When it comes to addiction treatment, the traditional approach has often been about aiming for total abstinence. But let’s face it—this one-size-fits-all method doesn’t always fit everyone’s reality. That’s where harm reduction comes in. It’s a more flexible, compassionate way of supporting people with substance use issues, recognizing that while quitting entirely is a fantastic goal, it might not be the first step for everyone. 

What’s Harm Reduction All About?

Harm reduction is a way of approaching drug use that focuses on minimizing the negative impacts rather than insisting on complete abstinence. It’s meeting people where they are at and giving them tools to make their lives safer and healthier. This can range from providing clean needles to offering safe spaces for drug use under medical supervision. The main goal? To reduce harm and improve overall well-being, not just to get people to quit drugs.

Why Bother with Harm Reduction?

1. It’s realistic and personal.  We are only human.  We have autonomy.   Pointing a finger and telling someone with a substance use disorder how to live their life isn’t impactful and is just…rude.  Not everyone is ready to stop using substances overnight. Not everyone’s goals are universal or what you may feel their goal should be.  Harm reduction is recognizing it is not your job to live someone else’s life.  Harm reduction meets people at their current stage and helps them take manageable steps toward better health. It’s about setting realistic goals and respecting where people are in their journey.  I often tell my patient’s “I am not here to tell a grown adult how to live their life, my goals are not yours, and at the very core, my job as an Addiction Doc is to help my patient die from something else, something not related to substance use, and hopefully waaay down the road.  This disease can be deadly and/or associated with lots of negative health issues, but utilizing harm reduction …well…reduces harm.
2. Less Stigma: Not only does harm reduction reduce the harmful health issues around substance use, it also reduces stigma.  As a Doc , I am embarrassed how poorly my medical education in the early 2000s prepared me in regards to addiction.  It wasn’t taught as a chronic disease, and certainly we didn’t learn about medication assisted treatment which is life saving.  I did not witness the “care” in healthcare.  My colleagues often asked why I wanted to work with “that population”. There is so much stigma in healthcare often my patients don’t want to go see a Doctor.  Let’s face it, people with substance use disorders know they have an issue – and I promise, having done this for over a decade, nobody is beating themselves up more than the individual dealing with their addiction.  There’s enough personal shame, the last place a patient with a substance use disorder wants to be met with stigma is by the health care provider they’re desperately seeking medical CARE from.  Society beats up people with addiction enough, a way to incorporate harm reduction in healthcare is quite simple – meet your patient where they’re at, educate yourself about addiction as a chronic disease, and about medication assisted treatment but at the core – just be kind.    The traditional approach to addiction can sometimes come with a lot of judgment and an authoritative, punitive approach.  If I point my finger at my patient and say “you need to do this, and stop doing that, because I’m the doctor” ( which is the classic approach), if I was the patient I’d walk right out with some choice words.   We can reduce stigma by simple changing our language.  Instead of “addict” consider a person with a substance use disorder.  Instead of describing drug screens as “clean” or “dirty” ( b/c I know a lot of filthy sober folks, and a lot of folks who choose to use drugs that are quite hygienic) use “drug screen absent or present of illicit substances”.  
3. Better Health Outcomes: Harm reduction practices, like needle exchanges and safe consumption spaces, have been shown to improve health outcomes. For instance, needle exchange programs help prevent the spread of diseases like HIV and hepatitis C, and safe consumption spaces can prevent overdose deaths.  Medication assisted treatment such as Methadone, Buprenorphine and Naltrexone are the gold standard treatment for Opioid Use Disorder and significantly reduce harm and save lives.  I am 100% certain that when a person with a history of a substance use disorder dies, whoever meets them at the pearly gates, is not handing out a gold medal if they twelve-stepped to the finish line and a silver if they utilized Medication Assisted Treatment !  What allows for function and reduces morbidity ( negative health consequences of a disease) and mortality ( death) cannot be argued with !
4. More Engagement: When treatment isn’t all about quitting cold turkey, people are more likely to stick with it.  In the Fentanyl era, quitting cold turkey is exceptionally challenging due to the pharmacology of the drug ( it really holds on tight to the opioid receptors in the brain).  Next time you get a chance, ask somebody that knows what it feels like to go through opioid withdrawal ( “dope sick”), they will paint an exceptionally colorful and uncomfortable description I can assure you , you don’t want to experience.  Medication assisted treatment allows someone to avoid withdrawal which is crucial if their goal is avoiding continued opioid use.  Harm reduction removes some of the pressures and barriers, making it easier for individuals to stay in treatment and make positive changes over time.  I see it every single day.  There is no doubt I am squeezing more good and lives saved out of my medical license practicing Addiction medicine through a harm reduction lens, then any other field of medicine I could engage in.  

At Mayrx, we embrace and utilize Practical Harm Reduction Strategies such as:

 Overdose Prevention: Distributing naloxone (Narcan) to reverse opioid overdoses and teaching people how to use it can save lives. Training on how to recognize and respond to an overdose is also crucial.

Education and Support: Offering tips on safer drug use, along with mental health support and counseling, can help individuals manage their substance use more effectively.

Comprehensive Services: Combining harm reduction with other treatments like medication-assisted therapy, counseling, and support groups in a stigma free, non judgmental atmosphere, creates a more rounded approach to recovery.