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A Harm Reduction Framework

In December 2021, SAMHSA, the Centers for Disease Control, and the White House Office of National Drug Control Policy assembled more than 100 experts in the field of substance use for the inaugural Harm Reduction Summit. A primary initiative of the Summit was to develop a framework for harm reduction strategies. In the published framework, SAMHSA outlines the importance of harm reduction strategies, an overview of the framework, and next steps for advancing harm reduction initiatives.

As defined by SAMHSA, harm reduction is “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 healthy, self-directed, and purpose-filled lives. Harm reduction centers the lived and living experience of people who use drugs…, especially those in underserved communities, in these strategies and the practices that flow from them.” Examples of harm reduction strategies include syringe service programs, substance testing sites, and naloxone distribution. The framework cites research that demonstrate such strategies reduce risk of overdose, limit transmission of HIV and Hepatitis C, increase use of safety behaviors, and increase the likelihood of initiating substance use treatment. Notably, this framework highlights the importance of viewing substance use on a continuum and developing strategies that benefit individuals who have a wide range of use patterns, goals, and motivations related to use.

In the present framework, SAMHSA has identified six pillars, listed here, representing elements that should be included in harm reduction initiatives, programs, or services.

Harm reduction…

1) … is guided by people who use drugs and with lived experience of drug use.

2) … embraces the inherent value of people.

3) … commits to deep community engagement and community building.

4) … promotes equity, rights, and reparative social justice.

5) … offers lowest barrier access and non-coercive support.

6) … focuses on any positive change, as defined by the person.

Iin addition, the framework provides a list of twelve core principles that are linked to the six pillars, a list of six core practices areas, and examples and research evidence relating to harm reduction strategies that target safer practices, settings, access to healthcare, and transitions to care as well as practices for a sustainable workforce and infrastructure.

SAMHSA seeks input and revisions to this framework, particularly on social determinants of health and health inequities, and will accept comments through August 14, 2023 at 5:00 PM ET.

Source: Substance Abuse and Mental Health Services Administration (2023, April 24). Harm Reduction Framework (draft). Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. 25 pp.