According to the U.S. Department of Health and Human Services, 116 Americans died in 2016 every day from an opioid overdose with over two million people struggling with opioid misuse. The current opioid epidemic affects all segments of global society through its cultivation, trafficking, sales, and misuse. The prevalence of injecting drug use is rising around the world (see full article http://www.who.int/hiv/topics/idu/en/). Addiction is defined as “... a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes can be long lasting and can lead to many harmful, often self-destructive, behaviors.”


Harm reduction was defined by the World Health Organization in 1974 as policies and measures "...to prevent or reduce the severity of problems associated with the non-medical use of dependence-producing drugs." The General Assembly of the United Nations has endorsed harm reduction and set targets in 2001 for all countries to make such interventions available to drug users. Needle exchange programs are based on a harm reduction approach that seeks to minimize the risk of infection and damage to the user and community by non-judgmentally meeting injecting drug users where they are at and providing them with the tools to keep themselves and their communities safe. Needle exchange is one of the most effective ways to prevent the transmission of blood-borne infectious diseases, such as HIV and Hepatitis C. 


The practice of harm reduction has been widespread in Europe since the 1980s. Needle exchanges have been commonplace for decades, and many European countries are moving towards drug consumption rooms. However, there has been a ban on federal funding for needle exchange in the United States since 1988. This prohibition has resulted in the lack of a centralized policy on needle exchange and has given birth to a patchwork of diverse practices and regulations throughout the nation. Many of the most disadvantaged regions of the United States do not have access to needle exchange because policymakers often do not understand the public health value of harm reduction, believing that needle exchange enables drug use.

My interest in harm reduction is based on my work with the European Project AIDS & Mobility (1997-2005) the Fresno Needle Exchange (2008-2015). I am looking to extend my work in the area of harm reduction policy and practice in Helsinki. 

Stories from the Fresno Needle Exchange

This qualitative research project collected preliminary qualitative and quantitative data about the identities, needs, and lives of people using a local unauthorized needle exchange in Fresno California; a region with a high level of poverty and injecting drug use. The data is currently being analyzed.


The project was funded by an Extramural Associates Research Development grant awarded to California State University, Fresno from the NICHD (Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institues of Health [#5 G11 HD057605-02]), and additional funding from the Department of Family & Community Medicine of the University of California, San Francisco, Fresno.

Research on Harm Reduction

Needle exchange is one of the most effective public health interventions to prevent the transmission of infectious disease by injecting drug users. Despite the preponderance of scientific evidence, US federal funding for needle exchange programmes has been banned since 1988. This prohibition has resulted in the lack of a centralised policy on needle exchange and has given birth to a patchwork of diverse practices and regulations throughout the nation. This article focuses on how various local players interpreted the meaning of needle exchange through the debate on an unauthorized site in Fresno, California. In exploring a specific context, this study delineates the narratives used to outline competing views about needle exchange and to offer a snapshot of how the issue of widespread injecting drug use was handled in an impoverished and socially conservative region of the United States.

Clarke, Kris (2006)

The Case of a Needle Exchange Policy Debate in Fresno, California.

Critical Social Policy.
Vol 36, 2: pp. 289-306.

To read full article, click here.

Clarke, Kris; Harris, Debra; Zweifler, John; Lasher, Marc; Mortimer, Roger; Hughes, Susan (2016)

The Significance of Harm Reduction as a Social and Health Care Intervention for Injecting Drug Users:

An Exploratory Study of a Needle Exchange Program in Fresno, California.

Social Work in Public Health.

To read full article, click here.

Kris Clarke, Ph.D

Academic and social commentator
Helsinki, Finland

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