Harm reduction is an evidence-based prevention strategy that aims to minimize the negative impacts of drug and alcohol use without requiring abstinence or relying on punitive approaches. Rather than judging or penalizing individuals who use drugs or alcohol, harm reduction keeps them engaged in care. Additional benefits include helping prevent the spread of infectious diseases such as HIV and hepatitis C virus (HCV), decreasing costly emergency care utilization, and building trust through proactive, non-judgmental engagement. This trust can strengthen connection to health care and support services.

How is harm reduction used for people who use substances?

The National Harm Reduction Coalition defines harm reduction as a practical, person-centered approach to minimize the harms associated with drug use. As both a philosophy and practice, harm reduction offers a compassionate approach for responding to substance use in communities and can take many forms depending on the setting and goals of the people served.

While harm reduction is most commonly integrated into community-based harm reduction programs, such as syringe access programs, its principles are increasingly being used in all settings where people who use drugs receive care, including hospitals, emergency departments, safety net health centers, outpatient and inpatient behavioral health treatment programs, residential treatment programs, and other health care settings. Successful integration across sectors requires buy-in, collaboration, and staff training at all levels to develop a shared plan and vision for positive, equitable outcomes.

Harm Reduction in Clinical Practice

For health care providers, harm reduction may include:

• Offering non-judgmental, respectful care regardless of a person’s substance use;
• Providing education on overdose or overamping;
• Encouraging safer use practices, such as using with a group, quantifying the amount of drugs or alcohol consumed, and staying hydrated;
• Supporting patient-led changes in substance use, such as reducing use or adjusting patterns of alcohol consumption;
• Co-prescribing naloxone when prescribing opioids (for pain or otherwise) and providing or supporting access to safer use supplies; and
• Prescribing or referring patients to evidence-based treatments, such as medications for addiction treatment (MAT) and contingency management.

Harm Reduction at the Organizational Level

For health care systems and provider organizations, harm reduction may involve:

• Training staff across roles in harm reduction principles to support consistent, person‑centered care;
• Establishing low-barrier programs, such as Bridge Models, to expand access to medications for opioid use disorder (MOUD) and linkages to care; 
• Expanding access to safer‑use supplies — such as naloxone, clean needles, syringes, and fentanyl test strips — and removing punitive policies that limit access to services or treatment;
• Partnering with community-based harm reduction organizations to share expertise and co-locate services;
• Hiring people with lived experience to support outreach and care delivery; and
• Engaging patients or clients in organizational culture change efforts.

What funding is available for harm reduction?

Historically, harm reduction services have been supported by a combination of federal, state, and local resources. Available funding varies widely between states based on evolving priorities. State laws and regulations on harm reduction, particularly around syringe distribution, can also vary widely. It is important that health care providers and community-based harm reduction organizations have a clear understanding of state and local laws and regulations to use available funding effectively and appropriately.

Partnering with State and Local Agencies

States receive funding from various federal agencies to support a wide range of substance use prevention and treatment activities, including harm reduction. The two primary federal funding sources are the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention (CDC). State agencies, such as departments of health or human services, then regrant portions of federal funds to provider organizations and/or community-based organizations to support the implementation of substance use and harm reduction services.

Some states also provide state or county funding to support harm reduction services. This funding is an important complement to federal resources because federal law currently prohibits the use of federal funds to purchase syringes.

Health care organizations can partner with state agencies to use federal funding to implement harm reduction services in health care settings. They can also collaborate with community-based harm reduction organizations to develop more comprehensive substance use care continuums within local and regional care ecosystems. Health care and harm reduction providers, particularly those with lived experience of substance use, can play a critical role in informing states’ strategic investment in substance use services and policy development based on their expertise and familiarity with community needs.

Opioid Settlement Funds

Through legal settlements with opioid manufacturers and distributors, states and local jurisdictions have collectively been awarded at least $50 billion to address the impacts of the opioid epidemic and help prevent future overdoses. States vary in how settlement funds are distributed, with differing decision-making authority at state and local levels. Since counties and municipalities have some discretion over settlement spending in most states, health care providers can partner with local government agencies to advance harm reduction initiatives. Given the magnitude of these funds, and the flexibility of allowable uses, including harm reduction, opioid settlement dollars represent an unprecedented opportunity to support collaboration and innovation among health care and harm reduction providers.

What is the evidence for harm reduction?

The following resources provide evidence to support the use of harm reduction for people who use drugs and alcohol.

• Harm Reduction: The Neglected Pillar of US Drug Policy: This resource summarizes the evidence for harm reduction interventions, the impact of these services on the populations served, as well as the policy environment that impacts harm reduction. More specifically, it highlights the value of programs that distribute safer use supplies, drug checking programs, and safer supply interventions.
• Cost-Effectiveness of Syringe Service Programs, Medications for Opioid Use Disorder, and Combination Programs in Hepatitis C Harm Reduction Among Opioid Injection Drug Users: A Public Payer Perspective Using a Decision Tree: This study explored the cost-effectiveness of three alternative approaches to reducing HCV transmission among people who inject opioids, including: (1) syringe services programs (SSPs), (2) MOUD, and (3) SSPs and MOUD combined. It found that SSP, MOUD, and SSP-MOUD combination programs are cost effective compared to no intervention programs.
• Naloxone Prescribing Associated with Reduced Emergency Department Visits in the Military Health System: This retrospective study analyzed the odds of an emergency department (ED) visit 60 days after an opioid was dispensed among those who were and were not co-dispensed naloxone. It found those who received naloxone had a statistically significant lower odds of ED utilization in the study period.
• Cost-Effectiveness of Full and Partial Opioid Agonists for Opioid Use Disorder in Outpatient Settings: United States Healthcare Sector Perspective: This study modeled a cost-effectiveness analysis of three types of MOUD and counseling in outpatient and opioid treatment program settings. It found that outpatient MOUD led to improved quality of life, life expectancy, and that some types of MOUD were cost-effective in both treatment settings.

What resources can support the adoption of harm reduction?

The following resources offer practical information to support the adoption of harm reduction into health and social care settings.

• The ABCs of Harm Reduction: A Toolkit for Hospitals: This toolkit offers guidance for hospitals to better deliver care to people who use drugs through harm reduction strategies, tools, and interventions.
• Harm Reduction is Healthcare: Sustainable Funding for Harm Reduction Programs: This toolkit explores health care financing options and sustainable funding opportunities — such as Medicaid reimbursement or partnerships with health systems — to strengthen harm reduction services.
• National Harm Reduction Coalition: Start a Harm Reduction Program: This step-by-step tutorial supports stakeholders interested in implementing a harm reduction program and includes tools to gauge community readiness and understand existing state law. It also includes practical training guides and other resources to get started.
• Meeting People Where They Are: Implementing Hospital-Based Substance Use Harm Reduction: This article outlines how a hospital-based addiction program partnered with a community-based harm reduction program to integrate harm reduction education and supplies into addiction care.