NACCHO and Balanced Imperfection
are pleased to announce
Harm Reduction Hacks in Focus:
SPACE
HACKS
hacks for creating functional
harm reduction spaces
Space Hacks is the culmination of surveys, qualitative interviews, and community collaboration. Balanced Imperfection initiated the project by researching various aspects of space management, trauma-informed care, transformative and restorative justice models, and de-escalation techniques. This groundwork informed the development of a survey tailored for frontline staff and individuals with experience in harm reduction settings.
Following the analysis of 180 completed surveys, Balanced Imperfection conducted detailed interviews with twelve leaders in the harm reduction field, who collectively offered 261 years of combined expertise, shaped by extensive national and international involvement in harm reduction. These leaders had managed diverse fixed-site harm reduction facilities, including drop-ins, overdose prevention sites, syringe access services, and medication-assisted treatment programs. Interviews, held between March 15 and May 16, 2024, ranged from 67 to 128 minutes each, resulting in 939 minutes of insightful discussions. Their experiences, predominantly from the Northeast and Pacific coast, were pivotal in shaping Space Hacks, which integrates their insights into best practices across prevention, immediate response, and long-term strategies. This collaborative effort was finalized through a community editing process by harm reduction experts, ensuring Space Hacks provides a comprehensive PDF resource for practitioners and organizations in the field.
The Space Hacks is being finalised and will be availiable soon!
The Project
NACCHO, with funding from the CDC, collaborated with Balanced Imperfection to develop guidance for fixed-site harm reduction programs on responding to escalated situations. It contains policy and protocol resources for harm reduction programs such as stand alone and embedded fixed site outdoor, drop in, or other Syringe Services Programs (SSPs), Recovery Community Organizations (RCOs), and Overdose Prevention Centers (OPCs).
In the true spirit of harm reduction, this resource emphasizes non-punitive de-escalation intervention and prevention, drawing inspiration from restorative and transformative justice practices.
The guidance aligns with the SAMHSA Harm Reduction Framework, emphasizing equity, rights, and social justice, and aims to equip communities and participants with the tools necessary to prevent and better respond to challenging situations. This effort supports capacity building and technical assistance for Local Health Departments and harm reduction programs.
-
"Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
Martin Luther King Jr. -
“The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
Mayor Jim Kenney -
“Many of the harm reduction leaders interviewed talked about the importance of not having too many policies and involving your participants in the development of policies—especially those that impact them directly.”
-
"If you question harm reduction works, I can’t help but wonder if you have ever actually seen what happens in these spaces. We promote health safety and dignity, and it works. It is simple, beautiful and changes peoples lives."
Haven Wheelock -
"The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
Judith Lewis Herman -
“Identify five things that you can see, four things that you can touch, three things that you can hear, two things that you can smell and one thing that you can taste.”
-
"One of the most important things we can do as advocates is to define & make concrete the vague terms used by politicians. What does it mean to “take a public health approach”? What you mean when you say “treatment”? Politicians rarely know. Our job is to make it plain for them."
Jonathan Giftos -
“One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
Charles M. Blow -
"Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
Dominique de Villepin -
"Letting go gives us freedom, and freedom is the only condition for happiness. If, in our heart, we still cling to anything - anger, anxiety, or possessions - we cannot be free."
Thich Nhat Hanh -
"We live in a world in which we need to share responsibility. It's easy to say "It's not my child, not my community, not my world, not my problem." Then there are those who see the need and respond. I consider those people my heroes."
Fred Rogers -
“As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
-
"We have to be ready and able to reach clients where they are, not where we want them to be”
-
"I describe my experiences as a nurse volunteer at the overdose prevention site as “being in the right place at the right time doing the right thing.” And that’s exactly where I want to be as a nurse: working outside the system to make a real difference in people’s lives, showing up in the community when it matters most and challenging rules that directly contribute to the overdose crisis, and exposing government inaction by being part of the solution on the ground. For me, this is what nursing is all about."
Marilou Gagnon -
"Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
Gabor Maté -
We need to play that game where we require politicians to finish every sentence denouncing supervised injection facilities with the phrase, “and that is why I think injecting alone in a McDonald’s bathroom is better.”
Jonathan Giftos -
"Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
Fred Rogers -
“In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
-
"One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult. "
-
“People who cause harm are often also survivors of harm. If we want to address the roots of violence, we have to honour both truths.”
Danielle Sered -
"Opponent’s of syringe service programs and harm reduction in general typically remark that it “sends the wrong message.” The message they are referring to is, “We love you and want you to be safe.”
Christopher Abert -
“Boundaries help me to give all that I can and still come back tomorrow.”
-
“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
Audre Lorde -
"There isn’t a way things should be. There’s just what happens, and what we do."
Terry Pratchett -
"We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
Jules Netherland -
"What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured."
Kurt Vonnegut Jr. -
"Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
Fred Rogers -
“When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help. That's the message he is sending.”
Thich Nhat Hanh
- "Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
- “The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
- “Many of the harm reduction leaders interviewed talked about the importance of not having too many policies and involving your participants in the development of policies—especially those that impact them directly.”
- "If you question harm reduction works, I can’t help but wonder if you have ever actually seen what happens in these spaces. We promote health safety and dignity, and it works. It is simple, beautiful and changes peoples lives."
- "The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
- “Identify five things that you can see, four things that you can touch, three things that you can hear, two things that you can smell and one thing that you can taste.”
- "One of the most important things we can do as advocates is to define & make concrete the vague terms used by politicians. What does it mean to “take a public health approach”? What you mean when you say “treatment”? Politicians rarely know. Our job is to make it plain for them."
- “One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
- "Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
- "Letting go gives us freedom, and freedom is the only condition for happiness. If, in our heart, we still cling to anything - anger, anxiety, or possessions - we cannot be free."
- "We live in a world in which we need to share responsibility. It's easy to say "It's not my child, not my community, not my world, not my problem." Then there are those who see the need and respond. I consider those people my heroes."
- “As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
- "We have to be ready and able to reach clients where they are, not where we want them to be”
- "I describe my experiences as a nurse volunteer at the overdose prevention site as “being in the right place at the right time doing the right thing.” And that’s exactly where I want to be as a nurse: working outside the system to make a real difference in people’s lives, showing up in the community when it matters most and challenging rules that directly contribute to the overdose crisis, and exposing government inaction by being part of the solution on the ground. For me, this is what nursing is all about."
- "Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
- We need to play that game where we require politicians to finish every sentence denouncing supervised injection facilities with the phrase, “and that is why I think injecting alone in a McDonald’s bathroom is better.”
- "Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
- “In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
- "One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult. "
- “People who cause harm are often also survivors of harm. If we want to address the roots of violence, we have to honour both truths.”
- "Opponent’s of syringe service programs and harm reduction in general typically remark that it “sends the wrong message.” The message they are referring to is, “We love you and want you to be safe.”
- “Boundaries help me to give all that I can and still come back tomorrow.”
- “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
- "There isn’t a way things should be. There’s just what happens, and what we do."
- "We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
- "What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured."
- "Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
- “When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help. That's the message he is sending.”
The Hacks
We have divided the hacks into logical sections for ease of navigation, but you also have the option of viewing the hacks as one big collection… we’ve even included the option to view a random hack for you if you just want to allow serendipity to guide you.
Featured Hacks
These featured hacks highlight creative, practical solutions from harm reduction leaders on the ground. From DIY tools to clever workarounds, each one reflects the ingenuity, care, and real-world experience that keeps this movement alive.
Resilience Building
Featured in: Featured, Hacks for Preventing Escalation
Because so many of us are so similar to the folks we serve, including the trauma we carry with us, and because it is now recognized that extreme stress impacts people who care for people experiencing that trauma nearly as much as the people directly impacted by that trauma, it is essential that people in […]
Policy Creation Hacks
Featured in: Featured, Hacks for Preventing Escalation
Creating effective policies in harm reduction work means grounding them in your mission, being thoughtful about their impact, and ensuring they’re both practical and inclusive. The tips below offer a starting point for organisations looking to build policies that reflect their values, meet external requirements, and genuinely support the people they serve and work with.
-
"Opponent’s of syringe service programs and harm reduction in general typically remark that it “sends the wrong message.” The message they are referring to is, “We love you and want you to be safe.”
Christopher Abert -
“As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
-
"What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured."
Kurt Vonnegut Jr. -
"I describe my experiences as a nurse volunteer at the overdose prevention site as “being in the right place at the right time doing the right thing.” And that’s exactly where I want to be as a nurse: working outside the system to make a real difference in people’s lives, showing up in the community when it matters most and challenging rules that directly contribute to the overdose crisis, and exposing government inaction by being part of the solution on the ground. For me, this is what nursing is all about."
Marilou Gagnon -
"Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
Dominique de Villepin -
"Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
Gabor Maté -
"Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
Fred Rogers -
“When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help. That's the message he is sending.”
Thich Nhat Hanh -
“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
Audre Lorde -
“The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
Mayor Jim Kenney -
"Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
Martin Luther King Jr. -
“Many of the harm reduction leaders interviewed talked about the importance of not having too many policies and involving your participants in the development of policies—especially those that impact them directly.”
-
“Boundaries help me to give all that I can and still come back tomorrow.”
-
"Letting go gives us freedom, and freedom is the only condition for happiness. If, in our heart, we still cling to anything - anger, anxiety, or possessions - we cannot be free."
Thich Nhat Hanh -
"We live in a world in which we need to share responsibility. It's easy to say "It's not my child, not my community, not my world, not my problem." Then there are those who see the need and respond. I consider those people my heroes."
Fred Rogers -
“One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
Charles M. Blow -
"There isn’t a way things should be. There’s just what happens, and what we do."
Terry Pratchett -
"If you question harm reduction works, I can’t help but wonder if you have ever actually seen what happens in these spaces. We promote health safety and dignity, and it works. It is simple, beautiful and changes peoples lives."
Haven Wheelock -
“In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
-
We need to play that game where we require politicians to finish every sentence denouncing supervised injection facilities with the phrase, “and that is why I think injecting alone in a McDonald’s bathroom is better.”
Jonathan Giftos -
"We have to be ready and able to reach clients where they are, not where we want them to be”
-
“People who cause harm are often also survivors of harm. If we want to address the roots of violence, we have to honour both truths.”
Danielle Sered -
"One of the most important things we can do as advocates is to define & make concrete the vague terms used by politicians. What does it mean to “take a public health approach”? What you mean when you say “treatment”? Politicians rarely know. Our job is to make it plain for them."
Jonathan Giftos -
"The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
Judith Lewis Herman -
"We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
Jules Netherland -
“Identify five things that you can see, four things that you can touch, three things that you can hear, two things that you can smell and one thing that you can taste.”
-
"Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
Fred Rogers -
"One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult. "
- "Opponent’s of syringe service programs and harm reduction in general typically remark that it “sends the wrong message.” The message they are referring to is, “We love you and want you to be safe.”
- “As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
- "What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured."
- "I describe my experiences as a nurse volunteer at the overdose prevention site as “being in the right place at the right time doing the right thing.” And that’s exactly where I want to be as a nurse: working outside the system to make a real difference in people’s lives, showing up in the community when it matters most and challenging rules that directly contribute to the overdose crisis, and exposing government inaction by being part of the solution on the ground. For me, this is what nursing is all about."
- "Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
- "Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
- "Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
- “When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help. That's the message he is sending.”
- “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
- “The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
- "Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
- “Many of the harm reduction leaders interviewed talked about the importance of not having too many policies and involving your participants in the development of policies—especially those that impact them directly.”
- “Boundaries help me to give all that I can and still come back tomorrow.”
- "Letting go gives us freedom, and freedom is the only condition for happiness. If, in our heart, we still cling to anything - anger, anxiety, or possessions - we cannot be free."
- "We live in a world in which we need to share responsibility. It's easy to say "It's not my child, not my community, not my world, not my problem." Then there are those who see the need and respond. I consider those people my heroes."
- “One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
- "There isn’t a way things should be. There’s just what happens, and what we do."
- "If you question harm reduction works, I can’t help but wonder if you have ever actually seen what happens in these spaces. We promote health safety and dignity, and it works. It is simple, beautiful and changes peoples lives."
- “In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
- We need to play that game where we require politicians to finish every sentence denouncing supervised injection facilities with the phrase, “and that is why I think injecting alone in a McDonald’s bathroom is better.”
- "We have to be ready and able to reach clients where they are, not where we want them to be”
- “People who cause harm are often also survivors of harm. If we want to address the roots of violence, we have to honour both truths.”
- "One of the most important things we can do as advocates is to define & make concrete the vague terms used by politicians. What does it mean to “take a public health approach”? What you mean when you say “treatment”? Politicians rarely know. Our job is to make it plain for them."
- "The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
- "We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
- “Identify five things that you can see, four things that you can touch, three things that you can hear, two things that you can smell and one thing that you can taste.”
- "Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
- "One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult. "