harm reduction


Summary: The application of methods designed to reduce the risk of harm associated with certain behaviors without reduction in frequency of those behaviors. The risk-associated behaviors include ongoing and active addictive behaviors.

Top Publications

  1. De Vos A, van der Helm J, Matser A, Prins M, Kretzschmar M. Decline in incidence of HIV and hepatitis C virus infection among injecting drug users in Amsterdam; evidence for harm reduction?. Addiction. 2013;108:1070-81 pubmed publisher
    ..We examined possible explanations for these time trends, among which the implementation of harm reduction measures aimed at reducing the risk behaviour of IDU...
  2. Lambers F, Stolte I, van den Berg C, Coutinho R, Prins M. Harm reduction intensity-Its role in HAART adherence amongst drug users in Amsterdam. Int J Drug Policy. 2011;22:210-8 pubmed publisher
    ..DU in Amsterdam receive methadone within a harm reduction programme...
  3. Berg C, Carpenter M, Jardin B, Ostroff J. Harm reduction and cessation efforts and interest in cessation resources among survivors of smoking-related cancers. J Cancer Surviv. 2013;7:44-54 pubmed publisher
    ..Cancer survivors who smoke demonstrate actions toward harm reduction and cessation...
  4. Bowring A, Luhmann N, Pont S, Debaulieu C, Derozier S, Asouab F, et al. An urgent need to scale-up injecting drug harm reduction services in Tanzania: prevalence of blood-borne viruses among drug users in Temeke District, Dar-es-Salaam, 2011. Int J Drug Policy. 2013;24:78-81 pubmed publisher
    ..Rapid scale-up of targeted primary prevention and testing and treatment services for PWID in Tanzania is needed to prevent further transmission and consequent morbidities. ..
  5. Sami M, Timberlake D, Nelson R, Goettsch B, Ataian N, Libao P, et al. Smokers' perceptions of smokeless tobacco and harm reduction. J Public Health Policy. 2012;33:188-201 pubmed publisher
    Existing survey data indicate that most smokers are not receptive to harm reduction incentives of switching to smokeless tobacco (SLT). Little is known about the underlying reasons for these views...
  6. Lambdin B, Bruce R, Chang O, Nyandindi C, Sabuni N, Zamudio Haas S, et al. Identifying programmatic gaps: inequities in harm reduction service utilization among male and female drug users in Dar es Salaam, Tanzania. PLoS ONE. 2013;8:e67062 pubmed publisher
    ..Services have not been mobilized adequately to address the clear needs of females who inject drugs. A clear and urgent need exists for women-centered strategies that effectively engage female PWID into HIV prevention services. ..
  7. Lee H, Yang Y, Yu W, Su L, Lin T, Chiu H, et al. Essentiality of HIV testing and education for effective HIV control in the national pilot harm reduction program: the Taiwan experience. Kaohsiung J Med Sci. 2012;28:79-85 pubmed publisher
    In 2005, a national pilot harm reduction program (PHRP), which mainly included a methadone maintenance treatment program (MMTP) and a needle/syringe exchange program (NSP), was implemented in Taiwan...
  8. Ayo Yusuf O, Burns D. The complexity of 'harm reduction' with smokeless tobacco as an approach to tobacco control in low-income and middle-income countries. Tob Control. 2012;21:245-51 pubmed publisher
    To review the implications of recommending smokeless tobacco (ST) use as a harm reduction approach for low-income and middle-income countries (LMICs)...
  9. Noble D, Pronovost P. Underreporting of patient safety incidents reduces health care's ability to quantify and accurately measure harm reduction. J Patient Saf. 2010;6:247-50 pubmed
    ..Underreporting and the associated biases are a significant problem in realizing the epidemiological potential of incident reporting in health care. ..

More Information


  1. Macneil J, Pauly B. Needle exchange as a safe haven in an unsafe world. Drug Alcohol Rev. 2011;30:26-32 pubmed publisher
    ..The need for both fixed sites and the integration of harm reduction services as part of a broader network of primary health-care services was reinforced.
  2. Dutta A, Wirtz A, Baral S, Beyrer C, Cleghorn F. Key harm reduction interventions and their impact on the reduction of risky behavior and HIV incidence among people who inject drugs in low-income and middle-income countries. Curr Opin HIV AIDS. 2012;7:362-8 pubmed publisher
    ..HIV incidence among PWID in LMIC settings is avoidable with the implementation of immediate scale-up of key harm reduction and ARV treatment interventions...
  3. Rowe S, Wiggers J, Wolfenden L, Francis J. Establishments licensed to serve alcohol and their contribution to police-recorded crime in Australia: further opportunities for harm reduction. J Stud Alcohol Drugs. 2010;71:909-16 pubmed
  4. Frost Pineda K, Appleton S, Fisher M, Fox K, Gaworski C. Does dual use jeopardize the potential role of smokeless tobacco in harm reduction?. Nicotine Tob Res. 2010;12:1055-67 pubmed publisher
  5. Harris M, Rhodes T. Venous access and care: harnessing pragmatics in harm reduction for people who inject drugs. Addiction. 2012;107:1090-6 pubmed publisher
    ..Participants expressed an unmet desire for non-judgemental venous access information and advice. Harm reduction interventions which attend to the immediate priorities of people who inject drugs, such as venous access and ..
  6. Mejia A, Ling P, Glantz S. Quantifying the effects of promoting smokeless tobacco as a harm reduction strategy in the USA. Tob Control. 2010;19:297-305 pubmed publisher
    ..Some health professionals argue that snus should be promoted as a component of a harm reduction strategy, while others oppose this approach...
  7. Moro L, Rácz J. Online drug user-led harm reduction in Hungary: a review of "Daath". Harm Reduct J. 2013;10:18 pubmed publisher
    b>Harm reduction has been increasingly finding its way into public drug policies and healthcare practices worldwide, with successful intervention measures justifiably focussing on the highest-risk groups, such as injecting drug users...
  8. Sajadi L, Mirzazadeh A, Navadeh S, Osooli M, Khajehkazemi R, Gouya M, et al. HIV prevalence and related risk behaviours among female sex workers in Iran: results of the national biobehavioural survey, 2010. Sex Transm Infect. 2013;89 Suppl 3:iii37-40 pubmed publisher
    ..A combination of prevention efforts addressing unsafe sex and injection are needed to prevent further transmission of HIV infection. ..
  9. Erdman J. Harm reduction, human rights, and access to information on safer abortion. Int J Gynaecol Obstet. 2012;118:83-6 pubmed publisher
    A harm reduction and human rights approach, grounded in the principles of neutrality, humanism, and pragmatism, supports women's access to information on the safer self- use of misoprostol in diverse legal settings...
  10. Barrio G, Bravo M, Brugal M, Diez M, Regidor E, Belza M, et al. Harm reduction interventions for drug injectors or heroin users in Spain: expanding coverage as the storm abates. Addiction. 2012;107:1111-22 pubmed publisher
    ..of need and coverage of needle-exchange programmes (NEPs) and opioid substitution treatment (OST) to assess harm reduction policies targeting drug injectors or heroin users. Multiple methods applied to secondary data. Spain...
  11. Smyrnov P, Broadhead R, Datsenko O, Matiyash O. Rejuvenating harm reduction projects for injection drug users: Ukraine's nationwide introduction of peer-driven interventions. Int J Drug Policy. 2012;23:141-7 pubmed publisher
    ..drug users (IDUs) was implemented in five Ukrainian city-sites to test-pilot its effectiveness in rejuvenating harm reduction (HR) projects that had become moribund...
  12. Turner K, Hutchinson S, Vickerman P, Hope V, Craine N, Palmateer N, et al. The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction. 2011;106:1978-88 pubmed publisher
    ..41, 95% confidence interval (CI): 0.21-0.82 and 0.48, 95% CI: 0.25-0.93, respectively]. Full harm reduction (on OST plus high NSP coverage) reduced the odds of new HCV infection by nearly 80% (AOR=0.21, 95% CI: 0.08-0...
  13. Parker J, Jackson L, Dykeman M, Gahagan J, Karabanow J. Access to harm reduction services in Atlantic Canada: implications for non-urban residents who inject drugs. Health Place. 2012;18:152-62 pubmed publisher
    ..relatively little about the challenges injection drug users (IDUs) living in such places face in accessing harm reduction services...
  14. Alistar S, Owens D, Brandeau M. Effectiveness and cost effectiveness of expanding harm reduction and antiretroviral therapy in a mixed HIV epidemic: a modeling analysis for Ukraine. PLoS Med. 2011;8:e1000423 pubmed publisher
    ..Our findings are potentially relevant to other settings with mixed HIV epidemics. Please see later in the article for the Editors' Summary. ..
  15. le Houezec J, McNeill A, Britton J. Tobacco, nicotine and harm reduction. Drug Alcohol Rev. 2011;30:119-23 pubmed publisher
    ..Most toxicity due to cigarette smoking is related to the burning process. Models of harm reduction applied to tobacco suggest that use of non-combustible, less toxic, nicotine-containing products as a ..
  16. Lalmuanpuii M, Biangtung L, Mishra R, Reeve M, Tzudier S, Singh A, et al. Scale-up of a comprehensive harm reduction programme for people injecting opioids: lessons from north-eastern India. Bull World Health Organ. 2013;91:306-12 pubmed publisher
    b>Harm reduction packages for people who inject illicit drugs, including those infected with human immunodeficiency virus (HIV), are cost-effective but have not been scaled up globally...
  17. Geiger Brown J, Trinkoff A. Is it time to pull the plug on 12-hour shifts? Part 3. harm reduction strategies if keeping 12-hour shifts. J Nurs Adm. 2010;40:357-9 pubmed publisher
    ..This article presents strategies for mitigating the effects of 12-hour shifts for nurses who continue to work 12-hour shifts despite the potential risks to their health and to patient safety. ..
  18. LIN S, Fonteno S, Weng J, Talbot P. Comparison of the toxicity of smoke from conventional and harm reduction cigarettes using human embryonic stem cells. Toxicol Sci. 2010;118:202-12 pubmed publisher
    This study evaluated the hypothesis that smoke from harm reduction cigarettes impedes attachment and proliferation of H9 human embryonic stem cells (hESCs)...
  19. Wodak A, Maher L. The effectiveness of harm reduction in preventing HIV among injecting drug users. N S W Public Health Bull. 2010;21:69-73 pubmed publisher
    There is now compelling evidence that harm reduction approaches to HIV prevention among injecting drug users are effective, safe and cost-effective...
  20. Smith K, Bartlett N, Wang N. A harm reduction paradox: comparing China's policies on needle and syringe exchange and methadone maintenance. Int J Drug Policy. 2012;23:327-32 pubmed publisher
    ..Semi-structured, serial interviews were conducted with key informants, knowledgeable about China's harm reduction policies...
  21. Torrens M, Fonseca F, Castillo C, Domingo Salvany A. Methadone maintenance treatment in Spain: the success of a harm reduction approach. Bull World Health Organ. 2013;91:136-41 pubmed publisher
    ..using heroin led to a shift from a drug-free approach to the treatment of opioid dependence to one focused on harm reduction. A substantial change in legislation made it possible to meet public health needs and offer OAMT as part of ..
  22. Rowland B, Allen F, Toumbourou J. Impact of alcohol harm reduction strategies in community sports clubs: pilot evaluation of the Good Sports program. Health Psychol. 2012;31:323-33 pubmed publisher
    ..Implementation of the Good Sports accreditation strategy was associated with lower alcohol consumption in these settings. ..
  23. Schaub M, Uchtenhagen A. Building a European consensus on minimum quality standards for drug treatment, rehabilitation and harm reduction. Eur Addict Res. 2013;19:314-24 pubmed publisher
    ..aiming at establishing a set of European minimum quality standards (MQS) for treatment/rehabilitation and harm reduction in the field of drug abuse and dependence...
  24. Malekinejad M, Vazirian M. Transition to injection amongst opioid users in Iran: implications for harm reduction. Int J Drug Policy. 2012;23:333-7 pubmed publisher
    Driven by opioid use, HIV prevalence is high (15-27%) amongst injection drug users (IDU) in Iran. Harm reduction programmes are associated with a reduction in high risk injecting behaviours; however, Iran has a large number of non-..
  25. Abdul Quader A, Feelemyer J, Modi S, Stein E, Briceno A, Semaan S, et al. Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: a systematic review. AIDS Behav. 2013;17:2878-92 pubmed publisher
    ..The results support NSP as a structural-level intervention to reduce population-level infection and implementation of NSP for prevention and treatment of HIV and HCV infection. ..
  26. Jackson L, Dykeman M, Gahagan J, Karabanow J, Parker J. Challenges and opportunities to integrating family members of injection drug users into harm reduction efforts within the Atlantic Canadian context. Int J Drug Policy. 2011;22:385-92 pubmed publisher
    ..in order to understand the potential opportunities for, and challenges to, having these family members provide harm reduction services (e.g., clean syringes)...
  27. Navarro H, Doran C, Shakeshaft A. Measuring costs of alcohol harm to others: a review of the literature. Drug Alcohol Depend. 2011;114:87-99 pubmed publisher
    ..This review may be considered a starting point for future research on costing alcohol harm to others. ..
  28. Beard E, McNeill A, Aveyard P, Fidler J, Michie S, West R. Association between use of nicotine replacement therapy for harm reduction and smoking cessation: a prospective study of English smokers. Tob Control. 2013;22:118-22 pubmed publisher
    It is important to know how far smokers' attempts at using nicotine replacement therapy (NRT) for smoking 'harm reduction' (reducing harm from continued smoking) promote or undermine cessation...
  29. Gartner C, Jimenez Soto E, Borland R, O Connor R, Hall W. Are Australian smokers interested in using low-nitrosamine smokeless tobacco for harm reduction?. Tob Control. 2010;19:451-6 pubmed publisher
    ..These results support further examination of the potential for LNSLT to reduce smoking-related harm in Australia. ..
  30. Getahun H, Gunneberg C, Sculier D, Verster A, Raviglione M. Tuberculosis and HIV in people who inject drugs: evidence for action for tuberculosis, HIV, prison and harm reduction services. Curr Opin HIV AIDS. 2012;7:345-53 pubmed publisher
    ..health issues, in addition to ensuring HIV and TB prevention, diagnosis and treatment as core components of harm reduction services...
  31. Lavoie D. Alcohol identification and brief advice in England: A major plank in alcohol harm reduction policy. Drug Alcohol Rev. 2010;29:608-11 pubmed publisher
    ..Lavoie D. Alcohol identification and brief advice in England: A major plank in alcohol harm reduction policy.
  32. Massin S. Is harm reduction profitable? An analytical framework for corporate social responsibility based on an epidemic model of addictive consumption. Soc Sci Med. 2012;74:1856-63 pubmed publisher
    ..It advances that reputation effects are crucial in this issue and that determining whether harm reduction practices are costly or profitable for the producers can help to assess the sincerity of their discourse...
  33. Huang Y, Kuo H, Lew Ting C, Tian F, Yang C, Tsai T, et al. Mortality among a cohort of drug users after their release from prison: an evaluation of the effectiveness of a harm reduction program in Taiwan. Addiction. 2011;106:1437-45 pubmed publisher
    ..07). In ex-prisoners in Taiwan with a history of opiate injecting, enrollment and continued participation in methadone maintenance treatment is associated with substantially lower mortality. ..
  34. Clatts M, Goldsamt L, Giang L, Colón López V. Accelerated transition to injection among male heroin initiates in Hanoi, Vietnam: implications for early harm reduction interventions. J Community Health. 2011;36:999-1003 pubmed publisher
    ..Critical intervention goals include delaying the onset of injection and improved education about safer drug sharing and drug injection practices. ..
  35. Petrie D, Doran C, Shakeshaft A. Willingness to pay to reduce alcohol-related harm in Australian rural communities. Expert Rev Pharmacoecon Outcomes Res. 2011;11:351-63 pubmed publisher
    ..These findings can be compared with the cost of implementing interventions to determine whether they are likely to be welfare enhancing. ..
  36. Stanekzai M, Todd C, Orr M, Bayan S, Rasuli M, Wardak S, et al. Baseline assessment of community knowledge and attitudes toward drug use and harm reduction in Kabul, Afghanistan. Drug Alcohol Rev. 2012;31:451-60 pubmed publisher
    ..The study aim was to assess community knowledge and attitude toward drug use and harm reduction in Kabul, Afghanistan...
  37. Benowitz N. Smokeless tobacco as a nicotine delivery device: harm or harm reduction?. Clin Pharmacol Ther. 2011;90:491-3 pubmed publisher
    ..This Opinion piece discusses the controversies pertaining to ST and health, the pros and cons of ST in harm reduction, and progress in treatment for those who would like to quit ST use.
  38. Bridge J, Hunter B, Atun R, Lazarus J. Global Fund investments in harm reduction from 2002 to 2009. Int J Drug Policy. 2012;23:279-85 pubmed publisher
    ..and Malaria is the leading multilateral donor for HIV programmes and encourages applicants to include harm reduction interventions in their proposals...
  39. McNeil R, Guirguis Younger M, Dilley L, Aubry T, Turnbull J, Hwang S. Harm reduction services as a point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs: a qualitative analysis. BMC Public Health. 2012;12:312 pubmed publisher
    ..This article explores the role of harm reduction services in end-of-life care services delivery to homeless and marginally housed persons who use alcohol and/..
  40. Klesges R, Sherrill Mittleman D, Ebbert J, Talcott G, DeBon M. Tobacco use harm reduction, elimination, and escalation in a large military cohort. Am J Public Health. 2010;100:2487-92 pubmed publisher
    ..g., tobacco cessation), harm reduction (e.g., from smoking to smokeless tobacco use), and harm escalation (e.g...
  41. Bowie P, McKay J, Kelly M. Maximising harm reduction in early specialty training for general practice: validation of a safety checklist. BMC Fam Pract. 2012;13:62 pubmed publisher
    ..However adherence to a checklist reminder may improve the reliability of task delivery and maximise harm reduction. We aimed to prioritise the most safety-critical issues to be addressed in the first 12-weeks of specialty ..
  42. Li J, Gilmour S, Zhang H, Koyanagi A, Shibuya K. The epidemiological impact and cost-effectiveness of HIV testing, antiretroviral treatment and harm reduction programs. AIDS. 2012;26:2069-78 pubmed publisher
    ..and cost-effectiveness of expanded voluntary counseling and testing (VCT), antiretroviral treatment (ART), and harm reduction programs in preventing the spread of HIV...
  43. Lund K, Scheffels J, McNeill A. The association between use of snus and quit rates for smoking: results from seven Norwegian cross-sectional studies. Addiction. 2011;106:162-7 pubmed publisher
    ..In Scandinavia, snus may play a role in quitting smoking but other explanations, such as greater motivation to stop in snus users, cannot be ruled out. ..
  44. Polosa R, Rodu B, Caponnetto P, Maglia M, Raciti C. A fresh look at tobacco harm reduction: the case for the electronic cigarette. Harm Reduct J. 2013;10:19 pubmed publisher
    ..But, there is a third choice for smokers: tobacco harm reduction. It involves the use of alternative sources of nicotine, including modern smokeless tobacco products like snus ..
  45. Rahimi Movaghar A, Amin Esmaeili M, Haghdoost A, Sadeghirad B, Mohraz M. HIV prevalence amongst injecting drug users in Iran: a systematic review of studies conducted during the decade 1998-2007. Int J Drug Policy. 2012;23:271-8 pubmed publisher
    ..Scaling up harm reduction measures, increasing their availability and coverage, and improving the quality of services is highly ..
  46. Ruan Y, Liang S, Zhu J, Li X, Pan S, Liu Q, et al. Evaluation of harm reduction programs on seroincidence of HIV, hepatitis B and C, and syphilis among intravenous drug users in southwest China. Sex Transm Dis. 2013;40:323-8 pubmed publisher
    The aim of this study was to evaluate the impact of a multifaceted harm reduction program by comparing seroincidence rates of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV), and syphilis before and after implementation of harm ..
  47. Allen E, Palmateer N, Hutchinson S, Cameron S, Goldberg D, Taylor A. Association between harm reduction intervention uptake and recent hepatitis C infection among people who inject drugs attending sites that provide sterile injecting equipment in Scotland. Int J Drug Policy. 2012;23:346-52 pubmed publisher
    ..The Scottish Government has invested significantly in harm reduction interventions with the goal of reducing HCV transmission among PWID...
  48. Greenspan N, Aguinaldo J, Husbands W, Murray J, Ho P, Sutdhibhasilp N, et al. "It's not rocket science, what I do": Self-directed harm reduction strategies among drug using ethno-racially diverse gay and bisexual men. Int J Drug Policy. 2011;22:56-62 pubmed publisher
    Research on harm reduction has typically focused on broad-based or organisational strategies such as needle exchange and opiate substitute programmes...
  49. Cruz M, Patra J, Fischer B, Rehm J, Kalousek K. Public opinion towards supervised injection facilities and heroin-assisted treatment in Ontario, Canada. Int J Drug Policy. 2007;18:54-61 pubmed
    ..Given the current political climate and the tentative position of SIFs and HAT in Canada, understanding the public's opinion is crucial for the feasibility and long-term sustainability of these interventions. ..
  50. Reid G, Higgs P. Vietnam moves forward with harm reduction: an assessment of progress. Glob Public Health. 2011;6:168-80 pubmed publisher
    ..However, 2006 saw the government formally endorse harm reduction interventions...
  51. Guinness L, Vickerman P, Quayyum Z, Foss A, Watts C, Rodericks A, et al. The cost-effectiveness of consistent and early intervention of harm reduction for injecting drug users in Bangladesh. Addiction. 2010;105:319-28 pubmed publisher
    To assess the cost-effectiveness of the CARE-SHAKTI harm reduction intervention for injecting drug users (IDUs) over a 3-year period, the impact on the cost-effectiveness of stopping after 3 years and how the cost-effectiveness might vary ..
  52. Cohen J, Wolfe D. Harm reduction and human rights: finding common cause. AIDS. 2008;22 Suppl 2:S93-4 pubmed publisher
  53. McBride N, Farringdon F, Kennedy C. Research to practice--formal dissemination of the School Health and Alcohol Harm Reduction Project (SHAHRP) in Australia. Drug Alcohol Rev. 2007;26:665-72 pubmed
    This paper discusses the formal dissemination of the School Health and Alcohol Harm Reduction Project (National SHAHRP Dissemination Project) in Australia...