Reviewed by: Gilbert Schmidt, MD, FASAM | BrightView Medical Director, NC & MD and Brianna Ramseur, MSN, NP, ACNPC-AG | BrightView Lead Advanced Practice Provider
Published: October 2026
Updated: October 2026
Harm reduction is often associated with tools such as naloxone, syringe service programs, and fentanyl test strips. Those interventions can save lives and reduce immediate risks.
But what happens next?
That question was at the center of BrightView Health’s recent virtual forum, “Rethinking Harm Reduction: A Modern Framework,” featuring Gilbert Schmidt, MD, FASAM, and Brianna Ramseur, MSN, NP, ACNPC-AG.
Their message: effective harm reduction should do more than help someone survive a dangerous moment. It should create opportunities for connection, treatment, better health, stronger families, and long-term recovery.
As Dr. Schmidt summarized during the forum:
“Meeting people where they are is where harm reduction begins. But it should never be where it stops.”
What Is Harm Reduction?
Harm reduction includes evidence-based strategies designed to decrease preventable harm associated with substance use.
During the forum, Dr. Schmidt proposed a broader definition:
Harm reduction is “any evidence-based intervention that decreases preventable harm while increasing the likelihood of health, recovery, family stability, and community well-being.”
That definition matters because substance use disorder rarely affects only one person.
According to the 2024 National Survey on Drug Use and Health data presented during the forum, approximately 1 in 6 Americans meets diagnostic criteria for a substance use disorder. The effects can also reach spouses, children, parents, employers, coworkers, neighbors, and entire communities.
A comprehensive harm reduction approach therefore asks a bigger question:
How can we reduce harm not only for the person using substances, but for everyone affected by addiction?
Why Harm Reduction Matters When Many People Never Enter Treatment
Telling someone to “just get help” overlooks how difficult accessing treatment can be.
People may face:
- Limited treatment availability
- Transportation barriers
- Insurance or cost concerns
- Fear of withdrawal
- Co-occurring mental health conditions
- Stigma and shame
- Previous negative treatment experiences
- Fear of legal consequences
The forum highlighted that roughly four out of five people who meet criteria for a substance use disorder do not receive treatment. That creates an important challenge: if someone has not yet entered treatment, there still must be ways to reduce their risk and keep the door to recovery open.
As Ramseur explained, harm reduction begins by acknowledging where someone is today rather than demanding perfection before offering help.
What Are Examples of Harm Reduction?
Harm reduction can take many forms. Different interventions serve different purposes, and not every strategy is intended to produce the same outcome.
Naloxone
Naloxone can rapidly reverse an opioid overdose and prevent death.
That makes it one of the most important tools available for reducing opioid-related harm.
But reversing an overdose is not the same as treating opioid use disorder.
“Naloxone changes the outcome of the overdose,” Ramseur explained during the forum. “But really only treatment is going to change the trajectory of the disease.”
An overdose reversal can therefore become an important opportunity to connect someone with treatment and additional support.
Syringe Service Programs
Syringe service programs can help reduce HIV and hepatitis C transmission, injection-related infections, and unsafe syringe sharing while increasing contact with healthcare services.
Ramseur compared these services to a bridge.
A bridge is valuable because it helps someone get somewhere. But the bridge itself is not the destination.
In the same way, syringe services can create a connection that eventually leads to primary care, infectious disease treatment, medications for substance use disorder, counseling, housing assistance, or other recovery supports.
Fentanyl Test Strips
Fentanyl test strips can identify the presence of fentanyl and give people information that may influence how they use a substance.
The forum reviewed evidence suggesting that a positive fentanyl test may lead some people to use less, use more slowly, avoid using alone, make sure naloxone is nearby, or decide not to use the substance.
But information alone does not treat addiction.
The larger opportunity is using that moment of awareness to connect someone with resources that can reduce risk over the long term.
Medications for Opioid Use Disorder
Medications such as buprenorphine and methadone can reduce withdrawal symptoms and cravings and are an important part of evidence-based treatment for opioid use disorder.
During the forum’s Q&A, Dr. Schmidt emphasized that treatment with these medications should not be viewed as simply replacing one drug with another.
Ramseur echoed that point, explaining that medication treats a medical condition and can help people regain stability, improve their health, work, rebuild relationships, and reduce their risk of overdose.
Harm Reduction Should Create a Path Toward Treatment
One of the clearest ideas to emerge from the forum was that individual harm reduction interventions work best when they are part of a larger system.
Ramseur described that system in three steps:
1. Survive
The first priority is preventing death.
Naloxone, safer-use education, infectious disease prevention, and other interventions can keep someone alive long enough for another opportunity to occur.
As the presenters put it plainly, a person who dies cannot recover.
2. Engage
Every interaction can become an opportunity to build trust.
That may begin with a simple question:
What else can we do for you today?
Someone who is not ready for treatment today may be ready tomorrow. Maintaining the relationship can make that future conversation possible.
3. Treat
Treatment should address more than substance use alone.
That can include:
- Medications for substance use disorder
- Behavioral health treatment
- Psychiatric care
- Chronic pain management
- Hepatitis C or HIV treatment
- Primary medical care
- Treatment for health complications associated with substance use
“The greatest harm reduction strategy that we have is to restore health,” Ramseur said.
Harm Reduction Can Include Treating Hepatitis C
One of the forum’s strongest examples of this broader approach involved hepatitis C.
Hepatitis C can cause serious long-term health complications, including cirrhosis and liver cancer, but modern treatment can cure the infection in most patients.
Dr. Schmidt argued that identifying and treating hepatitis C should be considered part of harm reduction rather than a separate issue.
“There’s no such thing as successful harm reduction if we leave a curable, awful, fatal disease untreated,” he said.
For people receiving addiction treatment, addressing conditions such as hepatitis C can improve health today while also supporting recovery over the long term.
Recovery Is More Than Not Using Drugs
Preventing overdose and treating disease are important. But recovery also requires something to move toward.
The forum described this as building recovery capital.
Recovery capital includes the resources, relationships, stability, and sense of purpose that can help someone sustain recovery.
That may include:
- Safe housing
- Employment
- Transportation
- Education
- Family and social connections
- Nutrition
- Exercise
- Healthy sleep
- Meaning and purpose
Dr. Schmidt summarized the concept with a statement that became a recurring theme throughout the presentation:
“The opposite of addiction is not abstinence. It’s recovery.”
The goal is not simply to remove a substance from someone’s life. It is to help them build a life that feels healthier, safer, more connected, and worth protecting.
Does Harm Reduction Mean Abstinence Is Not Important?
Not necessarily.
For some people, abstinence is their goal. For others, it may not be their goal when they first seek help.
Dr. Schmidt encouraged providers to start by asking a different question:
Whose goal is it?
A clinician may believe abstinence is the safest outcome, but imposing that goal before a patient is ready can undermine the very principle of meeting someone where they are.
“If abstinence is not their goal, that’s okay,” he explained. “I can support their recovery today by reducing harm today.”
Progress can begin with smaller steps: reducing overdose risk, using less frequently, treating an infection, taking medication consistently, attending appointments, or beginning counseling.
The goal can become more ambitious as health and stability improve.
Recovery Is Not Always a Straight Line
Substance use disorder is a chronic condition, and recovery does not always happen in a straight line.
Relapse or an unexpected drug screen does not have to mean someone has failed treatment.
Instead, it can become another opportunity to reassess risk, strengthen the treatment plan, and reconnect.
“Harm reduction and recovery are not opposites,” Dr. Schmidt said. “They are points in the same continuum.”
A complete system of care continues offering support even when someone’s recovery takes an unexpected turn.
Measuring Harm Reduction by What Happens Next
Traditional harm reduction programs may report how many naloxone kits, syringes, or fentanyl test strips were distributed.
Those measures can be useful.
But the forum challenged healthcare providers and communities to look further.
Did fewer people die?
Did fewer people acquire HIV or hepatitis C?
Did more people enter treatment?
Did more people receive medications for opioid use disorder?
Did their health improve?
Did they find housing or employment?
Did their families become more stable?
Did their lives improve?
Those are the outcomes that can help show whether harm reduction is becoming more than a collection of individual interventions.
Watch the Full Forum: Rethinking Harm Reduction
In “Rethinking Harm Reduction: A Modern Framework,” Gilbert Schmidt, MD, FASAM, and Brianna Ramseur, MSN, NP, ACNPC-AG, explore the evidence behind current harm reduction approaches and discuss how healthcare providers, families, and communities can help create stronger pathways toward treatment and recovery.
Help Is Available
Someone does not have to have every part of recovery figured out before asking for help.
BrightView provides outpatient addiction treatment designed to meet people where they are and help them take their next step toward better health and recovery.
