11.0 Introduction
Chapter Introduction
As you have learned throughout this eBook, drug prohibition policies originating in the 20th century continue to negatively impact the health and well-being of people who use substances (PWUS) and people experiencing substance use disorders (SUDs). Rather than stopping or curtailing substance use, these costly policies have exacerbated harm to PWUS, their families and communities. A harm reductionist orientation to substance use, particularly around injection drug use, began to emerge in different parts of the world in the mid-1980s as a less costly and less harmful way to address the harms tied to substance use. Harm reduction (HR) initiatives have been the subject of extensive research and have grown and spread since that time. This chapter explores the principles and practices of harm reduction as they apply to substance use, substance use control polices, strategies and practices.
Chapter Objectives/Learning Outcomes
After completing the chapter materials, you should have an understanding of:
- The meaning and basis of HR.
- The science behind HR.
- The variety of HR programs and initiatives that exist.
- The rationale for expanding HR programs and for HR-oriented policy change.
- The importance of including people with lived and living experience (PWLLE) in the design, implementation and evaluation of substance-related policies and programs.
- The impact of HR interventions (upstream & downstream) on the social determinants of health (SDoH) of PWUS and people experiencing SUDs.
Questions to Think About When Completing Chapter Materials
- What did you know about harm reduction (HR) and HR approaches/programs prior to taking this course? What did you think of HR prior to completing this week’s material and the course more generally? In what ways has your opinion/perspective changed? Explain the change and why you think it occurred.
- What are the benefits and barriers to HR approaches and policies?
- In what way is the implementation of HR services/policies/approaches a matter of human rights?
- Why do you think governments have been reluctant to implement HR initiatives and policies, despite the research and evidence that demonstrate their effectiveness?
- What research and evidence would you use to argue in favour of HR policy and program implementation/expansion?
