Harm reduction approaches can be stand-alone interventions, and can also be part of how health and social services support people. Offering a range of options means people can access services that suit their needs at different times.

Harm reduction initiatives often emerge from the communities they support. These communities understand from their own experiences what information and support they need, and how to work within their legal and health systems to support each other. Laws and regulations greatly influence what harm reduction approaches exist in different countries, how they work, and what they aim to do. 

Here are examples of harm reduction initiatives from Aotearoa and overseas. Some are not available yet in Aotearoa. 

Health and social services that incorporate a harm reduction approach

These services incorporate a harm reduction approach. They provide information and support that helps people live healthier lives without requiring them to stop or reduce substance use.

These systems detect risky substances in the illicit drug market - especially those that are new, misrepresented, or contain unexpected adulterants. Spotting these substances early is crucial in a volatile international drug market where substances are increasingly varied and more potent – all of which increase the risk of overdose.  

Examples:

Grounded in mātauranga Māori, these services provide holistic care that offers flexible support based on Māori values and incorporates connections to whānau, hapū, and iwi. Whānau-centred approaches take a holistic view of family wellbeing and allow whānau to determine what success is to them. This approach can allow for a wide range of support to be provided that can help people prevent harm from substance use without first requiring them to commit to stopping or reducing their use. 

Example: 

Stable housing is essential for addressing complex health and social issues. Harm reduction housing support does not require abstinence, providing stability and making it easier for people to address underlying challenges.  

Example:

These services can support people without requiring them to stop or reduce substance use. Integrating harm reduction ensures everyone receives appropriate care, reducing preventable harm. 

Often initiatives that target particular groups focus on understanding what people need and minimising barriers that can prevent people from getting care. Examples include: 

Initiatives for women

Women-focused harm reduction initiatives work to eliminate barriers that women face when accessing services. These barriers include: Systems that do not understand the nuance of hormonal and life stages for women; power imbalances (including violence); societal expectations to provide childcare; and face harsher judgement for substance use. Women-focused initiatives understand and aim to address this by actively combatting stigma, while also provided support in a way that understands what women may experience. 

Example:

 

Support for families

Family support services are for friends and whānau of people who use substances. These services provide space for people to talk about their situation, meet other people that are going through similar experiences, and share ways to prevent and reduce harms. They recognise that each family member will have their own unique experience and needs. HealthLinkBC in British Columbia has produced this fact sheet on harm reduction for families, caregivers, and friends of people who use substances.

 

Antenatal, postnatal, and early childhood care

Harm reduction approaches being incorporated into these services removes stigma and barriers, allowing for open and non-judgemental discussion of substance use, and access to appropriate information and support. These services understand and minimise the barriers, such as fear of losing custody of their children, that could prevent parents who use substances from accessing the essential care that they provide. 

Harm reduction initiatives

These initiatives are designed according to harm reduction principles and typically delivered by a workforce trained in harm reduction (especially peers from the supported community). Some, like substitution therapies, require medical expertise. 

Online and print access to harm reduction information allows people to get information to help them prevent and reduce the potential for health, social, and legal harm from substances. 

Examples:

Harm reduction peer support involves sharing harm reduction information and support among people with similar experiences. Peer outreach services help those who might not access formal services to engage with harm reduction. These services influence norms, shared experiences, and language, making services more effective. In Aotearoa, the peer workforce is guided by values of mutuality, experiential knowledge, self-determination, participation, equity, recovery and hope. 

Examples:

Low-threshold services, like drop-in centres, make it easier to access harm reduction information, tools, and support by removing barriers. These services typically: 

  • Have minimal entry requirements. 
  • Are located in easily accessible places. 
  • Are open at convenient times. 
  • Are low-cost or free. 
  • Provide a welcoming and supportive environment. 

Similar to sexual health services that offer regular check-ups without requiring symptoms of infections, holistic substance use check-ups could help people identify and address potential issues without any entry criteria. 

Examples:

  • Drop-in services or centres
  • Regular holistic check-ups (like sexual health check-ups)
  • Chill-out spaces at events

Mutual aid communities provide free, peer-led support. Some are based on harm reduction principles and aim to provide a space where people can connect with other people who have similar experiences and support each other. Some mutual aid communities focus on providing ongoing support for people with shared goals (e.g., maintaining recovery). 

Examples:

Using sterile equipment lowers the risk of infections from sharing. Needle exchanges help prevent blood-borne infections by giving out clean needles and syringes and safely disposing of used ones.  

Depending on a countries legislation, sterile gear can be provided for different methods of using substances such as injecting, smoking, snorting, or genital/anal insertion. Peer services are great for offering relatable support, along with extras like Hepatitis C screening and wound care. 

Examples:

Cost-benefit analysis of the New Zealand Needle Exchange Programme (NZNEP) 

A report conducted by Keen and Weston from the University of Canterbury in 2021 found that for every $1 the NZNEP spends, they create $6.79 worth of benefits.

The report states: “The key benefits of the NZNEP come from reducing the harm to PWID [people who inject drugs] and reducing the burden on the New Zealand health system. By providing clean, unused needles and syringes (along with other equipment) the NZNEP reduces the sharing and reuse of that equipment, which are two factors that greatly increase the risk of contracting blood-borne viruses and non-viral injecting injuries.”

Drug checking in Aotearoa is a free, legal, and confidential health service that checks substances to see what’s in them. These services help people to know whether a substance they have purchased from an unregulated market is what they think it is, and whether it contains any other substances. They also provide an opportunity for people to have personalised harm reduction conversations, where information can be shared about ways to prevent potential problems.

A systemic review of drug checking services found that: 

"Drug checking services appeared to influence behavioural intentions and the behaviour of people who use drugs, particularly when results from drug checking services are unexpected or drugs of concern.”

It also found that drug checking services provided unique and useful monitoring of the unregulated drug market, identifying new psychoactive substances and drugs of concern.

Find a drug checking clinic in Aotearoa on The Level.

These are safe environments where people who are intoxicated can stay until they are no longer intoxicated or are safe to leave. These low-entry-threshold services can provide support (often including peer support), a bed to sleep in, and basic healthcare if needed. Some also offer light meals, showers, and laundry facilities. Referrals to other support services may also happen.  

Overdose prevention and reversal initiatives provide information for people on how to prevent an overdose, identify when someone is overdosing, and how to respond to an overdose. Some initiatives involve training provided by peers and the provision of tools to respond to an overdose (e.g., naloxone). Most are also available for friends, family members, and household members of people who use drugs. 

Examples:

  • Take-home naloxone initiatives
    Training provided as part of needle exchange services
  • Opioid substitution therapy programmes

Substitution therapies, also known as agonist pharmacotherapy programmes, involve prescribing a medication to replace another drug. For example, opioid substitution therapy can involve replacing an opioid drug (such as heroin) with a legal substitute (such as methadone or buprenorphine); this is done with medical supervision. People may access these services to help get more stability in their lives or make changes to their substance use. These therapies can increase stability in people’s lives and reduce potential health, social, and legal problems from using illicit drugs.  

Examples:

  • Opioid substitution therapy
  • Methamphetamine substitution therapy
  • Plant-based assisted therapy

Safer supply initiatives provide prescribed medications as a safer alternative to substances from the unregulated market. There is a constant risk of substances purchased in an unregulated market being misrepresented or containing other substances – increasing the risk of overdose and death. These initiatives can help prevent overdoses, provide information and support, and connect people to other health and social services. 

An independent assessment of ten safer supply pilot projects in Canada prepared by Dale McMurchy Consulting for Health Canada found that the initiatives had a positive impact on participants’ lives.

Participants and staff say having access to a safer supply of drugs has resulted in improvements to the lives of many participants. They reported that participants: 

  • Have improved health, wellbeing, and quality of life. 
  • Have decreased overdose risk and decreased use of street drugs. 
  • Have addressed health issues related to drug use, mental health, and chronic diseases. 
  • Have reduced stress, more energy and are more active. 
  • Are eating and sleeping better. 
  • Are becoming housed and employed. 
  • Have more time in the day and can pursue hobbies and interests. 
  • Have increased stability in their life. 
  • Have more money and no longer have to hustle for drugs. 
  • Experience greater safety and interact less often with the street (such as dealers, violence, crime, police). 
  • Are no longer engaged in survival sex work. 
  • Have improved/improving relationships with family and friends. 
  • Feel hopeful for their future. 

These supervised spaces provide safer conditions for people to use substances, with support from peers and medical staff who can respond to overdoses. Some also offer managed alcohol programmes (also known as ‘wet houses’), where people experiencing homelessness can consume alcohol safely without losing access to housing. These services can be standalone, mobile, or integrated with other support services, offering stability and reducing harm for people dependent on alcohol or other substances.

A review of international literature found that supervised injecting facilities and drug consumption rooms:

  • Attract people who use drugs who are at high risk of experiencing problems. 
  • Manage drug-related overdose and decrease overdose-related mortality. 
  • Enhance safe injecting practice. 
  • Decrease public drug use and improve public amenity. 
  • Increase access to treatment and other health and social services. 
  • Prevent blood-borne virus transmission and fatal overdoses. 

In addition, the review found that these services do not increase drug use and related risks, and do not increase crime. 

These membership-based cooperatives, similar to housing or grocery co-ops, emerged in the 1980s and 1990s to help people access cannabis and medicines, especially during the AIDS epidemic. Members own and run the clubs, working together towards shared goals. This collective model helps establish safer access to substances (e.g., substance testing, partnerships with pharmaceutical companies), share harm reduction tools (e.g., overdose prevention), and connect members with health services.

Examples:

  • Cannabis compassion clubs (including medical cannabis compassion clubs)
  • Drug User Liberation Front compassion club. 

Social clubs provide safe environments for people to consume (and at times purchase) alcohol and other drugs. Most aim to provide a pro-social space, minimise potential risks, and share information about how to prevent harm. Most operate on a non-profit, membership-based model, and are generally specific to one substance. 

Examples: 

  • Cannabis social clubs
  • Coffee shops in Amsterdam
  • CSC (cannabis social club) networks in Barcelona
  • Vancouver Area Network of Drug Users.  

Read more

Harm reduction principles and values

Values to guide harm reduction practice in Aotearoa and examples from overseas.

Working with different communities

Things to consider when using a harm reduction approach with different communities.