We are currently experiencing the most crucial substance abuse and overdose crisis our country has ever faced. After being significantly worsened by the worldwide COVID-19 pandemic, deaths continue rising.

Last year there more than 100,000 people died due to drug-involved overdose deaths.

The use of highly potent synthetic opioids (like fentanyl) and animal tranquilizers (like xylazine) into drugs from Xanax, to cocaine, to methamphetamine, to counterfeit pills, has had a huge hand in the deadly surge in overdose deaths in the U.S. It has gotten to the point where buying drugs on the street has become a game of Russian roulette.

People who use recreational drugs however, have always been at risk.

Injection drugs and their harms

Besides the obvious, that a substantial quantity of any illicit drug can lead to an overdose, we have to consider the other effects that drugs can have, especially injection drugs.

The AIDS epidemic, beginning in 1981 continues to impact people today. A major qualifier in this epidemic was non-sterile injection equipment as a means of injecting certain potent drugs such as heroin and methamphetamine.

Injection drug users share injection equipment for a variety of reasons. Speaking pragmatically, clean "works" (needles and other injection equipment) are scarce; legally, the possession of injection equipment is a criminal offense in many states; socially, sharing represents a form of social bonding among injection drug users.

The main consequences for sharing needles are Hepatitis C and HIV. AIDS is the most advanced stage of HIV.

In her book Undoing Drugs, Mia Szalavits talks about how one single person possibly saved her life after telling her to soak her needle in rubbing alcohol before using it. That was during the height of the AIDs epidemic.

That is the basis of Harm Reduction.

The basis of harm reduction

Harm Reduction offers an opportunity to reach the people hesitant to or unable to access substance use disorder (SUD) treatments or healthcare services.

The connection to treatment is critical, especially considering the data from SAMHSA that shows that only one out of ten people with a substance use disorder have received treatment and nearly all people with a substance use disorder who didn’t get treatment at a specialty facility didn’t think they needed it.

Harm Reduction organizations can make that connection and provide the services that people need and want, in their own time, in order to create a new avenue for a change in the way this country deals with illicit drugs and the people who use them.

Providing tools like Naloxone, also known by the brand name Narcan (a medicine that rapidly reverses an opioid overdose) and making it readily available is one way that Harm Reduction organization saves lives.

We’ve seen an overwhelming change in the awareness and introduction of Naloxone products in places like schools and music festivals.

Ohio-based nonprofit, This Must Be the Place, founded by Ingela Travers-Hayward, is flooding festivals with Kloxxado, a nasal spray version of the lifesaving medicine. "We want to move around the campground and proactively hand this out." Their movement has gained over 12,000 followers on Instagram alone.

While the focus on opioid overdose reversal has been instrumental in the movement of overdose prevention and education, Harm Reduction International widens the umbrella with education on safe-use and connections to alternative treatments.

Addiction as a disease

People with substance use disorder have been stigmatized and categorized as selfish or undisciplined people unworthy of a life worth living due to their own choices.

Upon entering the world of recovery, addiction is learned to be a disease rather than a battle of willpower. “No one chooses leukemia, heart disease or depression. Abusing drugs, however, appears to many to be a choice, and a reckless and selfish one. It’s not,” Says David Sheff in an excerpt from his book Clean: Overcoming Addiction and Ending America’s Greatest Tragedy.

“Our prevention and treatment efforts have failed mostly because they’ve focused on dealing with drugs themselves, but drug abuse is almost always the result of kids starting to use early, genetics, and other problems — stress, trauma, mental illness, or some combination of these factors. The new paradigm is rooted in recognizing that drugs are a symptom, not a cause, and whatever problems underlie them must be (and can be) addressed. Until they are, our prevention and treatment systems will continue to fail most people.”

Harm reduction services focus on the need for compassion and understanding, breaking the stigma that has been imprinted on people who use illicit drugs.

Harm Reduction International

Harm Reduction International, a website for the organization that puts Harm Reduction into practice, states very clearly on their What Is Harm Reduction page that “Harm reduction refers to policies, programs and practices that aim to minimize the negative health, social and legal impacts associated with drug use, drug policies and drug laws. Harm reduction is grounded in justice and human rights. It focuses on positive change and on working with people without judgement, coercion, discrimination, or requiring that people stop using drugs as a precondition of support.”

Note that last statement: without requiring that people stop using drugs as a precondition of support.

Harm Reduction Practices

The Substance Abuse and Mental Health Services Administration lists these services practiced by Harm Reduction organizations:

• Connecting individuals to overdose education, counseling, and referral to treatment for infectious diseases and substance use disorders.

• Distributing opioid overdose reversal medications to individuals at risk of overdose.

• Lessening harms associated with drug use and related behaviors that increase the risk of infectious diseases, including HIV, viral hepatitis, and bacterial and fungal infections.

• Reducing stigma associated with substance use and co-occurring disorders.

• Promoting a philosophy of hope and healing ― by employing people with living and lived experience in leadership and in the planning, implementation, and evaluation of services. .

• Stable housing, building community and increasing protective factors ― for people who use drugs and their families.

• Drug checking (like fentanyl or xylazine test strips) that can detect adulteration in the drug supply

• Accurate and fact-based drug education

Does harm reduction encourage drug use?

This is a question many people have upon learning about harm reduction. Harm Reduction International clarifies that no, harm reduction doesn't promote or encourage drug use.

At the end of the day, there will always be people who use drugs and many drug-users, especially those with Substance Use Disorder can be unwilling or unable to stop, and that's where harm reduction comes in. It is meant to help minimize the negative health and social repercussions for the people who continue to use.

Harm reduction is cost-effective, evidence-based and has been proven to have a positive impact on individual and community health.

Nearly a hundred countries already have harm reduction policies and practices in place, and as long as we can spread awareness and accessibility to harm reduction practices, we can continue to save lives.