Changing Harm Reduction Approaches Is Not a Choice; It Is Necessary to Survive


avatar Shahram Naderi ORCID 1 , avatar Nader Charkhgard ORCID 1 , * , avatar Peyman Rad ORCID 2 , avatar Sara Jafari 3 , avatar Saman Niknejad 4

School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
Aja University of Medical Sciences, Tehran, Iran
Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
Department of Low, Tehran University, Tehran, Iran

how to cite: Naderi S , Charkhgard N, Rad P, Jafari S, Niknejad S. Changing Harm Reduction Approaches Is Not a Choice; It Is Necessary to Survive. Int J High Risk Behav Addict. 2023;12(3):e139609.


Service providers have tried to reduce harm reduction and objectively improve health and infectious indicators caused by the consumption of illegal drugs for years. However, some disappointment has happened to these people. On the other hand, policymakers and society still need to remember the efforts of harm reduction service providers or have more and higher expectations in this regard. This article looks at the services and achievements of harm reduction from the past to the present. Also, it discusses the new harm reduction methods that align with today's needs of the global community. Today, a new mission is needed for harm reduction and other goals, such as mediation and human rights issues related to disease and addiction. The undeniable success of harm reduction in curbing and controlling many infectious aspects has caused policymakers and harm reduction service providers to become weak and need clarification. It has plunged harm reduction into a halo of uncertainty. There is a need to give new life to this dynamic thinking by redefining harm reduction.

1. Background

Harm reduction has a long history, but it is not very old in its classic form, which is primarily of interest to healthcare providers (1). The history of harm reduction can be traced back to the 1980s when the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic was spreading quickly among injection drug users (IDUs) in numerous parts of the world (2). At that time, viable medications were needed for HIV/AIDS, and numerous individuals were passing on from the disease. In reaction, activists and healthcare providers started pushing for harm reduction strategies to anticipate the spread of HIV among IDUs. Harm reduction strategies quickly found their way into healthcare systems. They enabled therapists to objectively measure the measurable statistics on preventive and treatment activities in addiction disorders, HIV, and sexually transmitted diseases. Policymakers were also impressed by the outstanding achievements of harm reduction at that time (3). Harm reduction needs to be acknowledged more broadly by governments and healthcare suppliers worldwide (4). Numerous nations presently have national harm reduction policies or rules, and harm reduction interventions are regularly included in broader open well-being activities. Harm reduction reached the set goals (5), but the policymakers expect further achievements, which has imposed double pressure on harm reduction service providers and has caused them some frustration (6, 7). Policymaking in the field of harm reduction seems to have the Cobra effect.

2. Cobra Effect on Addiction Disorders Policies

The Cobra effect might be a wonder that happens when a proposed course of action to a problem ends up making the issue more complicated (8). The Cobra effect may occur in various settings, such as money-related (9), administrative (10), and social (11) issues. It can happen when an approach or methodology arranged to comprehend an issue has unintended consequences, exacerbating the problem. The Cobra effect serves as a cautionary story for policymakers to carefully consider the potential unintended consequences of any proposed courses of action for issues. We are in a period of history where new approaches are necessary in the field of harm reduction. In this transition period from the classical form of harm reduction to its new form, the policymakers may face a Cobra effect, and all the harm reduction achievements are affected or destroyed.

3. Systemic Thinking is Needed Today

System thinking can be critical in recognizing unused targets for harm-reduction endeavors (12). It incorporates understanding complex interrelationships and input circles inside a system and how they contribute to system behavior. This approach can help to recognize the root causes of issues and make more compelling courses of action (13). In terms of harm reduction, systemic thinking can help recognize the essential components that contribute to drug-related harm and find unused targets for harm reduction endeavors. Instead of only centering on providing sterile needles and syringes to control disease spread, systemic thinking can help identify other factors contributing to drug-related harm, such as desperation, social division, and mental prosperity issues. By tending to these principal factors, harm-reducing endeavors can be more fruitful in diminishing drug-related harm.

Moreover, systemic thinking can help determine the potential unintended outcomes of harm reduction endeavors. For outline, giving sterile needles and syringes may decrease the spread of ailments. However, if the patient considers the syringe and needle exchange program as an incentive, it will encourage the patient to use more. By understanding the interrelationships and feedback circles in a system, harm reduction endeavors can be laid out to play down unintended consequences and maximize positive results.

Overall, systemic thinking can assist in recognizing novel targets for harm-reducing efforts and ensure that harm-reduction endeavors are compelling and prudent over the long term. By taking an inclusive approach to harm reduction, systemic thinking can help to address the fundamental components contributing to drug-related harm and develop the prosperity and well-being of individuals who use drugs and the community.

4. New Targets for Harm Reduction

Human rights and mediation are unused targets that can be included in harm-reducing endeavors (14). Human rights imply the elemental rights and adaptabilities entitled to all individuals, regardless of their race, the right to life, prosperity, and non-discrimination. Mediation insinuates the strategy of settling clashes or wrangling between parties through an impartial third party (15). In harm reduction, advancing human rights can help ensure that people who use drugs are not subject to partition, violence, or other mishandling. Harm reduction programs, as they should pay attention to patients (drug users), should also support organizations and providers of services to these patients and somehow provide legal immunity for harm reduction service providers. Intervention can also play a role in harm-reducing endeavors by contrasting to resolve clashes or wrangling between individuals who use drugs and the community (13). There is a conflict between people who use drugs and adjacent tenants, and an intermediary action can help to energize a talk and find a course of action commendable to both parties. This will be useful for decreasing the risk of harm to individuals who use drugs and developing a more calm and concordant community.

5. Conclusions

In conclusion, solidifying human rights and intercession into harm reduction endeavors can help address essential factors contributing to drug-related harm and develop a more comprehensive and fair-minded approach to harm reduction. By progressing human rights and utilizing interventions to resolve clashes, harm-reducing endeavors can be more effective in progressing the prosperity and well-being of individuals who use drugs and society.

The focus of harm reduction on the fundamental rights of patients and mediation can be effective in identifying patients with these disorders and introducing a new approach to providing services to them. Harm reduction is a thought that needs dynamics and evolution. If our harm reduction thinking does not evolve, we will fall behind the virtual civilization, and all the achievements of harem reduction will be lost quickly.


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