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Harm Reduction: Findings from the Field

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Date: May 07, 2024
Categories: Prevention, Substance Use

In 2022, the Substance Abuse and Mental Health Services Administration (SAMHSA) funded 25 awards for its inaugural Harm Reduction Grant Program. Harm reduction is nested throughout the continuum of prevention, treatment, and recovery, with a service model that is strategic, practical, and transformative.

SAMHSA defines harm reduction as a practical and transformative approach that incorporates community-driven public health strategies — including prevention, risk reduction, and health promotion — to empower people who use drugs and their families with the choice to live healthier, self-directed, and purpose-filled lives. Harm reduction centers the lived and living experience, especially those in underserved communities, in these strategies and the practices that flow from them.

In 2022 and 2023, SAMHSA staff visited 15 harm reduction grant recipients in states with the highest number of these grantees (California, New York, Texas, and Florida). The site visits aimed to enhance rapport with grant programs’ key staff, provide programmatic support, observe service delivery models, engage with members of the local community, and expand practical knowledge of program implementation.

Visiting SAMHSA funded sites across various contexts allowed us to witness the many ways community-driven, person-centered approaches have expanded access to harm reduction services. My key take-away from our visits: it is important for SAMHSA to support the people who show up every day in their communities to carry out our shared mission. What resonates most with me is the promise that harm reduction holds: to help address the gaps (in inequities and circumstances) that place many people at higher risk for overdose and infectious disease.

When doing harm reduction work, it is important for all of us to keep in mind that individuals’ life experiences are unique, complex, and dynamic. As a useful analogy, think about comparing people and combination locks: just as each lock has a different code (made up of various numbers), each person has a different code (made up of a variety of environmental conditions, economic factors, personal support systems, and life experiences, such as adverse childhood experiences and trauma). Much like people, combination locks require specific information to unlock them. Each person holds the details needed to inform the harm reduction strategies and interventions best suited to support them. Listening, with cultural humility, assists with learning the code.

Harm reduction is a key pillar in the U.S. Department of Health and Human Services’ Overdose Prevention Strategy, and is incorporated in SAMHSA’s Strategic Plan. Harm reduction promotes a philosophy of hope and healing. It is one essential component of a comprehensive strategy (including prevention, treatment, recovery, and health promotion) to prevent overdose and save lives.