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Overview of harm reduction principles

The harm reduction approach to substance use is based on a strong commitment to public health principles. It is evidence based and cost effective when delivered in a targeted way at reducing the harms and risks to an individual and the community in which they live.

Harm reduction:

  • Is pragmatic
  • Prioritises goals
  • Is based on humanist values
  • Focuses on risks and harms
  • Does not focus primarily on abstinence but does incorporate recovery as part of a range of goals and outcomes over time
  • Seeks to maximise the range of intervention options available
  • Is facilitative rather than coercive and grounded in the needs of individuals.

The objective of harm reduction in a specific context can often be arranged in a hierarchy with the more feasible options at one end (e.g. measures to keep people healthy) and less feasible but desirable options at the other end. Abstinence can be considered a difficult to achieve but desirable option for harm reduction in such a hierarchy. Keeping people who use drugs and alcohol alive and preventing irreparable damage is regarded as the most urgent priority.

Harm reduction may be seen as an integral part of recovery. In Wales, recovery from problematic drug or alcohol use is defined as a process that enables an individual to make changes which improve their quality of life. The Welsh Government substance misuse strategy outlines the process and goal of recovery as “enabling, encouraging and supporting substance misusers to reduce the harm they are causing to themselves, their families and communities, and ultimately return to and maintain a life free of alcohol or drug dependency”.

The harm reduction approach is designed to be relevant to all psychoactive drugs including controlled and licit drugs, alcohol, tobacco and pharmaceutical drugs.

Welsh Government – Substance Misuse Treatment Framework, Health and Wellbeing Compendium



  • The only way to avoid all the risks is to not take any drugs which are not prescribed for you. Think carefully about the risks before you start.
  • Make sure someone else is with you, ideally someone you can trust to look after you if things go wrong.
  • Try to eat well, rest and drink plenty of liquid before you start using drugs. You’ll feel better after the session. Avoid alcohol or energy drinks if at all possible.
  • Make sure you know what you are buying. Describe what you want, including the effects you are seeking from the drug, and see if this matches what the seller is offering. If going to a new seller, be particularly cautious and ask questions about the product especially if it looks, smells or tastes different to what you are used to.
  • Carry condoms so that you don’t have unprotected sex. Drugs and alcohol raise the desire for sex but decrease performance, making orgasm for both sexes harder to achieve. This can lead to more vigorous sex, especially with stimulant use, which can cause a condom to rip. So have spare condoms and a water-based lubricant available.


Council for the Homeless and Public Health Agency, Northern Ireland – Harm Reduction for Drug Users



  • Mixing any drug with another drug increases the risk of dangerous side effects. This includes alcohol.
  • Some drugs are especially risky to mix. This includes:
    • cocaine and alcohol;
    • opioids (such as heroin or morphine) and downers /depressants (such as benzos), alcohol or other opioids such as tramadol.
  • Prescription drugs which are highly likely to cause serious side effects when taken along with an illegal drug or drugs include:
    • painkillers (such as morphine, oxycodone, co-codamol, tramadol);
    • antidepressants (fluoxetine/Prozac, amitriptyline);
    • tranquilisers and sleepers (diazepam, nitrazepam, phenazepam);
    • drugs normally used for epilepsy and nerve pain such as Lyrica/pregabalin


Council for the Homeless and Public Health Agency, Northern Ireland – Harm Reduction for Drug Users



  • Start low and go slow, especially if you are taking a drug you have never used before. Take a small amount at first and let it reach its peak effect to test how strong it is. Remember, you can always take more later on – you can never go back and take less.
  • Remember that different drugs act at different speeds, and a slow response does not necessarily mean that the drug is weak – it may mean you have taken a slow-acting drug which could in fact be strong. Redosing could lead to overdose.
  • Bear in mind that drugs that look the same as each other may not be the same. A pill or powder that looks like one you took last week may in fact have entirely different drugs in it.
  • It is important to keep hydrated. Aim to drink about a pint of fluid per hour during the session. Avoid alcohol as this causes dehydration. Energy drinks contain lots of caffeine which can increase the strain on the heart. Keeping hydrated is especially important in warm, sunny weather.
  • Look after your friends. It’s ok to tell each other to take it easy; that’s what good friends do. Don’t let anyone go off by themselves. If anyone becomes unwell stay with them. Some people can become aggressive. This can be a sign of someone having taken too much and may be an indicator of overdose.
  • If you or a friend have any worrying symptoms, call an ambulance. Try to remain calm, keep the noise down in the area and reassure the person that you are there to help. If they are breathing normally encourage them to put themselves into the recovery position or at least to keep still.


Council for the Homeless and Public Health Agency, Northern Ireland – Harm Reduction for Drug Users



  • Try to avoid taking other drugs to help you come down as these could prolong the come down or even cause overdose.
  • Go somewhere you feel safe to relax and keep numbers of people you can talk to in your phone if you start to feel depressed, frightened or unwell.
  • Some people experience suicidal thoughts and feelings after taking drugs, especially after a binge. If you are concerned about yourself or another user, make sure you talk to someone like a GP, Substance misuse service or mental health service immediately.


Council for the Homeless and Public Health Agency, Northern Ireland – Harm Reduction for Drug Users



Safer Administration


  • Always use clean devices (snorter)
  • Use your own device
  • Don’t share devices; there may be traces of blood on your equipment.
  • Snort high up the nostril to avoid the most sensitive soft tissue.
  • Clean out nasal passages after use, with damp tissue or a ear bud.
  • Alternate nostrils to lessen damage to one side
  • If your nose is bleeding – give it a rest.


  • Smoking equipment, e.g. pipes should not be shared
  • When chasing, use foil provided by Needle Exchanges if possible. If not, use tinfoil. Do not use foil from sweet packaging as it is often covered with contaminants
  • If you are smoking substances in cigarettes or joints – use unbleached card to make filters to avoid breathing in harmful substances from the card
  • Pipe users should switch from using plastic bottles or cans to using quality glass pipes to avoid inhaling ash, paint, dust, water and other particles into the lungs



  • Stimulant drugs are caustic and can corrode soft tissues. This may result in damage to the lining of the throat, oesophagus and stomach. Ingest within a capsule/cigarette paper



  • Don't share any injecting equipment; this includes water, spoons and filters as well as needles and syringes. It is best practice to use a filer for drawing up
  • Ensure you have enough needles for repeat injecting
  • Rotate Sites
  • Ensure any wounds are treated as soon as possible
  • Heat and redness at injecting site – seek medical attention
  • Ensure that your equipment is correct for its intended use (
  • Dispose of used needles and syringes safely.