In relation to drugs, harm reduction was at one point synonymous with public health initiatives, such HIV prevention efforts among people who use drugs – primarily through interventions such as needle and syringe programs and opioid substitution therapy.
- Harm reduction
Over time, however, the concept of ‘harm reduction’ widened to include societal and individual harms attributed to international drug control efforts (such as mass incarceration and human rights violations). Harm reduction has been embraced by the UN General Assembly2 and other UN human rights and health fora,3 by the International Federation of Red Cross and Red Crescent Societies,4 by PEPFAR,5 the Global Fund6 and other leading donors, and –in some way or another- by almost a hundred countries around the world, including about a dozen OAS Member States and the entire European Union.7 Nonetheless, the term ‘harm reduction’ remains controversial for the UN Commission on Narcotic Drugs, where its use in resolutions still draws resistance from certain Member States. PAHO’s Regional Strategy embraces the concept but also avoids the term itself, speaking instead about “support services to reduce the adverse consequences of substance use.”
- Harm reduction
WHO, UNODC, and UNAIDS have identified a basic ‘comprehensive package’ of evidence-based interventions for injecting drug users.9 Civil society groups have argued for the extension of this list of essential harm reduction services to include, inter alia, overdose interventions, advocacy for policy reform, stigma reduction, violence reduction, legal services, drug consumption rooms, and alternative development.10 The implementation of effective harm reduction measures for smokeable cocaine (crack, basuco, paco) in the Americas is still in an early stage, with several pioneering projects ongoing in Canada, the US, Brazil, Uruguay, Argentina, and Colombia.
- Harm reduction
Harm reduction is best implemented as a complementary pillar of a balanced drug policy response, alongside demand reduction and supply reduction. Advocates argue that it is a targeted, incremental, evidence-based, and cost effective approach.11 By acknowledging that many people throughout the world are unable or unwilling to stop their engagement in drug markets, harm reduction seeks to protect their health, human rights, dignity, and wellbeing as far as possible.
- Harm reduction