In harm reduction programs there are usually three components for creating policies, procedures, and programs – ethics, experience, and evidence.
To build policies, procedures, and programs in line with harm reduction best practices and ethics, they must always be grounded in the principles of harm reduction. These principles were developed over a period of about four years in the 1990s amid much debate among early harm reductionists who came to consensus on these enduring principles:
Principles of Harm Reduction
1997 Harm Reduction Coalition
(Initially acting as the Harm Reduction Working Group)
- Accepts, for better and for worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.
- Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence and acknowledges that some ways of using drugs are clearly safer than others.
- Establishes quality of individual and community life and well-being–not necessarily cessation of all drug use–as the criteria for successful interventions and policies.
- Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
- Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.
- Affirms people who use drugs themselves as the primary agents of reducing the harms of their drug use and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.
- Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.
- Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.
From these principles, harm reduction leaders can address some of the more ethically challenging aspects of providing services to vulnerable, stigmatized populations who have historically been the recipients of “services” that actually reinforce the structural violence they face.
Leaders in harm reduction report testing policies and procedures against the Principles of Harm Reduction as a way to avoid reinforcing structural violence and to build programs in line with harm reduction best practices. As a part of these principles, ensuring that people who use drugs and others receiving services are included in decisions is essential for policy creation in harm reduction.
After checking for alignment with the Principles of Harm Reduction, the next most important test of any potential policy or procedure is its basis in the practical experiences of folks working on the ground and the lives of participants. Policies should never be created that would exclude them from services, undermine the value they get from services, or cause undue hardship for those directly providing services because of the practical realities of service provision or participants’ lives.
Finally, the best policies and procedures in harm reduction rely on peer-reviewed evidence. Peer-reviewed evidence means that something has been evaluated and critiqued by researchers and experts in the same field before the information is published.
In harm reduction, of course, practice has always preceded research. Activists whose intuition told them that reducing harm was better than letting people die were handing out syringes before the research caught up to them. At the same time, harm reduction has also always followed research – abandoning practices such as bleaching syringes that have not shown strong peer reviewed evidence of utility. Evidence from within the agency, in the form of program evaluation, is also used by harm reductionists to edit and improve programs and policies.