Harm reduction is a client-centered, public health approach based on empirical evidence that aims to lessen the harms of behaviors on a person’s physical, mental, and social health. Although it was developed for and mainly used in the context of drug and alcohol use, harm reduction is relevant for everyone and in many day-to-day situations. Let’s take a look at what harm reduction is, then see why we should all apply this approach to our client care.

Principles of harm reduction

BC Harm Reduction Strategies & Services (2011) describes six principles of harm reduction. They are pragmatism, human rights, focus on harms, maximizing intervention options, prioritizing immediate goals, and involving drug users. Let’s take a look at each of these.

Pragmatism

• Pragmatic: dealing with things realistically and by considering the practicality of a situation
• Drug use is complex, has many facets, and occurs along a continuum
• There are pros and cons to non-medical drug use for an individual and the society they live in
• Drug use is universal–it happens across the world

Human rights

• Respect for human beings’ right to make their own choices
• Avoid forming judgments about people’s choices
• Emphasis on basic human dignity and rights
• Personal choice based on informal decision-making, responsibility, and management

Focus on harms

• Prioritize minimizing the harms of drug use regardless of amount of drug use
• Shift focus away from decreasing the actual use of drugs (like abstinence-based methods)

Maximize intervention options

• Recognize individuality
• No “one size fits all” approach

Priority of immediate goals

• Focus on most immediate needs
• Meet the person “where they’re at”–starting interventions at an appropriate stage for the person

Drug user involvement

• People who use drugs are the best source of information for drug use
• They are the “experts”
• Active participation is the heart of harm reduction work

How is harm reduction useful?

Harm reduction recognizes that certain human behaviors are inevitable even though they have consequences. People cannot be forced to change against their will. However, they can be educated on those risks and taught ways that they can be safer and healthier. For example, there were 152,847 injuries related to car accidents in 2018 in Canada. Clearly, driving can lead to injury or even death. Does this mean we should stop people from driving? No. With harm reduction, we can minimize risk by putting speed limits in high risk areas and require passengers to wear seat belts.

Harm reduction is relevant to nurses and other clinicians who don’t work in the area of mental health and additions. In healthcare, we see people every day who do things that very obviously contribute to the decline of their health. For example, a patient that struggles with obesity and disordered eating can be taught healthy coping strategies when feeling the urge to binge eat, rather than expecting them to completely turn around their diet (see: Harm reduction principles of healthcare settings).

We see over and over again that imposing strict rules on people does not yield the intended results. Children rebel against rules, and adults become demotivated when they don’t have a say. As a result, we need to identify approaches to mental health and physical health care and select an approach that fits the client best. Harm reduction should certainly always be an option.