Ethics

Harm reduction has become an important concept in substance use treatment and policy in the last few decades, as the United States has increasingly been adopting these policies in a number of different areas (Van Wormer & Davis, 2013). As these policies continue to grow in prevalence, it is important that such practices can be justified through research evidence and ethical principles. While there is debate in the field as to whether or not harm reduction is truly neutral of value judgments (Miller, 2005), chemical addiction professionals must be involved in the ongoing discussion of harm reduction and its relationship to ethics. As this paper will illustrate, there is a large amount of disagreement concerning how direct service professionals, researchers, and policy-makers should understand the values of harm reduction, there are differences in opinion about the role of ethics in harm reduction, there are ethical concerns related to each concept and its implementation, and more needs to be done to unify the voices involved in the discussion of ethics in harm reduction.

Before diving into the ethical issues related to harm reduction, it is necessary to attempt to define the concept. As William Miller (2008) writes, “The term ‘harm reduction’ describes a public health approach intended to reduce risks and adverse consequences of behavioral choices” (p. 41). Examples of this policy include needle exchange programs for heroin addicts, the limiting of alcohol sale in certain stores, the banning of smoking in public places, and supervised injection rooms (Fry, Treloar, & Maher, 2005). While the concept has been largely used as a type of public policy (Kleinig, 2008), it has begun to move into the individual practice arena, with profes...

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...their current circumstances to provide efficacious care. While there is widespread agreement for policies like banning smoking in all public places, there is clearly a push against programs such as clean needle exchanges, free medical check-ups for those involved in prostitution, and monitored injection clinics. Division within a side only serves to delegitimize the side’s beliefs, and more needs to be done to unify the individuals in support of harm reduction. One way to further legitimize harm reduction would be to create a harm reduction code of ethics. I imagine this would be a hard fought document, but it would be a proactive step in resolving these disputes. Nevertheless, I am glad to see the discussion of ethics and harm reduction is occurring, and I hope that as it endures, it will help implement sound and fair harm reduction policies throughout the world.