Chapter 1 Harm reduction and the mainstream

Harm reduction encompasses interventions, programmes and policies that seek to reduce the health, social and economic harms of drug use to individuals, communities and societies. We envisage harm reduction as a ‘combination intervention’, made up of a package of interventions tailored to local setting and need, which give primary emphasis to reducing the harms of drug use. We note the enhanced impact potential derived from delivering multiple harm reduction interventions in combination, and at sufficient scale, especially needle and syringe distribution in combination with opioid substitution treatment programmes. We note that harm reduction is a manifestation of mainstream public health approaches endorsed globally by the United Nations, and in the EU drugs strategy and action plans, and features as an integral element of drug policy in most of the European region. However, we note evidence that links drug harms to policies that emphasise strict law enforcement against drug users; an unintended consequence of international drug control conventions. The continuum of ‘combination interventions’ available to harm reduction thus extends from drug treatment through to policy or legal reform and the removal of structural barriers to protecting the rights of all to health. We end by introducing this monograph, which seeks to reflect upon two decades of scientific evidence concerning harm reduction approaches in Europe and beyond.