Harm reduction: what it is and is not

The meaning of the term "harm reduction" has changed over the decades of its existence but it is now increasingly being aligned with public health approaches. An agreed meaning for the term would be helpful and should be sought. Antecedents are easy to find. Emphasis on small achievable steps is an important element; neither inherently supportive of prohibition nor of legalization, harm reduction is essentially pragmatic and tends to favour regulatory approaches. HIV has focused attention on harm reduction but even in the illicit drug field, a strong tradition of research and policy with an identical philosophical framework can be traced back well before the AIDS era. Harm reduction primary prevention educational approaches are more open, honest and respectful of responsible decision making processes. With current illicit drug users, harm reduction emphasizes the need to understand existing individual control mechanisms. The concept can be well understood if contrasted with prevailing approaches to drugs which generally emphasize punishment, lack of regulation and often augment harm.