Allie Mikolanis recently returned from a year-long immersion in community-led harm reduction programs around the world, through the Thomas J. Watson Fellowship. Her Fellowship project was inspired by her work founding a harm reduction organization at Wellesley College, where she studied Sociology and critically researched drug court programs.

Traditional harm reduction approaches apply medicalized strategies to reduce the health harms of drug use. While these remain necessary, community-led organizations innovate different forms of harm reduction, responding to unique political and cultural contexts. This renders “harm reduction” a contested term: Which “harms” do we prioritize? How do we “reduce” them? Who makes these decisions?

With insights from immersion in over 24 community-led harm reduction organizations across 6 continents, this project reflects on the variance in definitions and practices of harm reduction.

Where harm reduction is professionalized in “non-profit industrial complex” settings, PWUD may feel their movement has been co-opted and divorced from its political roots. Community-led organizations often respond by naming racial capitalism/imperialism as a primary harm in the lives of PWUD and investing in activism. These organizations, along with those in collectivist cultures, focus on building solidarity between intersecting populations, like sex workers and racialized, unhoused, and LGBTQ+ people. In environments where medical care for PWUD is sparse, community-led organizations that offer health services subvert mainstream stigma against PWUD. Other organizations center on reducing the drug war’s social harms by cultivating communities of PWUD. Yet, not every community-led organization independently defines and practices harm reduction: some must compromise their goals with those of their funder(s).

This project endeavors to spark a globally-grounded conversation about how definitions of harm reduction can create opportunities for authenticity and expression. In the iterative spirit of harm reduction, this project proposes that there is no singular definition of “harm reduction." Along shared principles, communities implement definitions that align with their experiences. Harm reduction embraces the gray, adaptable space between certainties; its definition is no exception. By welcoming a multitude of meanings and rejecting a one-size-fits-all view of harm reduction, we can empower organizations and their funders to uplift diverse voices among PWUD.