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Publications Explainer

What Is Harm Reduction?

A man holds up an overdose kit
A man holds up an overdose kit during a protest denouncing New York City's response to the overdose crisis on August 10, 2017. © Drew Angerer/Getty

Harm reduction refers to an approach to services and policy that protects the life, health, and dignity of people who use illegal drugs and their communities. Unlike approaches that insist that people stop using drugs, harm reduction recognizes that many people are not willing or able to abstain, and that withholding assistance and otherwise punishing people and communities for using illegal drugs only worsens health, racial and economic inequities, and other harms.

What are some examples of harm reduction?

Evidence shows that harm reduction saves lives, improves health and strengthens families and communities. Examples include:

  • Community management of opioid overdose through administration of the medication naloxone, which reverses the effect of overdose. People can learn to use naloxone after only five minutes of training.  Harm reduction programs distribute naloxone to people who are most likely to witness an opioid overdose, including people who use opioids themselves, so that they can save a life in an emergency. Nearly 500,000 people died in the U.S. alone from opioid overdose in from 1999 to 2019, and the number of yearly deaths appear to have risen yet further in subsequent years.
  • Needle and syringe distribution programs that help reduce HIV and hepatitis C infections by providing people who inject substances with sterile injection equipment. Research overwhelmingly shows that needle and syringe programs do not increase drug use, and act as a bridge to other services such as HIV testing and drug dependency treatment.
  • Overdose Prevention Sites (also known as Supervised Consumption Sites), where people can safely use currently illegal substances without fear of arrest and under the supervision of trained staff.
  • Medication Assisted Treatment (MAT) with methadone and buprenorphine, which reduces cravings for heroin and other opiates while helping to improve adherence to HIV medications and other treatments and increasing personal and community stability.
  • Peer programs that engage current and former drug users to play a role in the design of and advocacy for harm reduction programs, increasing the effectiveness of those programs and their accountability to the communities they serve.
  • Non-abstinence housing (sometimes known as Housing First) that offers safe and, where possible, permanent housing to homeless or underhoused people without requiring a commitment to abstinence from using illegal drugs.
  • Community mobilization for rights protection, which recognizes that the protection of human rights are as critical to health as access to a clean needle. This includes legal empowerment to increase access to justice for people who use currently illegal substances and to decrease police harassment, as well as advocacy for drug policy reform to diminish incarceration, prevent and hold accountable for rights abuses, and reduce law enforcement interference with lifesaving services.

How do the Open Society Foundations support harm reduction?

Through grant making and advocacy, we support efforts to advance harm reduction in Eastern Europe, Asia, Africa, and the Americas, including the following:

  • in Kenya, opening the country’s first peer-led needle and syringe distribution programs and pioneering alternative community dispute resolution mechanisms to keep people who use currently illegal substances out of jail
  • in Ukraine, ensuring that patients in pretrial detention have access to methadone treatment, and opening the country’s first supervised consumption site
  • in Kyrgyzstan, piloting the country’s first methadone services, needle and syringe programs inside prisons, and improving services for pregnant people who use drugs
  • in Macedonia, bringing the national government to the table around financing of harm reduction programs, and introducing, for the first time, a process for contracting with the civil society sector in the delivery of services
  • in Brazil, building a community resource center for homeless people who smoke crack cocaine in the Maré favela of Rio de Janeiro
  • in Colombia, opening the first in-country harm reduction services for people who inject heroin, and a successfully mounting a constitutional challenge around the right to universally accessible restrooms for homeless people
  • in Mexico, supporting the first supervised drug consumption site in Latin America with a special focus on women
  • in the United States, advocating to partially lift the Congressional ban on funding syringe service programs, allowing federal dollars to go toward supporting harm reduction programs with “everything but the needles,” and helping to enable the distribution of more than one million doses of the lifesaving medicine naloxone to people who use drugs and their communities 

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