Harm Reduction

Harm reduction is a strategy which minimizes the impacts of drug use and drug-related harms. Harm reduction supports interventions which are aimed at reducing negative effects without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery.

Harm reduction does not fall neatly within any single domain within the Institute of Medicine's (IOM) Continuum of Care, but rather supplements the prevention, treatment, and recovery strategies. Therefore, it is useful for anyone working within any of the IOM domains to be familiar with the harm reduction approach. Since it incorporates a number of innovations within the substance use disorder field, some of the strategies are controversial and have historically been met with community resistance. This makes it even more important for all behavioral health practitioners to be informed about the full spectrum of harm reduction strategies.

SAFE Solutions provides two clusters of harm reduction articles. The first addresses the major approaches to harm reduction and includes an article on the incarcerated population. The second set of articles details unique substance use issues associated with a second specific population — people who are pregnant or parents of newborns.

• The first article, "Expand Harm Reduction Practices," provides the definition and principles of harm reduction promoted by the National Harm Reduction Coalition. It introduces the four major approaches which are implemented in harm reduction.
• "Increase Access to Overdose Reversal Medications" covers the most common harm reduction strategy. While the use of naloxone in preventing death by overdose has been adopted by pharmacists, EMS, law enforcement, and even public libraries, it has also received significant resistance to its adoption.
• "Expand Drug Testing Options" covers another major strategy in harm reduction — the use of fentanyl testing strips (FTS). In addition to reducing the number of overdoses, the distribution of FTS provides opportunities for drug users to become aware of other treatment and recovery services.
• "The Linkage Between Syringe Use and Infectious Disease" is the first in a series of three articles associated with the complex topic of syringes. It provides a context for understanding the health risks associated with injecting drugs and the need to address the behavioral health issues of substance use within the arena of public health in curbing the spread of Hepatitis C, HIV, and AIDS.
• "Increase Access to Syringe Exchange Programs" details a variety of types of syringe service programs (SSPs) and documents the positive results and cost-benefits associated with SSPs.
• "Expand Number of Safe Injection Sites" makes a case for national adoption of a harm reduction practice which has been proven successful in a variety of international settings.
• "Adopt Harm Reduction Practices in Jails and Prisons" addresses concerns associated with one of two specific populations addressed by SAFE Solutions. While there are several articles under "Treatment" within "Focus on Criminal Justice," this article addresses unique concerns linked to harm reduction.

Articles which focus on the perinatal period include:

• "Minimize Substance Use During Pregnancy" addresses the broad spectrum of issues facing an increasingly prevalent population having high risks for both parent and child. It ranges from increased chance of unintended pregnancies associated with substance use disorder to statistics on use during pregnancy to challenges and barriers unique to the perinatal period. It includes emerging resources and promising practices.
• "Expand Perinatal Treatment and Support for People with SUDs" is the first in a cluster of three articles focused on the community role in norm change around pregnancy and substance use. It provides the context for the following two articles.
• "Reduce Stigma for Pregnant People with SUDs" delineates the need for norm change at the community scale and offers strategies and cases in which stigma reduction has been advanced.
• "Enhance Collaboration Among Medical, Behavioral Health, and Social Services Providers" spells out the synergistic benefits of service provision to families through collaborative efforts. It also details the mechanics of a family-centered approach.

The next three articles focus on the baby:

• "Increase Awareness of Risks of SUD on the Baby" addresses Fetal Alcohol Syndrome (FAS) and Neonatal Abstinence Syndrome (NAS).
• "Improve Care for Babies Born Drug Dependent" covers treatment options for NAS.
• "Improve Identification and Data Collection for NAS" details the benefits of system-level changes, such as universal screening and a national NAS data registry.

The last four articles address specific perinatal SUD considerations and methods to support people before, during, and after pregnancy:

• "Increase Access to Contraception" addresses the high rate of unintended pregnancies associated with substance use and public health consensus around the need to increase access to contraceptive choices. In particular, this article details the benefits of long-acting reversible contraception (LARC) methods.
• "Expand Motivational Interviewing for Pregnant People" describes a harm reduction approach which builds upon a desire to make positive changes during pregnancy by inspiring incremental steps to behavior change. As a positive psychology model, it is person-driven and empowering, which builds assets to address stigma and other challenges associated with substance use during pregnancy.
• "Expand Access to MAT/MAR for Pregnant People" supplements a cluster of MAT/MAR articles within SAFE Solution's menu on Treatment. It provides information specifically relevant for the role of MAT/MAR during and after pregnancy.
• "Improve Access to Recovery Coaches for Parents of Newborns" highlights the vulnerability of the postpartum period and the positive role which recovery coaches could play to support parents of newborns.