Harm reduction principles for healthcare settings

Abstract

BackgroundHarm reduction refers to interventions aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely. The vast majority of the harm reduction literature focuses on the harms of drug use and on specific harm reduction strategies, such as syringe exchange, rather than on the harm reduction philosophy as a whole. Given that a harm reduction approach can address other risk behaviors that often occur alongside drug use and that harm reduction principles have been applied to harms such as sex work, eating disorders, and tobacco use, a natural evolution of the harm reduction philosophy is to extend it to other health risk behaviors and to a broader healthcare audience.MethodsBuilding on the extant literature, we used data from in-depth qualitative interviews with 23 patients and 17 staff members from an HIV clinic in the USA to describe harm reduction principles for use in healthcare settings.ResultsWe defined six principles of harm reduction and generalized them for use in healthcare settings with patients beyond those who use illicit substances. The principles include humanism, pragmatism, individualism, autonomy, incrementalism, and accountability without termination. For each of these principles, we present a definition, a description of how healthcare providers can deliver interventions informed by the principle, and examples of how each principle may be applied in the healthcare setting.ConclusionThis paper is one of the firsts to provide a comprehensive set of principles for universal harm reduction as a conceptual approach for healthcare provision. Applying harm reduction principles in healthcare settings may improve clinical care outcomes given that the quality of the provider-patient relationship is known to impact health outcomes and treatment adherence. Harm reduction can be a universal precaution applied to all individuals regardless of their disclosure of negative health behaviors, given that health behaviors are not binary or linear but operate along a continuum based on a variety of individual and social determinants.

A palliative care approach in psychiatry: clinical implications

“…In this context, it is also worth distinguishing palliative care in psychiatry from the concept of harm reduction [10], i.e., interventions aimed at reducing negative consequences of problematic behaviors such as substance use without necessarily fully extinguishing the underlying behaviors themselves [68]. Harm reduction techniques can certainly be applied as part of a palliative approach to mental health, as seen in the clinical scenarios described above.…”

Serving High-Risk Youth in Context: Perspectives from Hong Kong

“…Harm reduction was the therapeutic foundation described by all of the practitioners in their inventions with youth. The harm-reduction approach aims to reduce the negative effects of problematic behaviors without a focus on eradicating the behaviors (Hawk et al, 2017;Leslie, 2008). Building trust with clients by approaching and treating them directly and non-judgmentally is often the key for practitioners using the harm-reduction model of intervention (Ho, 2012;Logan & Marlatt, 2010).…”

“…The ecological approach to intervention was noteworthy, as practitioners consistently described engaging youth in various contexts. For harm-reduction and education-based interventions to be effective, the youth's environments and contexts must be considered (Hawk et al, 2017;Ho, 2012;Logan & Marlatt, 2010). Physical and social environments, as well as cultural, personal, temporal, and virtual contexts (AOTA, 2017), played a role in the practitioners' services to the youth.…”

Position Paper. Per un programma di eliminazione della Epatite C nella popolazione a rischio dei consumatori di sostanze e dei detenuti

“…In questo senso, le azioni di riduzione del danno hanno dimostrato di minimizzare la probabilità di reinfezione nella popolazione a rischio (Hawk et al, 2017). La situazione attuale in Italia pone in evidenza come importanti criticità ed ostacoli attualmente impediscono l'accesso alle cure per il trattamento dell'epatite C per le popolazioni a rischio.…”