Ask A Professional: Harm Reduction

This is the first interview in what I hope will become a series. I want to talk to people whose lives are involved with different aspects of the PRSL mission to get better understanding and perspective. Today I spoke with Claire, a Licensed Clinical Social Worker, about harm reduction. Questions and answers have been edited for clarity.

B: Hi! Thanks for taking the time to talk to me. Can you tell me about your background and your experience with harm reduction?

C: Hi! I’m Claire, I’m a fully licensed clinical social worker in six states, including the DMV and I work with DC clients as well as remotely with clients elsewhere. Harm reduction is something I think should be essential to the practice of any good mental health professional and I absolutely use it in my practice to keep my clients safe during different stages of change.

B: What is a good working definition of harm reduction? What is the goal?

C: Harm reduction is basically based on the understanding that every human being is worthy of respect and dignity, but may not be completely ready to stop or change a behavior yet and that’s okay. My job as an individual therapist is not to judge, it’s to help people exactly where they are. Harm reduction is the practice of helping people reduce the risk of risky behaviors if they aren’t ready to stop yet. It might sound a little strange, but it is a beautiful thing in practice. Through a harm reduction model, we are prepared, providing safety, and preserving the most clinic like settings to behaviors that may be considered taboo, illegal, or vilified by traditional societal standards. What does that mean? Harm reduction looks like clean needles and needle exchanges for those addicted to heroin or other injected substances. It is providing Fentanyl test strips so a college kid who wants to try ecstasy one time doesn’t accidentally die of an overdose to a substance he didn’t intend to take. It’s providing sex workers with condoms so that clients can never say they didn’t have them and transmit STIs or STDs. When we remove stigma, we don’t just see people, we have the ability and the opportunity to keep them safe and hold them in community.

B: Harm reduction can sometimes be controversial. Can you talk a bit about why? How would you respond to someone who objects to harm reduction policies? Is there clinical proof that harm reduction works?

C: Harm reduction can become controversial when people say they don’t want their “taxpayer dollars” keeping these terrible people addicted/in the sex industry/having access to drugs. But they say that until it’s someone they know. Or until it applies to them. Or until their kid dies in college because they were accidentally exposed to Fentanyl. Because the truth is that harm reduction works. It decreases criminal activity and saves lives. It protects the vulnerable and the marginalized. It gives choices to women. It is safer, better for everyone, and cheaper to keep a person out of the incarceration system because of a nonviolent offense. A lot of the time harm reduction is met with controversy because it takes the "War on Drugs", calls for a peace treaty, and drags the "seedy underbelly" that some people believe should be kept away from the pearl clutchers of the world out into the open. But what we do know is that harm reduction models WORK. Not only do they work, but they cost less money than "fighting" against drug use, prevent drug deaths and overdoses, and reduce overall crime in the areas where the programs are available. So to answer two questions in one, what would I say to someone who opposes harm reduction? I would tell them that not only does it work, but it works in their best interest. Also, I'd come with receipts - see the attached references,* which are just the tip of the iceberg for the many studies done on harm reduction.

B: PRSL provides Narcan, test strips for drugs and drinks, and sexual health supplies (plan b, condoms). What else can we do? What would you put in a harm reduction kit, if you were making one?

C: I love Narcan. Naloxone is the generic name and it is a drug used to interupt the binding mechanism of opioids in humans. It works almost instantaneously. An opioid overdose often leads to death when the opioid binding causes relaxation to the point where muscles of the diaphragm no longer work and breathing stops. ALL Narcan kits should come with Nitrile gloves and a one way mouth-to-mouth mask. Put your gloves on before touching someone who may have overdosed because Fentanyl can pass through skin-to-skin contact. Oftentimes, CPR must be performed. Additionally, two doses are provided because sometimes two doses are needed before an ambulance can arrive and the binding mechanism is properly disrupted to allow the patient to breathe again. I love test strips, again always provide instructions. Plan B and condoms, FANTASTIC! I always make sure that I also have pregnancy tests on hand to provide for clients who are unsure if they are pregnant. I also carry tampons and pads for clients who have a menstrual cycle in case they are in need. This might seem small, but it's actually lifesaving for some people. Hygiene products that come in contact with blood are a part of harm reduction (Bandaids count, shower wipes count, alcohol wipes count). Are these as controversial or "needed" in the community? Probably not, but they are needed. Diapers also - not that PRSL needs to provide everything for everyone! Just reminding people that any item that when used becomes a biohazard is often considered a harm reduction or a life-saving hygiene item. I do suggest Narcan kits: two doses, one set of gloves, and a one way CPR mask. 

B: What would be your “take home” about harm reduction?

C: The take home about harm reduction, always, is that it works. Harm reduction does not always require you to withhold judgment, but it does challenge you to do so. Harm reduction should be normalized, not stigmatized. Addiction is a mental illness, not a plague on society. Not only does harm reduction work for those receiving direct care and improve overall societal outcomes, but it is the most compassionate, financially responsible, and generally beneficial solution. Harm reduction is the human solution. It is the solution that stops looking at people as criminals and instead as people worthy of change. It encourages change by meeting people where they are and allowing them to get clean on their own terms, in safe, clinical environments. 

Harm reduction is how people heal.    

*Friedman, Nicholas MG, Caitlin A. Molina, and Melody J. Glenn. "Harm reduction and emergency medical services: opportunities for evidence-based programming." The American Journal of Emergency Medicine 72 (2023): 85-87. 

González-Ponce, Bella M., et al. "Harm reduction strategies among university students who use alcohol and cannabis, and related psychological variables: a systematic review." Journal of psychoactive drugs 54.5 (2022): 403-418. 

Levengood, Timothy W., et al. "Supervised injection facilities as harm reduction: a systematic review." American journal of preventive medicine 61.5 (2021): 738-749. 

Saloner, Brendan, et al. "Harm Reduction: The Neglected Pillar of US Drug Policy." Annual Review of Public Health 46 (2024). 

Wolfson, Lindsay, et al. "Examining barriers to harm reduction and child welfare services for pregnant women and mothers who use substances using a stigma action framework." Health & Social Care in the Community 29.3 (2021): 589-601.