How to involve people who use drugs in harm reduction programs

This post is also available in: Português (Portuguese (Brazil))

The importance of involving people with lived experience of drug use in harm reduction programs and drug policies in widely recognised.  People who use drugs have the right to participate in decisions that influence their lives and are the real experts when it comes to harm reduction. The International Network of People Who Use Drugs (INPUD) has been calling for the meaningful involvement of people who use drugs in all interventions involving the community, based on the motto “nothing about us, without us”. 

Yet, in the ground, many harm reduction programs face challenges to apply those principles in practice. That’s why this guide was built. It provides very practical advice on how to better involve, manage and employ people who use drugs.  The guide reflects the perspectives of peers and managers working in harm reduction programs. It draws first on the challenges faced, to then propose a set of very practical recommendations

The main principle

The main principle guiding all recommendations is to promote harm reduction internally:


The eight recommendations

The eight practical recommendations we concluded are:

  • Pay attention to recruitment

    It is recommended that both peers and managers are given the opportunity to be involved in all steps of the recruitment process for new staff.

  • Offer diverse work engagement levels

    Not everyone will be ready or willing to work full time or in specific outreach functions. Offering different levels of work engagement creates opportunities for people who use drugs to progress through the organisation while respecting their possibilities and needs at a given moment.

  • Promote a harm reduction approach to drug use among staff.

    Develop non-prohibitionist regulations at the workplace and focus on job performance instead of on drug use. What matters is that staff must be fit for work and protect the organisation’s image.

  • Foster a supportive work environment

    Be appreciative and build trust. Provide good work conditions and support workers’ needs and self-care, for instance, by being flexible with working hours when staff needs to frequent OST, HIV, or HCV treatment.

  • Provide and foster mental health care

    Offer debriefing sessions and other types of psychological and mental health support, both in groups and individually. Contribute to demystify mental health by promoting basic mental health training.

  • Build and sustain boundaries

    This implies being transparent about rules and how they are applied for everyone, but also help to recognise, building, and maintaining boundaries to help protect staff from emotional burden.

  • Invest in team care by promoting diversity and respect

    Invest in team care and promote an environment of trust among colleagues. Foster the construction of a diverse group and promote respect for this diversity within the team and the organisation.

  • Promote meaningful involvement of staff who uses drugs

    Involve staff who uses drugs at all levels, not only on service delivery. Include staff in planning, evaluating, policy-decision making.

Each culture is different

We know that each culture is different, and every country has a specific context regarding its official drug policies, the level of stigma around drug use, the types and number of harm reduction programs available, as well as the legislation supporting harm reduction. For that reason, the guide is focused on the South African context. Nevertheless, we believe that many of its recommendations can be useful for programs anywhere in the world. These recommendations offer perspective on challenges we have commonly seen in harm reduction programs elsewhere.  

The guide is available for reading here and will soon be available for download on the project page.


about the project

The project was funded by the Centers for Disease Control and Prevention and the Foundation for Professional Development (FPD) in South Africa and was coordinated by Mainline. I have performed the research as a consultant.

To write the guide, I interviewed in-depth 20 peers and managers working in harm reduction programs in South Africa and ran two focus group discussions with peers. I also had a fantastic time following peers in their outreach work activities in the country. Previous guides and literature were also included. Once a first draft of the guide was ready, a community review took place, where study participants and other relevant stakeholders were invited to revise and feedback the document. The revision resulted in the final guide.  

I’m happy the guide is ready to be shared!! And I hope it can contribute to reducing the harms in the work environments of many peers.

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