Applying Harm Reduction Principles in Family Medicine Beyond Substance Misuse 

Jennifer Hardell, MD
April 27, 2026

The first patients of your clinic day are a young man living with HIV who receives his monthly extended-release subcutaneous buprenorphine injection and his partner for whom you prescribe preexposure prophylaxis (PrEP). A proponent of harm reduction, you have developed a partnership with these patients as you navigate their health with humanism and pragmatism in efforts to reduce harm. 

Your clinic day continues. An 80-year-old man with multiple chronic conditions is struggling to remember to take his medications. A frazzled mom has started co-sleeping with her 4-month-old infant. You perform 24-hour diet recalls for two teenagers in a row: one who has an elevated body mass index and one who has been restricting and purging. You see a young woman in her mid-twenties who you worry could be experiencing intimate partner violence. A 30-year-old woman with depression who you have been following closely has started to cut her wrists again.

Physicians are practicing in an age when patient-centered care has largely replaced the paternalistic model. But what if we took this care to the next level? There is a movement to incorporate principles of harm reduction into all aspects of family medicine. Abstinence-only messaging in patient care can increase anxiety, create shame and stigma, reduce engagement in care, and paradoxically increase harm. Insistence on providing universal advice that recommends only the “safest” option deprives patients of harm-reducing information.  

Harm reduction approaches have naturally expanded from substance misuse and HIV prevention into other areas of family medicine (eg, adolescent medicine, contraception). The practice of harm reduction also embodies a radical rethinking of providing patient-centered care, including applying shared decision-making to learn from patients about high-risk behaviors and offering information to reduce harm.  

By interacting with patients as both a learner and informer, physicians can learn more about patients’ day to day lives, develop stronger relationships, realize that patients have the right to make their own health decisions (even if the decisions could be harmful), and offer harm-reducing options to optimize health.  

For the 80-year-old patient, conversations can be started about deprescribing and pill packs or other strategies for remembering to take medications. For the overburdened, anxious mother, you can listen to her struggles, understand her goals, empathize, and recognize that strict, universal advice such as Back to Sleep may not be effective here. You can share International La Leche League’s Safe Sleep Seven about decreasing risks of bed-sharing and strategize ways for this behavior to change if she wishes to sleep separately from her child in the future. 

For the teenagers with disordered eating, we can withhold judgment, learn more about “Health At Any Size” approaches, and congratulate them for making incremental changes. For someone experiencing intimate partner violence, recognize that immediate action may cause more harm, provide resources, and support the patient in her autonomy to make relationship decisions. 

For a patient returning to self-harm, listen empathetically and realize that “backward” movement can be a part of the healing process. You can collaborate with this patient to think through coping strategies that minimize harm and also make safety plans. 

Harm reduction has a fundamental history in substance misuse, and it gained widespread recognition in the activism of the AIDS epidemic of the 1980s and 1990s.  However, its principles, rooted in patient autonomy and social justice, can and should be applied far beyond these topics. As patient-centered care and shared decision-making are increasingly emphasized, we can approach each and every interaction with humanism and pragmatism, commit to learning more about our patients, and provide them with an informed spectrum of options to navigate their health.

Dr. Jennifer Hardell is a second-year family medicine resident at Lancaster General Hospital in Pennsylvania.