As one Municipal Drug Policy Coordinator states, "of all the four pillars, harm reduction is the most commonly misunderstood or misrepresented."   While almost everyone agrees with the goal of preventing and reducing harm, there can be disagreement about the use of harm reduction strategies in achieving this goal.   The following section responds to some of the common misunderstandings about harm reduction.  It is worth noting that in many communities these misunderstandings have been bridged through efforts to work together while listening to and respecting differences of opinon. 

Harm reduction enables substance use and entrenches addictive behaviour

Most of us want to reduce harm and help people who struggle with addiction get the help they need and desire. In an ideal world, there would be no harm and no addiction. It is unfortunate that everyone who is addicted to substances cannot enter a four week treatment program and stop using for good. The reality is that there are individuals who do not want to quit, cannot quit, or relapse into drug use, and harm reduction offers an approach that meets individuals where they are at in the cycle of change. In addition to effectively preventing HIV, hepatitis C and other drug related harms, harm reduction services such as mobile health units and needle exchange are often the first or only contact marginalized individuals have to the health and social service system. This contact can be vital in keeping them alive, improving their health and ultimately increasing the likelihood of taking steps to reduce or eliminate their use of substances. The harm reduction approach of ‘meeting people where they are at’ is helpful as a tool of engagement:

 “The harm reduction approach is as much a means of relationship building, getting people connected with programs and services, assisting them in taking better care of themselves and discovering new options and opportunities, and making positive changes to improve their quality of life and well-being as it is about safer drug(substance) use.” Learning from Each Other, Canadian Harm Reduction Network

Harm Reduction applies only to illegal drug users

For the past several years, there has been an unfortunate equation of harm reduction with injection drug use. This can be seen in the focus with the media and society on services such as needle exchanges, methadone replacement therapy and supervised injection sites as examples of harm reduction. While an often controversial term in the substance use realm, harm reduction is a philosophical underpinning of a variety of public health approaches to reduce harm to individuals, communities and society. Examples of harm reduction policies and strategies include policies developed to limit the harmful impact of automobile use, drinking and driving, and second hand smokes, for example, in measures such as seat belts, alcohol driving limits and policies prohibiting second hand tobacco use.

A broad conceptualization of harm reduction that acknowledges harms stemming from all substances – legal, prescription and illegal – is warranted. Harms include those to fetal, child, youth and family development; physical and mental health; personal safety and well-being; public safety and order; and environmental health.

Harm reduction drains resources from treatment services

For the most part, harm reduction services and programs are a practical, cost effective and feasible means to increase safety and health within communities. Harm reduction effectively prevents the spread of blood borne diseases. Further, harm reduction acknowledges that many people who use drugs don’t necessarily require treatment, for example many people are able to drink alcohol and not develop a substance use issue.  Nor do all substance users become regular users, as much use is exploratory, recreational and sporadic.[1] In these cases, the public may benefit from information to help them consume alcohol in a manner that is less harmful, for example to provide information that allows them to use in a safer manner.

Treatment, such as residential treatment centres and counselling, is an essential component of a continuum of care targeting individuals with who are ready to address their substance use problems. Harm reduction complements treatment, and is an equally essential component of a continuum of care by providing informal and non-clinical options to help individuals reduce their drug consumption or reduce the risks of their use. It recognizes the important of incremental steps towards positive change, as many people are able to “take multiple tiny steps rather than one or two huge steps.” In particular, harm reduction services provides an important opportunity to engage some of the most marginalized members of our society.

Harm reduction is the Trojan horse for decriminalization and legalization

Harm Reduction increases disorder and threatens public safety and health

Many harm reduction strategies focus on decreasing disorder and enhancing public safety and health. Alcohol harm reduction strategies, such programs designed to promote responsible alcohol consumption in bars, have been shown to reduce violence in communities. Needle exchange programs often recover more needles than they distribute, which means fewer needs discarded in the community. Supervised Injection facilities reduce the number of public injections by providing a safe, indoor alternative to open drug use.