year when drug-related deaths in the UK had peaked, a pioneering study of drug safety testing was conducted on festival grounds. Its impact on drug-related harm was measured at various levels, including drug-related hospital admissions, behaviours of 230 people who received harm reduction advice, and actions that stakeholders took after receiving information about drugs being mis-sold or contaminated.

Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in people who inject drugs (2019)
What would happen to rates of infection with hepatitis C if we closed down all the needle exchanges? In three UK municipalities, the answers were predicted to be more infections, lost low-cost opportunities to improve and save lives, and in two of the areas, greater health-related costs overall. Conclusion was that these services are among the best investments UK health services can make.

Usage of low dead space syringes and association with hepatitis C prevalence amongst people who inject drugs in the UK (2018)
For people who share injecting equipment, ‘low dead space’ syringes may lead to a reduced risk of becoming infected with blood-borne viruses by limiting the volume of fluid that is drawn up but not injected. However, they may not (yet) be suitable for all types of injectors or injections.

“Once I’d done it once it was like writing your name”: Lived experience of take-home naloxone administration by people who inject drugs (2018)
Important implications for overdose prevention policy and practice in Scotland and the UK from this qualitative study which provides the first detailed insights into how people who inject drugs experience administering naloxone rescue kits.

Overdose antidote naloxone takes harm-reduction centre stage (2017)
‘Hot topics’ offer background and analysis on important issues which sometimes generate heated debate. National programmes distributing the opiate overdose antidote naloxone have become the great hope for curbing the rise in overdose deaths, but England is lagging behind the rest of the UK – and planning for the likelihood not of recovery but relapse may for some services and patients be hard to accept.

Key harm reduction reports and journals

The Global State of Harm Reduction (2020)
The Global State of Harm Reduction is the only report that provides an independent analysis of harm reduction in the world. Now in its the seventh edition, it is the most comprehensive global mapping of harm reduction responses to drug use, HIV and viral hepatitis | HRI, UK

Room for improvement: How drug consumption rooms save lives (PDF) (2019)
A report by Jarryd Bartle, a drug policy consultant and university lecturer, calls for Britain to introduce life-saving Drug Consumption Rooms | Adam Smith Institute, UK

Issue Brief: The Case for Supervised Consumption Services (2017)
This brief sets out the arguments for safe consumption rooms | amfAR, USA

Drug consumption rooms: an overview of provision and evidence (Perspectives on drugs) (2018)
This briefing from The EMCDDA provides the following: An analysis of drug consumption rooms: an overview of provision and evidence; a video of drug consumption rooms; facts and figures on their use; and a service model for a supervised drug consumption facility | EMCDDA, Portugal

Safer drug consumption facilities: A briefing paper (2021) | Scottish Government, UK

Scottish Affairs Committee calls for decriminalisation and safe drug consumption room (2019)

Syringe Services Programs (SSPs) Fact Sheet
Briefing from the CDC on the benefits of needle exchange services | CDC, USA

Finding a Needle in a Haystack: Take-Home Naloxone in England 2017/18
This report updates Release’s previous reporting on ‘Take-home Naloxone in England: 2016/17’ and presents novel findings on take-home naloxone provision in custodial settings, such as in prisons, across England for the period 2017/18 | Release, UK

Guidance: Widening the availability of naloxone (2019)
Naloxone is the emergency antidote for overdoses caused by heroin and other opiates/opioids (such as methadone and morphine) | DoH et al, UK

Harm Reduction Journal
This open access publication publishes research focusing on the prevalent patterns of psychoactive drug use, the public policies meant to control them, and the search for effective methods of reducing the adverse medical, public health, and social consequences associated with both drugs and drug policies.

See also the Harm Reduction page of DrugWise’s I-Know Knowlege hub.

Updated January 2022