A More Integrated Approach to Harm Reduction


Stacey McKenna
Resident Senior Fellow, Integrated Harm Reduction
Mazen Saleh
Policy Director, Integrated Harm Reduction

Key Points

Tobacco harm reduction (THR) is struggling to gain credibility and acceptance among the public health establishment.

Those who are skeptical of the harm reduction potential of alternative tobacco products, such as e-cigarettes, worry about youth initiation, the role of big tobacco in research and production and the newness of the products themselves.

THR advocates highlight emerging research that suggests electronic nicotine delivery systems (ENDS) may reduce health risks and increase quit rates for cigarette smokers. They also express concern that ENDS bans would undermine those benefits while contributing to overcriminalization.

An integrated approach would acknowledge the overlaps between historically siloed issues, including: comorbidities among populations served; the goal of reducing health disparities; and the commitment to providing a practical public health solution that accepts and supports individual autonomy.

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In April, the Biden-Harris administration issued unprecedented funding for harm reduction, a pragmatic public health solution to the opioid crisis that
killed almost 70,000 people in the United States in 2020. Strategies to mitigate the negative health consequences of risky behaviors are not new. In 1964, methadone maintenance emerged to help people manage heroin addiction,
and in the 1970s and 1980s modern harm reduction was born when syringe exchanges were introduced to slow the spread of bloodborne disease (especially HIV and hepatitis B) among individuals injecting drugs.

Today, most harm reduction programs still focus on the risks associated with illegal “drug use, drug policies and drug laws.” Because the ultimate goal is to provide practical, non-judgmental care tailored to individuals’ circumstances and goals, the approach has far broader public health utility. Thus, acceptance is growing in several arenas, from vaccination efforts to comprehensive sexuality education. Some organizations even embrace wrap-around services characterized by multiple harm reduction strategies in an effort to reduce risk for both overdose and infectious disease

However, tobacco harm reduction (THR) often remains overlooked or excluded outright from otherwise comprehensive initiatives. For example, syringe access programs may staunchly meet opioid users “where they’re at,” yet promote abstinence-only perspectives on nicotine addiction. Similarly, several of the jurisdictions chipping away at drug prohibition are simultaneously increasing restrictions on tobacco and e-cigarettes.

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