By Anna Jones.

What is harm reduction? To explain this concept, let’s start with skin cancer. We know that exposure to the sun’s rays causes skin cancer. We could simply say, “stay out of the sun,” or “wear long sleeves, pants, and a hat when outside.” This would be the most effective way to prevent any skin cancer – but is this realistic? No, because there will always be people who will swim in trunks, who run in a t-shirt, and who wear shorts to the amusement park. There will always be people at risk for skin cancer caused by UV rays. To this, we could say, “Well, you chose to go out in the sun, therefore you deserve to develop skin cancer.” Yet we do not. We wear sunscreen. Does sunscreen work without fail? No, burning is still possible. Does everyone use it? No, individuals still must choose to put it on. But choosing to do so significantly lowers your chances of a sunburn, and thereby developing skin cancer.

Harm reduction is a term that describes a variety of interventions that aim not to stop certain behaviors, but lower the risk that those behaviors lead to bad consequences. In our skin cancer example, providing sunscreen is an example of harm reduction: we know that people will be in the sun, but by encouraging the use of sunscreen, we can lower the risk of skin cancer. There are many other examples of harm reduction in our everyday lives, such as seat belts. In theory, we could tell every driver to drive the speed limit and obey all traffic rules, and we would never have an accident. This is unrealistic. Instead, we encourage people to wear seatbelts to lower the risk of severe injury or death in an accident.

In healthcare, harm reduction techniques help to mitigate many health risks. It has received the most pushback from critics of those with substance use disorder. For people who inject drugs, there is a high risk of contracting diseases like HIV and Hepatitis C, which can spread through sharing used needles. There is also the risk of overdose. Harm reduction programs try to address these two risks through two different interventions. First are syringe exchange programs, where people who inject drugs can exchange old, used needles for clean ones. At these exchange sites, people also receive information about treatment programs for addiction and are offered social services. The second intervention is making naloxone more available. Naloxone, more commonly known as Narcan in its intranasal spray form, helps reverse overdose from opioids. By encouraging people who use opioids to keep naloxone nearby while using drugs, we can reduce deaths from accidental overdoses. Critics of these programs worry that harm reduction encourages continued drug use and enables it. But just as encouraging someone to use sunscreen is not endorsing skin cancer, providing ways to avoid HIV or overdose is not endorsing substance use. Harm reduction aims to meet people where they are, and while they may be using drugs, they need a safer way to do so. The aim is not to perpetuate drug use; the aim is to prevent communicable disease and death.

Harm reduction techniques have come under legal attack in 2025. In July, an executive order denounced harm reduction, and  ordered that grants issued by the Substance Abuse and Mental Health Services Administration do not fund programs that include harm reduction techniques. This goes against what experts in the field and what research has supported: that harm reduction helps save lives. By taking away harm reduction as a tool for reducing disease, we take away the opportunity to lower HIV and hepatitis transmission rates. When you hear others arguing in favor of taking away harm reduction funding, it can be helpful to reframe. Using the above comparisons, people often can see how they themselves practice harm reduction on a daily basis.

Harm reduction acknowledges that each and every person is an autonomous human being. Being human means that sometimes we make risky decisions. People will still spend long days on the beach in the sun. People will still drive too fast, and neglect speed limits. People will still use needles for drug injections. Humans will continue to be humans. What can we do about it? We can make sure that when these actions happen, we can mitigate the risk of catastrophic consequences, whether it is by using sunscreen, seatbelts, or clean needles. It is still our individual choice to use these items, but they offer a safer alternative. This is the heart of harm reduction.

All views and opinions expressed here are solely those of the author alone and do not represent the views or opinions of the NC Schweitzer Fellowship.

Anna Jones
UNC School of Medicine Class of 2026
2025-26 NC Schweitzer Fellow