Harm Reduction

Harm reduction is critical to keeping people who use drugs alive and as healthy as possible, and is a key pillar in the multi-faceted Health and Human Services' Overdose Prevention Strategy.

  • Harm Reduction at SAMHSA

    Harm reduction is an approach that emphasizes engaging directly with people who use drugs to prevent overdose and infectious disease transmission, improve the physical, mental, and social wellbeing of those served, and offer low-threshold options for accessing substance use disorder treatment and other health care services.

    Harm reduction is an important part of the Biden-Harris Administration’s comprehensive approach to addressing substance use disorders through prevention, treatment, and recovery where individuals who use substances set their own goals. Harm reduction organizations incorporate a spectrum of strategies that meet people “where they are” on their own terms, and may serve as a pathway to additional prevention, treatment, and recovery services. Harm reduction works by addressing broader health and social issues through improved policies, programs, and practices.

  • Why are Harm Reduction Services Needed?

    The U.S. is experiencing the most significant substance use and overdose epidemic it has ever faced, exacerbated by a worldwide pandemic, and driven by the proliferation of highly potent synthetic opioids containing primarily fentanyl and other analogues.

    Provisional data from CDC show that we have crossed the tragic milestone of a predicted 100,000 overdose deaths in 12 months from May 2020 to April 2021; this represents a nearly 29 percent increase compared to the same window of time last year.

    Harm reduction services save lives by being available and accessible in a matter that emphasizes the need for humility and compassion toward people who use drugs. Harm reduction plays a significant role in preventing drug-related deaths and offering access to healthcare, social services, and treatment. These services decrease overdose fatalities, acute life-threatening infections related to unsterile drug injection, and chronic diseases such as HIV/HCV.

  • Hand reaching out and taking another hand

    Harm Reduction Grant Program

    This program supports community-based overdose prevention programs, syringe services programs, and other harm reduction services.

    Read more about this grant funding opportunity.

    Access the FAQs (PDF | 375 KB).

    View the award recipients.

Harm Reduction's Place in and Among Prevention, Treatment, and Recovery

A comprehensive prevention strategy, harm reduction is part of the continuum of care. Harm reduction approaches have proven to prevent death, injury, disease, overdose, and substance misuse. Harm reduction is effective in addressing the public health epidemic involving substance use as well as infectious disease and other harms associated with drug use. Specifically, harm reduction services can:

  • Connect individuals to overdose education, counseling, and referral to treatment for infectious diseases and substance use disorders.
  • Distribute opioid overdose reversal medications (e.g., naloxone) to individuals at risk of overdose, or to those who might respond to an overdose.
  • Lessen harms associated with drug use and related behaviors that increase the risk of infectious diseases, including HIV, viral hepatitis, and bacterial and fungal infections.
  • Reduce infectious disease transmission among people who use drugs, including those who inject drugs by equipping them with accurate information and facilitating referral to resources.
  • Reduce overdose deaths, promote linkages to care, facilitate co-location of services as part of a comprehensive, integrated approach.
  • Reduce stigma associated with substance use and co-occurring disorders
  • Promote a philosophy of hope and healing by utilizing those with lived experience of recovery in the management of harm reduction services, and connecting those who have expressed interest to treatment, peer support workers and other recovery support services.

SAMHSA's Current and Future Support for Harm Reduction

SAMHSA has awarded 25 grants for the first-ever SAMHSA Harm Reduction grant program. This funding, authorized by the American Rescue Plan, will help increase access to a range of community harm reduction services and support harm reduction service providers as they work to help prevent overdose deaths and reduce health risks often associated with drug use. SAMHSA accepted applications from State, local, Tribal, and territorial governments, Tribal organizations, non-profit community-based organizations, and primary and behavioral health organizations.

SAMHSA will distribute $10 million between 2022-2025. Grant recipients receiving federal funding must adhere to applicable federal, state, and local laws, regulations, and other requirements as specified in federal grant terms and conditions of award. Other SAMHSA grants may also support harm reduction activities (see individual Notice of Funding Opportunities). The following harm reduction services/supplies are allowable costs that may be covered with certain SAMHSA funds:

Harm Reduction Services Harm Reduction Supplies
  • Overdose reversal education and training services
  • Navigation services to ensure linkage to HIV and viral hepatitis prevention, testing, treatment and care services, including antiretroviral therapy for HCV and HIV, pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), prevention of mother to child transmission and partner services
  • Referral to hepatitis A and hepatitis B vaccinations to reduce risk of viral hepatitis infection
  • Provision of education on HIV and viral hepatitis prevention, testing, and referral to treatment services
  • Provision of information on local resources and/or referrals for PrEP
  • Overdose reversal supplies, including the purchase of naloxone kits (this may include syringes for the purpose of administering injectable naloxone only)
  • Substance test kits, including fentanyl test strips
  • Safer sex kits, including condoms
  • Sharps disposal and medication disposal kits
  • Wound care supplies
  • Medication lock boxes
  • Supplies to promote sterile injection and reduce infectious disease transmission through injection drug use, exclusive of sterile needles, syringes, and other drug paraphernalia*
  • Safer smoking kits to reduce infectious disease transmission, excluding pipes/pipettes and other drug paraphernalia**
  • FDA-approved home testing kits for viral hepatitis (i.e., HBV and HCV) and HIV
  • Written educational materials on safer injection practices and HIV and viral hepatitis and prevention, testing, treatment, and care services
  • Distribution mechanisms (e.g., bags for naloxone or safer sex kits, metal boxes/containers for holding naloxone) for harm reduction supplies, including stock as otherwise described and delineated on this list

*The Harm Reduction grant program is authorized under Section 2706 of the American Rescue Plan Act (ARPA) of 2021, which is not subject to the same syringe funding restrictions as other federal grants. Syringes to prevent and control the spread of infectious diseases are allowed for purchase with grant funds authorized by ARPA for SAMHSA Harm Reduction programs.

**No federal funding is used directly or through subsequent reimbursement of grantees to purchase pipes in safer smoking kits. Grants include explicit prohibitions of federal funds to be used to purchase drug paraphernalia.

National Harm Reduction Technical Assistance (TA) Center

SAMHSA is also collaborating with CDC on their National Harm Reduction Technical Assistance Center to provide a comprehensive approach to harm reduction through syringe services programs (SSPs) and to improve access to prevention and intervention services to prevent infectious disease consequences of drug use. Going beyond education and technical assistance efforts related to needle exchange, SAMHSA’s support of CDC’s existing National Harm Reduction Technical Assistance (TA) Center will enable the Center to also address also a variety of other individual and community factors related to harm reduction, such as, for example, naloxone distribution and administration, safer sex kits, HIV and viral hepatitis testing, COVID-19 response, community stigma, and opportunities for collaboration between harm reduction and other community efforts (e.g., peer-delivered recovery support efforts). Through the collaboration with SAMHSA, the TA Center will support efforts to expand capacity, increase effectiveness, and strengthen the performance and accountability of harm reduction services. This will be done within a comprehensive prevention strategy at the state and community levels and will provide technical assistance and consultation services to support implementation of effective, evidence-based harm reduction programs, practices, and policies in diverse settings.

Additional Resources

Last Updated: 08/16/2022