Key strategies to reduce harm in drug use
There are 25 million Americans in recovery, all utilizing many pathways of recovery. And just as substance use disorder is unique to the individual, the pathway a person uses to achieve recovery must also be unique and specific to them.
Over the years, the majority of these pathways have promoted abstinence as the main outcome of recovery. But that is not an accurate reflection of all the options available. In recent years, we have seen an increase in people using medication-assisted recovery and strategies to reduce harm.
Rather than considering if someone is abstinent or not, looking at all types of recovery as a means of reducing harm is a much more effective and supportive way to support individuals in achieving their recovery goals. It also is grounded in our firm belief that in order to fully support people finding recovery, we need to meet them where they are.
There are a number of options available to reduce harm in drug use that may include medication-assisted recovery (pharmacotherapy), moderation management, or other pathways of recovery.
What is harm reduction?
While harm reduction is not explicitly a pathway of recovery, it is a means of reducing the harm associated with drug use.
According to the Harm Reduction Coalition: “Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”
Central to the principle of harm reduction is the acknowledgement that drug use and behavior is complex. While some drugs are clearly safer than others, the reality is that drug use is part of the world we live in. Rather than ignoring, condemning, and asserting that we need to “just say no” to drugs, we instead advocate to reduce the harmful effects of drugs.
Harm reduction involves meeting the person where they are and addressing their reasons for using and the conditions surrounding the person's drug use. A key outcome of harm reduction is establishing quality of individual and community life and well-being, but not necessarily achieving cessation of drug use.
The other principles of harm reduction include:
Establishing quality of individual and community life and well-being
Calling for the non-judgmental, non-coercive provision of services and resources for people who use drugs and the communities in which they live in order to assist them in reducing harm
Ensuring that those who use drugs, or those with a history of drug use, are routinely consulted to have a real voice in the creation of programs and policies designed to serve them
Seeking to empower people who use drugs to reduce the harms of their drug use, and help share information in supporting their peers and their specific conditions
Recognizing that 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
Not attempting to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use
Strategies for harm reduction
Specific ways that people who use drugs can reduce harm include:
Intravenous (IV) drug use can increase the risk of getting and transmitting HIV, viral hepatitis and other bloodborne infections if the needle isn’t sterile, or if it’s being shared with other people. People using IV drugs can also contract infections and experience other medical issues. Fortunately, syringe services programs (SSPs) are available throughout the US in various clinics and through pharmacies without a prescription. They provide the following services:
Safe disposal of used syringes in exchange for new syringes, on a one-for-one basis
Overdose rescue kits including naloxone, a drug used to reverse opioid overdose
Sharps containers for safe storage of used syringes
Risk reduction counseling
Safer sex supplies
Wound and abscess care
Referrals to medical and mental health care, shelter services, and alcohol and drug treatment.
Multnomah County organizations providing these services can be found here. They include Multnomah County Harm Reduction Clinic, Clackamas Service Center, and Menlo Park Plaza, Outside In, and Cascade AIDS Project.
Scientific research in this area demonstrates that when they are used effectively, medications to treat substance use disorder and alcohol use disorder have been shown to be an effective protocol and have provided successful long-term outcomes. The approach is supported by the FDA and Substance Abuse and Mental Health Services Administration.
The three most commonly used medications in pharmacotherapy include:
Methadone, an opioid agonist that does not block other narcotics while preventing withdrawal while taking it. It is taken daily via regulated clinics.
Naltrexone, an opioid antagonist that blocks the effects of other narcotics. It is taken as a daily pill or monthly injection.
Buprenorphine, an opioid agonist/antagonist that blocks other narcotics while reducing withdrawal risk. It is taken daily as a dissolving tablet, cheek film, or 6-month implant under the skin.
Check with your doctor to see which may be the right one for you.
Safe injection sites
Supervised Injection Sites (SISs) are medically supervised facilities where people can go to safely consume their drugs. The aim of such sites is to reduce the risk of death and transmission of diseases like hepatitis C or HIV, and to provide access to treatment services. They do this by providing clean needles, condoms, kits to treat infections, and naloxone kits. They also dispose of used needles and provide a safe space to use drugs under supervision so that overdoses can be reversed. The facilities also provide information about various health services and crucially substance use disorder treatment.
While highly controversial among critics — who argue that the sites encourage drug use and increase crime in the local community — studies show that SISs are associated with lower overdose mortality, a 67 percent decrease in ambulance calls, a decrease in communicable diseases like HIV, and an increased number of people who seek substance use disorder treatment. A review of a safe injection site in Vancouver, B.C., found that the city’s safe injection facility has been associated with “an array of community and public health benefits without evidence of adverse impacts.”
Currently, there are no SISs in Portland, but that may change as the state is advocating for greater access to treatment and resources for people with substance use disorder.
Treatment instead of jail
In Portland, there is a STOP Drug Treatment Court (Sanction-Treatment-Opportunity-Progress). This provides an option to those who have substance use disorder and related criminal charges. It affords individuals the opportunity to participate in treatment, with regular court monitoring appointments, instead of criminal proceedings that may result in other sanctions such as jail. These kinds of programs have been shown to be more successful at reducing criminal behavior and they cost less than traditional court proceedings.
Narcan, otherwise known as naloxone, is a drug administered by injection or nasal spray to reverse the effects of an opioid-related overdose. Increased advocacy in the harm reduction movement has resulted in the drug being more widely available, and in some instances it is given at the same time as an opioid prescription. It is available in most states without a prescription. Multnomah County Syringe Exchange Program offers overdose rescue kits containing naloxone. It is also available to friends and family members of those who use opioids. Visit the Oregon Health Authority to find a map of pharmacies that offer naloxone.
Good Samaritan laws
Good Samaritan law offers criminal protection for those who volunteer to help someone suffering with a drug-related overdose, providing protection from being implicated in a potential death or possession of illegal substances. All 50 states have some form of Good Samaritan laws that vary in protection and prevent potential parole violation or other criminal violations. For more information about the specific statute within each state, click here.
For more information about a range of medical and harm reduction services in Portland, visit Multnomah County Harm Reduction Page, or visit the Harm Reduction Clinic (details below).
Helpful harm reduction resources in Portland
Multnomah County Harm Reduction Clinic
12425 NE Glisan Street (in Menlo Park Plaza, behind Walgreens)
Monday and Thursday, 11 a.m.–7 p.m.
Services: wound care, syringe exchange, sexual health services, urgent care, Oregon Health Plan enrollment
Mobile Exchange (look for the white van)
Tuesday and Friday, 7–9 p.m., SE 82nd Ave and Ash St, one block off Burnside
Wednesday, 3–5 p.m., SE 190th Ave, between Division & Yamhill Streets
1219 SW Main St, Portland
Monday-Friday, 12–5 p.m.
*Outside In and Clackamas Service Center will exchange up to 100 syringes per client per day.
Their mission is to help homeless youth and other marginalized people move towards improved health and self-sufficiency. They are a service provider and a fully licenced mental health clinic. They also provide medical care such as birth control and family planning, physical exams, treatment of skin infections, syringe exchange, HIV/STI testing and counseling, chronic disease management, acupuncture and Chinese medicine, behavioral health, dental care, Oregon Health Plan assistance and advocacy, transgender health services, and syringe exchange.
8800 SE 80th Ave, Portland
Tuesday and Thursday, 1–4 p.m.
*Outside In and Clackamas Service Center will exchange up to 100 syringes per client per day.
Sisters of The Road
133 NW Sixth Ave
Portland, Oregon 97209
Sisters is open Tuesday-Saturday 10:00am-2:30pm.
Phone: (503) 222-5694
Purpose: Sisters of the Road is a nonprofit Cafe in Portland’s Old Town/Chinatown neighborhood working to create systemic change that will end poverty and homelessness by providing nourishing meals in a safe, dignified space.
This is a comprehensive list of resources including substance use disorder treatment information, legal contacts, housing resources, domestic violence support, and other crisis contacts.
Other helpful numbers:
If someone has overdosed, dial 911 immediately, try to start rescue breathing, and give naloxone if you have it.