Substance use, and the context of substance use, can cause harms to both individuals and communities. Rather than any particular policy or program, harm reduction is a perspective that recognizes these harms and supports policies and programmes aimed at reducing them. It is a pragmatic response that focuses on minimizing death, disease, injury, violence and crime, and improving health, social functioning and connectedness. 

A harm reduction perspective recognizes a spectrum of substance use that ranges from beneficial to problematic.  For millennia people have used psychoactive substances for a variety of reasons that include:

• managing physical or psychological pain,
• celebrating and enjoying life with friends and family, and 
• pursuing meaning or gaining spiritual insight.

A harm reduction perspective acknowledges that these uses often have positive consequences, but it is mindful of the reality that the use of psychoactive substances increases the risk of real harm to the individual user and others.

People use drugs when the perceived benefits outweigh the expected harms in their particular circumstance. For some people, their substance use provides real benefit and has minimal harm (side effects) associated with it. Others may be unaware of the potential for harm associated with their substance use or of other ways to achieve the benefits they seek. For still others, substance use may be the best option available to them to meet their needs despite experiencing significant harm.  A few may even use substances in order to harm themselves (for them harm has become a benefit). By focusing on harm and the potential for harm (risk), a harm reduction perspective meets people where they are at and helps them make more informed and effective choices ands seeks to adjust the environment so as to change the range, likelihood and impact of choices.

This perspective is commonly used in relation to other potentially harmful substances and behaviours.  For example, we all recognize that motor vehicles provide benefits. We also understand that motor vehicles contribute to environmental damage and, in certain circumstances, accidents occur that can result in physical injury or even death. The effects are devastating to the families and communities of those involved and have an economic impact on the larger community.  Using a harm reduction perspective, several strategies have been implemented, including:

• Enforcing speed limits and other road safety regulations encourages driver choices that reduce the likelihood of accidents occurring
• Mandating the use of seatbelts encourages choices which help reduce the extent of physical injury in the case of an accident
• Improving highway design reduces the likelihood of accidents or injury even when drivers make poor choices
• Developing hybrid and electric cars reduces the impact of mass commuter choice to drive to work rather than take public transit
• Teaching children at a young age to look both ways before crossing the street helps keep pedestrians safe

One can debate and evaluate  the relative value of these and other harm reduction strategies. Each of them, however, begins with an acknowledgement of both the benefits and harms associated with the use of motor vehicles and seeks to reduce the risk of a specific harm.

As we apply this thinking to addressing the harms related to alcohol and other drugs, a similar range of strategies involving health and social services, regulation and enforcement, and educational programs needs to be considered and implemented.