Harm Reduction Teaching activities and resources

Harm reduction is a pragmatic public health approach to practices, programs, and policies that aim to reduce the adverse health, social, and economic consequences of substance use without requiring individuals to abstain from substance use (CNA, 2011; Rassool, 2010).

The aim of a harm reduction approach is to reduce the negative consequences of risky behaviours, including the harmful effects of substance use (CNA, 2011; Rassool, 2010). As such, a harm reduction response recognizes that substance use is a complex phenomenon that encompasses a continuum of behaviours, ensures a non-judgmental provision of care, and advocates for equal access to resources and services for care, regardless of drug use or engagement in other at-risk practices (CNA, 2011). It also focuses on promoting harm reduction within the communities that clients live in and in the areas and conditions where substances are used, rather than in contexts that are removed from these settings (Rassool, 2010).

The dangers associated with substance use are not minimized in a harm reduction approach, which also recognizes the realities of poverty, racism, social isolation, past trauma, and other social inequalities that affect a person’s vulnerability and capacity to deal effectively with substance-related harm (Rassool, 2010). According to RNAO’s (2015) Engaging Clients Who Use Substances, harm reduction:

• Is an alternative to the disease causation model of substance use.
• Accepts that at any given time some people are not ready to choose abstinence.
• Accepts that substance use occurs in society and works to minimize its harmful effects
• Accepts that people who are substance-dependent should have a voice in the creation of programs and policies designed to serve them
• Values patient autonomy.
• Does not exclude abstinence as an option (Beirness, Jesseman, Notarandrea, & Perron, 2008; CNA, 2011).

Nurses should integrate principles of harm reduction when working with clients who use substances and when treating those at risk for or experiencing a substance use disorder, according to RNAO’s Engaging Clients Who Use Substances (2015). Harm reduction principles and approaches can also be used to support individuals physical and mental health (e.g., from engaging in unprotected sex to refraining from driving after drinking).

Applying a harm reduction framework allows nurses to tailor their approach in order to meet clients “where they are,” establish goals collaboratively with the client, and develop a client-centred plan of care, while building trust and autonomy in the nurse–client relationship (RNAO, 2009). However, before integrating the principles of harm reduction, nurses must be aware of and address their own attitudes and biases (RNAO, 2015d).

For more information, see Resources.