Featured Research

Integration of Harm Reduction Services in the Veterans Health Administration

This qualitative study identified key barriers and facilitators to implementing a comprehensive bundle of harm reduction services within the VA system. Providers cited patient mistrust of the VA and institutional inertia as significant obstacles, while peer support and leadership buy-in emerged as facilitators.

U.S. Military Veterans and the Opioid Overdose Crisis: A Review of Risk Factors and Prevention Efforts

This review finds that harm reduction services have not been systematically tailored for veterans, particularly those outside the VA — a gap that disproportionately affects veterans with minority backgrounds and socioeconomic disadvantages. Veterans with “other than honorable” discharges for substance-related issues are excluded from VA care entirely, leaving one of the highest-risk groups without support.

Oral Nicotine Pouches Reduce Cigarette Consumption: Results from a Randomized Pilot Trial

A 2025 randomized pilot trial found that 82% of adult daily smokers decreased their average daily cigarette consumption after introduction of nicotine pouches over an 8-week period, with 16% cutting consumption by more than half. The findings provide early clinical evidence supporting nicotine pouches as a cigarette substitution strategy.

Veterans More Likely Than General Population to Use All Types of Tobacco Products

A 2025 peer-reviewed study — the first since 2015 to examine tobacco use by product type among veterans — found that veterans disproportionately use every commercial tobacco category, including the most harmful. Researchers call for coordinated DoD, VHA, and veteran-serving organization efforts to deliver veteran-centric cessation programs.

Walking a Tightrope: A Scoping Review of Harm Reduction Strategies in Self-Harm Management

This 2025 scoping review examines how harm reduction strategies are understood and used in the context of self-harm — from the perspectives of both practitioners and people with lived experience. The review highlights ongoing tension between risk reduction and clinical risk-aversion, and calls for greater integration of harm reduction principles into mental health practice.

Safer Solutions: When Will the Facts About Tobacco Harm Reduction Reach Veterans?

The VA spends nearly $3 billion per year on smoking-related care, and veteran smokers die at 1.73 times the rate of non-smoking veterans. Despite this, VA guidance on reduced-risk nicotine products lags far behind available evidence. Clinicians are beginning to explore e-cigarettes and nicotine pouches as pathways for veterans who cannot achieve abstinence through current programs.

Nicotine Pouches May Offer a Path to Reduced Tobacco Harm

A 2025 narrative review in Frontiers in Public Health finds that the FDA has determined tobacco-free nicotine pouches pose a lower cancer risk than combustible tobacco, and positions them as a potential harm reduction option for adult smokers. Current use rates remain low (around 2–4% in the U.S.), and the products are not risk-free, but they represent a significant and growing category of reduced-risk alternatives.

Tobacco Use Harm Reduction, Elimination, and Escalation in a Large Military Cohort

One of the only studies to apply an explicit harm reduction framework to tobacco use in the military. Following a period of forced abstinence in Air Force Basic Military Training, researchers tracked whether service members eliminated, reduced, or escalated tobacco use — providing a model for how military settings can serve as harm reduction intervention points.

Harm Reduction Strategies Among People Who Intentionally Use Fentanyl

A 2025 mini-review addresses the growing but understudied population of people who intentionally use fentanyl in North America. Unlike unintentional exposure cases, these individuals employ specific strategies to reduce overdose risk, and the authors call for tailored harm reduction tools and novel research designs as even more potent synthetic opioids emerge.

Tobacco-Free Nicotine Pouches and Their Potential Contribution to Tobacco Harm Reduction: A Scoping Review

This scoping review of published evidence found that tobacco-free nicotine pouches (TFNPs) result in substantially lower exposure to toxicants than combustible cigarettes and other tobacco products. While more long-term evidence is needed, the chemical profile of TFNPs supports their potential as a harm reduction option for adult smokers who are unable or unwilling to quit nicotine entirely.

Harm Reduction in U.S. Veterans Who Inject Drugs: A Nationwide Cohort Study

A 2026 retrospective analysis of nearly 90,000 VHA patients with opioid or stimulant use disorder found that veterans who inject drugs remain significantly underserved by existing harm reduction services. The study examined hepatitis C exposure, severe injection-related infections, demographics, and harm reduction receipt across VHA facilities from 2016–2022.

U.S. Substance Use Harm Reduction: A Review of the Current State of Policy, Barriers, and Recommendations

Published in the Harm Reduction Journal (June 2025), this comprehensive policy review finds that harm reduction interventions save lives and reduce serious infectious disease. However, only 26 states currently permit free distribution of any drug checking equipment, and critical funding and Medicaid policy barriers continue to limit access for the most vulnerable populations.

Substance Use and Use Disorders Among Veterans on Long-Term Opioid Therapy

A 2025 cohort study of VHA patients found that one in four veterans on long-term opioid therapy also had a co-occurring substance use issue. Fatal overdose rates were more than three times higher among those with stimulant use disorder alongside opioid therapy, highlighting the urgent need for integrated harm reduction in pain management care.

In the Face of a Volatile Drug Supply, People Take Harm Reduction Into Their Own Hands

A new Johns Hopkins study reveals that people who inject drugs in Baltimore are acutely aware of shifting dangers—like unknown adulterants & unpredictable potency—and are using strategies such as test doses, safer routes, and peer networks to protect themselves. The authors call for policies like drug-checking, surveillance, & removing legal barriers to harm reduction.

Nicotine Pouches May Offer Path to Reduced Tobacco Harm

Rutgers researchers estimate about 2.5% of U.S. adults now use nicotine pouches daily—mostly people who’ve used tobacco before or recently quit—suggesting these products might help reduce harm by substituting for more dangerous nicotine delivery systems. However, use among never-tobacco users is almost non-existent, and experts warn about potential risks, especially for cardiovascular health and youth uptake.

New Research Sheds Light on Treatment and Harm Reduction Gaps Among Drug Users

Amidst rising stimulant drug use and an increasingly contaminated drug supply, there is a need for broader communication and fewer barriers to access of harm-reduction strategies

The role of harm reduction in controlling HIV among injecting drug users

With harm reduction, governments can meet their human rights obligations in terms of improved public health outcomes for the general population and in redressing social justice inequities for drug users themselves.

The impact of condom use on the HIV epidemic

Current levels of HIV would be five times higher without condom use and that the scale-up in condoms use averted about 117 million HIV infections.

Housing and harm reduction: what is the role of harm reduction in addressing homelessness?

The introduction and development of ten year plans to end homelessness in North America heralds a new era of systemic responses to homelessness. Central to many of these plans is the adoption of 'Housing First' as a policy response. 

Primary, Secondary, and Tertiary Prevention of Substance Use Disorders through Socioecological Strategies

Latimore, A. D., E. Salisbury-Afshar, N. Duff, E. Freiling, B. Kellett, R. D. Sullenger, A. Salman, and the Prevention, Treatment, and Recovery Services Working Group of the National Academy of Medicine’s Action Collaborative on Countering the U.S. Opioid Epidemic. 2023. Primary, secondary, and tertiary prevention of substance use disorder through sociological strategies. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. 

What Is Harm Reduction?

Protecting the health of people who use drugs requires providing the services and resources they need.

Online gambling forums as a potential target for harm reduction: an exploratory natural language processing analysis of a reddit.com forum

Online gambling markets are rapidly expanding globally; between 2008 and 2022, revenue from online gambling grew from $21.7B to $63.5B.


In response to this rapid growth, there has been growing interest in gambling harm reduction and prevention research. 

How Should Harm Reduction Be Included in Care Continua for Patients With Opioid Use Disorder?

Harm reduction should be embraced as a core component of the continuum of services required for an effective response to the opioid overdose epidemic. Harm reduction interventions, such as syringe services, naloxone distribution, Housing First models, and low-barrier MOUD, are evidence based and should be funded and expanded nationally, with an eye toward reducing inequities.

Deficiencies in public understanding about tobacco harm reduction: results from a United States national survey

The discrepancy between current evidence and public perceptions of relative risk of various tobacco/nicotine products was marked; for most tobacco types, a large proportion of the population held inaccurate harm reduction beliefs.

The Swedish Experience

The risk of a man dying from a tobacco-related illness is less in Sweden than in any other European country, although tobacco consumption is on a comparable level with that of other countries in Europe. Researchers refer to this paradox as “the Swedish Experience”.

The Scientific Foundation for Tobacco Harm Reduction

"Compiled by leading experts in the field, this report makes the case for harm reduction strategies to protect smokers. It demonstrates that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved." – Royal College of Physicians

What the Experts Say

“When supported by the right policies, safer nicotine products can reduce harm and accelerate smoking cessation.” – Dr. David Abrams, Public Health Researcher