A common misunderstanding is that Harm Reduction is a set of practices and interventions that I can learn by studying some websites. Sterile syringes? Check! Carry Narcan? Check! PEP and PrEP? Check and Check! This misses the point entirely.

Harm Reduction is a philosophy rooted in lived experience, self-determination, bodily autonomy, and the resistance of oppressed people to discrimination and the criminalization of their health and lifestyle choices. Practices follow from the philosophy, and it cannot be otherwise.

To make this plain, let me break Harm Reduction into three tiers (ironic, I suppose, as Harm Reduction philosophy is against hierarchies - but give me some slack here.) For this example I will use syringe access services, with my action being to hand out sterile syringes.

Tier 1 Harm Reduction

Reason to do it: “This is my job, and it’s not my job to tell you what to do with your life.”

Philosophy: “Live and let live” (but you really should stop using).

Tier 2 Harm Reduction

Reason to do it: “I want to prioritize the engagement so I can help you.”

Philosophy: Acceptance, without condoning. Saviorism.

Tier 3 Harm Reduction

Reason: “I recognize that people are experts in their own lives.”

Philosophy: “Folx have a basic human right to bodily autonomy and self-determination, and I will defend that.”

I’m aiming for Tier 3 here. The reasons should be obvious.

In Tier 1 we have someone who is ready to shame the individual for accessing syringes. This will come through in tone and body language. Additionally, it’s just a job - if my boss tells me to do something else, I likely will. I am not invested in the health or rights of the participant.

In Tier 2 I am headed in the right direction, I see the value in providing the service and I am prioritizing the engagement. This is good practice. But there is still a component of judgment that hasn’t been processed. I may go home at night thinking I know what’s best for the participant. I still might be pushed out of the work for something easier or less traumatizing. I will likely burn out from the frustration of people not doing what I perhaps secretly want them to do. Much professionalized Harm Reduction (read: State-Sanctioned) looks like Tier 1 and Tier 2.

In Tier 3 we find the apotheosis of Harm Reduction - often practiced by people with similar lived experience to the participants being served. I have processed any judgments that I may have and left them at the door. I believe in every human’s right to healthcare of their choosing. If I were to be fired from the job I would go and do the work on the street corner. My belief system and identity are enmeshed with the work. This is justice-based and rights-based work.

Why is Tier 3 important? Because Harm Reduction is hard, personal, often traumatizing work. We see people that we care about suffering, and we can be traumatized vicariously. We are fighting to help people stay alive, and simultaneously fighting against the state and carceral social services that are trying to kill us. It’s justice work, it’s activism, and it isn’t always legal. There’s enormous joy in finally standing up for what’s right, and also… it’s hard. The work isn’t for everyone.

It's also important because we need to push back against state-sanctioned harm reduction that continues to take power away from communities and place it in the hands of professionalized helpers.  This only expands surveillance and carcerality. It’s actually the opposite of what Harm Reductionists are trying to achieve – a world where people have complete control over their bodies and their lives, and do not have limited access to the information and resources to make their own, best choices.

How do I get to Tier 3?

Great question. Harm Reduction starts with self-work. For a long time I was stuck on the idea of non-judgment. I thought that if I could expunge judgment from my mind I would become a natural Harm Reductionist. But I was missing a key point.

I’m human. I have judgments.

The paradigm shift came when a quick-witted soul told me to accept my judgments - and not let them get in the way of engagement and service.

This was a real eye-opener for me. It actually busted my brain. I had been working so hard at being the least judgmental person around that I was forcing myself to actively deny part of my human nature. Recipe for burnout.

I am going to have judgments. I am going to think “yeah, crushing and sniffing your Wellbutrin is probably a bad idea, man”. And also, if I can accept that those thoughts will arise and still set them aside for a while I can ask the participant if they were willing to call me beforehand in case something goes left. I can also stay humble and curious and ask about how the practice is helpful to them.

This was a turning point in my journey.

As that shift happened what I also started to see was this: a kindness that I needed to provide myself for being human. And that kindness was infectious. I subsequently felt a much softer heart and gentler compassion towards those that I accompany on their journeys.

Conclusion

When I began my Harm Reduction work I wish now that I had set aside the practice portion for a bit. There’s a lot to learn there and it’s easy to fall into the trap of thinking I know more about Harm Reduction than the next guy. That’s not a great mindset. Put the drive for expertise away.

Instead, I needed to focus on me. I needed to look inside and see where my judgments were coming from. I needed to see if I could be kind to those parts of myself, and find out the root causes of my judgments: personal experience, family, society. Making friends with those parts and then tucking them away for a while was key. Then, I could turn to the person next to me and ask them what they need. I can believe them when they tell me. I can walk-with.

Post-Conclusion

I obviously don’t know a damn thing about you, the communities you are part of and serve/are served by, or what is best for you. Advice-giving is treacherous. I get that. I tried to keep this on the “I”. The above is how I try to be in the world, and what I find helpful. If anything/everything I’ve said doesn’t apply to you please just trash it and we can both keep it pushing. I respect your right to practice Harm Reduction as you see fit. What I don’t respect is state-sanctioned “harm reduction” that’s actually just “shame with your syringe.”