Service Service Programs and Harm Reduction Debates

Background/Purpose: Harm reduction is commonly defined as the practice of reducing the negative consequences of certain behaviors, such as drug use. As harm reduction is often associated with public health and social work fields, this association has been heavily criticized by scholar-activists in a field called “liberatory harm reduction,” who have decried the co-optation and professionalization of harm reduction practices from its origins in the community-building efforts of queer, BIPOC, and drug-using communities. Criticisms of public health-oriented harm reduction involve its focus on categorizing people and behaviors in lenses of risk and focusing on behavioral change, instead of respecting self-determination and addressing the harms committed by state actors on marginalized populations. However, to date there has been little work looking at how harm reduction practitioners, such as those working at syringe service programs (SSPs), situate their work within these different factions. As such, this project seeks to answer the following question: How do SSP employees perceive the practice of harm reduction, and how does this perception of harm reduction affect services being provided?

Methods: This project involves 26 semi-structured, qualitative interviews with SSP employees at 22 SSPs in a Midwestern US state. 13 programs are SSPs run by public health departments, while nine programs are non-governmental SSPs. Interview questions focused on the inception of the syringe exchange, service practices, and how the respondent and the organization defined harm reduction. Transcribed interviews were analyzed using NVIVO. An interpretive framework with thematic analysis was used in analyzing the data, with member checking used to confer rigor.

Findings: Data shows that although respondents share similar definition of the basics of harm reduction—that of reduction of harm from drug use—they differ on how harm reduction services are implemented in practice. Employees at 11 of the 13 public health department SSPs describe their harm reduction efforts exclusively in terms of risk reduction of the harms of drug use, and indicate a preference for referring participants to recovery services. According to these employees, harm reduction is a pathway toward abstinence. In contrast, employees at seven of the nine community-based organizations described harm reduction in terms focusing on bodily autonomy and self-determination in the right to use drugs. These employees, who often have lived experience, describe structural and organizational factors (the state, service providers, law enforcement, medical practitioners, etc.) that have committed harm to their participants, instead of the drug use itself being a form of harm. At these organizations, abstinence or recovery services are not recommended unless specifically requested.

Conclusion/Implications: This project helps us understand how harm reduction is perceived and implemented through those that specifically practice services according to harm reduction philosophy. With a divide in how different factions of the social work profession think about harm reduction practices, it is important to understand how harm reduction workers provide these services at the ground level. The research findings will have implications for understanding how harm reduction practitioners do this difficult work, and how they situate their services among different debates within the field.