Harm Reduction

Harm reduction is an evidence-based approach that is critical to engaging with people who use drugs and equipping them with life-saving tools and information to create positive change in their lives and potentially save their lives. Harm reduction is a key pillar in the U.S. Department of Health and Human Services' Overdose Prevention Strategy.

Harm Reduction at SAMHSA

Harm reduction is a practical and transformative approach that incorporates community-driven public health strategies — including prevention, risk reduction, and health promotion — to empower people who use drugs (and their families) with the choice to live healthy, self-directed, and purpose-filled lives. Harm reduction centers the lived and living experience of people who use drugs, especially those in underserved communities, in these strategies and the practices that flow from them.

Harm reduction emphasizes engaging directly with people who use drugs to prevent overdose and infectious disease transmission; improve physical, mental, and social wellbeing; and offer low barrier options for accessing health care services, including substance use and mental health disorder treatment.

Harm reduction is an important part of the Biden-Harris Administration’s comprehensive approach to addressing substance use disorders through prevention, treatment, and recovery — and empowering people to reach their own goals, through incremental change.

Organizations who practice harm reduction incorporate a spectrum of strategies that meet people where they are ― on their own terms, and may serve as a pathway to additional health and social services, including additional prevention, treatment, and recovery services.

Harm reduction works by addressing broader health and social issues through improved policies, programs, and practices.

Why are Harm Reduction Services Needed?

The U.S. is experiencing the most significant substance use and overdose epidemic it has ever faced, exacerbated by the recent worldwide pandemic, and driven by the proliferation of highly potent synthetic opioids (containing fentanyl or fentanyl analogs) and animal tranquilizers (like xylazine) into many types of drugs (including stimulants and counterfeit prescription pills).

There were more than 100,000 drug-involved overdose deaths in 2023.

Harm reduction offers an opportunity to reach people who aren’t otherwise accessing healthcare services ― and offer them naloxone to reverse an overdose, and help connect them to other needed services. As an example, treatment services (such as medications for opioid use disorder) can be co-located with harm reduction services and offered as an option.

This potential connection to treatment is critical, when the data show that:

• Only around one out of ten people with a substance use disorder have received treatment.
• Nearly all people with a substance use disorder who didn’t get treatment at a specialty facility didn’t think they needed treatment.

Harm reduction organizations can fill that gap ― by providing services that people do feel they need, in order to make positive change.

Harm reduction services save lives by being available and accessible in a manner that emphasizes the need for humility and compassion toward people who use drugs. Harm reduction plays a significant role in preventing drug-related deaths and increasing access to healthcare, social services, and treatment. These services decrease overdose fatalities, acute life-threatening infections related to unsterile drug injection, and chronic diseases (such as HIV and hepatitis C).

It is ideal to implement overdose education and naloxone delivery (OEND) programs at syringe services programs. (Most studies that demonstrate OEND’s effectiveness focus on programs that deliver OEND services directly to people who use drugs.) Naloxone distribution at syringe services sites has been found to significantly reduce death rates. Scaling these efforts is a priority strategy to achieving adequate availability of (and access to) naloxone.

Harm Reduction's Place in and Among Prevention, Treatment, and Recovery

Harm reduction is part of a comprehensive prevention strategy and the continuum of care. Harm reduction approaches have proven to prevent death, injury, disease, overdose, and substance misuse. Harm reduction is effective in addressing the public health epidemic involving substance use as well as infectious disease and other harms associated with drug use.

As an approach, harm reduction emphasizes kindness and autonomy in the engagement of people who use drugs. It also increases the number of touchpoints (and opportunities) that peers and/or service providers have with people who use drugs.

Specifically, harm reduction services can:

• Connect individuals to overdose education, counseling, and referral to treatment for infectious diseases and substance use disorders.
• Distribute opioid overdose reversal medications (e.g., naloxone) to individuals at risk of overdose, or to those who are likely to respond to an overdose.
• Lessen harms associated with drug use and related behaviors that increase the risk of infectious diseases, including HIV, viral hepatitis, and bacterial and fungal infections.
• Reduce infectious disease transmission among people who use drugs (including those who inject drugs) by equipping them with sterile supplies, accurate information and facilitating referrals to resources.
• Reduce overdose deaths, promote linkages to care, facilitate co-location of services as part of a comprehensive, integrated approach.
• Reduce stigma associated with substance use and co-occurring disorders.
• Promote a philosophy of hope and healing ― by employing people with living and lived experience in leadership and in the planning, implementation, and evaluation of services. People with lived experience can also model for their peers what meaningful change can look like in their lives.
• Build community and increase protective factors ― for people who use drugs and their families.

SAMHSA's Current and Future Support for Harm Reduction

SAMHSA awarded 25 grants in FY 2022 for its first-ever Harm Reduction grant program. This funding, authorized by the American Rescue Plan, will help increase access to a range of community harm reduction services and support harm reduction service providers as they work to help prevent overdose deaths and reduce health risks often associated with drug use. SAMHSA accepted applications from State, local, Tribal, and territorial governments, Tribal organizations, non-profit community-based organizations, and primary and behavioral health organizations.

SAMHSA is distributing up to $9,750,000 per year (or $29,250,000 over 3 years). Grant recipients receiving federal funding must adhere to applicable federal, state, and local laws, regulations, and other requirements as specified in federal grant terms and conditions of award. Other SAMHSA grants may also support harm reduction activities (see Notice of Funding Opportunities).

The following harm reduction services/supplies are allowable costs that may be covered with certain SAMHSA funds:

Harm Reduction Supplies

• Overdose reversal supplies, including the purchase of naloxone kits (this may include syringes for the purpose of administering injectable naloxone only)
• Substance test kits, including fentanyl test strips and xylazine test strips
• Safer sex kits, including condoms
• Sharps disposal and medication disposal kits
• Wound care supplies
• Medication lock boxes
• Sterile water and saline
• Ascorbic acid (vitamin C)
• Nicotine cessation therapies
• Food (e.g., snacks, protein drinks, water)***
• Supplies to promote sterile injection and reduce infectious disease transmission through injection drug use — excluding sterile needles, syringes, and other drug paraphernalia*
• Safer smoking kits to reduce infectious disease transmission — excluding pipes/pipettes and other drug paraphernalia**
• FDA-approved home testing kits for viral hepatitis (i.e., HBV and HCV) and HIV
• Written educational materials on safer injection practices and HIV and viral hepatitis and prevention, testing, treatment, and care services
• Distribution mechanisms (e.g., bags for naloxone or safer sex kits, metal boxes/containers for holding naloxone) for harm reduction supplies, including stock as otherwise described and delineated on this list

Harm Reduction Services

• Overdose reversal education and training services
• Navigation services to ensure linkage to HIV and viral hepatitis prevention, testing, treatment, and care services — including antiretroviral therapy for HCV and HIV, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), prevention of mother to child transmission, and partner services
• Referral to hepatitis A and hepatitis B vaccinations (to reduce risk of viral hepatitis infection)
• Provision of education on HIV and viral hepatitis prevention, testing, and referral to treatment services
• Provision of information on local resources and/or referrals for PrEP

*The Harm Reduction grant program is authorized under Section 2706 of the American Rescue Plan Act (ARPA) of 2021, which is not subject to the same syringe funding restrictions as other federal grants. Syringes to prevent and control the spread of infectious diseases as well as syringe filters are allowed for purchase with grant funds authorized by ARPA for SAMHSA Harm Reduction programs.

**No federal funding is used directly or through subsequent reimbursement of grantees to purchase pipes in safer smoking kits. Grants include explicit prohibitions of federal funds to be used to purchase drug paraphernalia.

***Food is limited to $10 per person and must be used in the course of service engagement.

Additional Resources

• Overdose Prevention Strategy (U.S. Department of Health & Human Services)
• National Drug Control Strategy (The White House Executive Office of the President, Office of National Drug Control Policy) (PDF | 2.6 MB)
• The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year One (PDF | 334 KB)
• Homelessness Programs and Resources