Harm Reduction Hacks


Harm Reduction Hacks (HRH) was written by Catherine Swanson, MPH of Balanced Imperfection, as commissioned by the National Alliance of State and Territorial AIDS Directors (NASTAD) Harm Reduction TA Center, under the direction, and with funding from, the Centers for Disease Control and Prevention (CDC). As the former founder and director of a syringe services program (SSP), Ms. Swanson was eager to take on this project in the hopes of saving others from some of the practical difficulties, especially those unique to harm reduction, that she faced as an emerging leader and syringe services provider.

Catherine Swanson

This overview represents the synthesis of the invaluable opinions, experiences, and knowledge of nearly 70 harm reduction leaders. The author and sponsors of Harm Reduction Hacks would like to gratefully acknowledge the harm reduction leaders, old and new, who took the time to sit down and share their insights and experiences in a series of unstructured conversations and focus groups. We hope we do them justice and, in turn, ensure that newer folks starting out in harm reduction can face some of the issues addressed here prepared with the hard-fought experiences and insights shared by these amazing leaders.

The author and sponsors would also like to acknowledge the research, assistance, discernment, and editing of both Simon Knaphus, JD, and Jae Rodriguez of Balanced Imperfection.

The author would also like to thank the sponsors of this project for allowing her to create the practical guide she would have salivated for as an inexperienced leader in this movement.

Finally, she, and everyone involved in providing Harm Reduction Hacks, would also like to acknowledge and share their gratitude for each and every person providing harm reduction services with kindness and compassion to vulnerable people.

The world is a better place because you are in it.


The hacks on this site are shared with you under a Creative Commons Attribution-ShareAlike 4.0 International licence. This allows you (with attribution) to adapt content for your own use, although we do ask you to then also allow others to have equal access to anything you develop. More details of this licence can be found on the Creative Commons website.


We do not claim that this is an exhaustive set of strategies, shortcuts, or tips for running an SSP. What we do suggest is that Harm Reduction Hacks offers down-to-earth, practical information for being a better leader, starting and running an SSP, and providing syringe access services. We feel we can say this with confidence because the Hacks are based on interviews with, and the experiences of, literally generations of people who have been doing harm reduction work.

Please note that nothing in this guide should be construed as legal advice. Please consult an attorney local to your area to ensure your program is in compliance with all local, state and federal regulations that apply to your situation. 

Harm Reduction Hacks site design and implimentation by Nigel Brunsdon

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