Harm Reduction = Public Health
Harm reduction made national headlines recently with a bill to block federal funds from purchasing safer smoking supplies and other equipment that would help protect drug user health. The controversy stemmed from longstanding general confusion about what harm reduction is and how it promotes public health.
Harm reduction is a public health approach to drug use that prioritizes the health of drug users, including persons who inject drugs, and seeks to reduce the likelihood of injury, illness, and death. Harm reduction can include the provision of safer smoking supplies, including heat-resistant glass stems and mouthpieces, help prevent the transmission of viruses, including hepatitis. Using damaged pipes also increases the risk of cuts to the lips or hands, increasing the chances of infection. Harm reduction is also practiced when a person uses safer sex supplies.
Harm reduction is also a social justice movement built upon respect for the rights of people who use drugs. Harm reduction currently operates in a legal and political climate where personal possession and use of drugs remains criminalized, increasing stigma and intensifying health disparities. Criminalization continues to drive mass incarceration at the state and federal levels. Hawai῾i law retains severe penalties for personal possession and enforcement has disproportionately impacted Native Hawaiian communities.
For over thirty years, Hawai῾i has had a publicly funded syringe exchange program (SEP) that has successfully kept the incidence of HIV low among persons who inject drugs and their intimate partners. In the most recent year, HHHRC’s administration of SEP distributed a record 1,182,624 syringes, with a slight increase in visits on the neighbor islands. 137 individuals were trained to deliver nasal naloxone (Narcan), which is used to reverse opioid overdoses. Since 2016, 1,204 individuals were trained to deliver naloxone, resulting in 46 reported overdose reversals.
HHHRC will continue to be an advocate for harm reduction and drug user health in its service programs and community advocacy efforts. The latter includes public education about the principles and practices of harm reduction, including the use of person-centered language around those who use drugs or have diagnosed substance use disorders.