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Am Fam Physician. 2022;105(1):90-92

Related Letter to the Editor: Applying Harm Reduction Principles to Reproductive Health

Author disclosure: No relevant financial relationships.

Case Scenario

S.R., a 27-year-old patient with a history of depression, presents to my clinic with a painful outbreak of genital herpes. During the physical examination, I notice what appear to be track marks on the patient's feet. I mention my concern, and S.R. admits to recently resuming daily heroin and methamphetamine injection drug use with their partner. I offer a referral for treatment, but S.R. declines. What additional options are available for me to help this patient?



Patients engaged in high-risk activities are often ambivalent about changing their behavior.1 Harm reduction is an approach that focuses on limiting harm and improving quality of life for patients who persist with high-risk behaviors; the foundations of harm reduction are pragmatism and compassion. The approach encompasses a range of evidence-based practices that decrease risk for patients and the community.2 For health professionals, harm reduction is not only a set of evidence-based interventions, but it also conveys respect for personal autonomy that empowers patients to take responsibility for their behavioral changes.2 Acknowledging the complexity of high-risk behavior and using a supportive, practical approach to address the situation can decrease friction between the patient and physician and build trusting therapeutic relationships that can pay off in often unexpected ways.

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Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Send scenarios to Materials are edited to retain confidentiality.

This series is coordinated by Caroline Wellbery, MD, associate deputy editor.

A collection of Curbside Consultation published in AFP is available at

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