Balanced Imperfection
is 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
Balanced Imperfection has 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.
-
“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
Audre Lorde -
"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 -
"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 -
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 -
"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 -
"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.”
-
“As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
-
"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 -
"We have to be ready and able to reach clients where they are, not where we want them to be”
-
“In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
-
"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 -
“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.”
-
“Boundaries help me to give all that I can and still come back tomorrow.”
-
"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 -
"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 -
"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. -
"Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
Gabor Maté -
“One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
Charles M. Blow -
"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. "
-
"We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
Jules Netherland -
"Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
Dominique de Villepin -
"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 -
"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 -
“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 -
"There isn’t a way things should be. There’s just what happens, and what we do."
Terry Pratchett -
“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.”
- "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."
- "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."
- 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.”
- "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."
- "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.”
- “As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
- "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."
- "We have to be ready and able to reach clients where they are, not where we want them to be”
- “In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
- "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."
- “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.”
- “Boundaries help me to give all that I can and still come back tomorrow.”
- "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.”
- "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."
- "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."
- "Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
- “One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
- "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. "
- "We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
- "Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
- "The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
- "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."
- “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.”
- "There isn’t a way things should be. There’s just what happens, and what we do."
- “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.
Post-Exposure Prophylaxis Hacks
Featured in: Featured, Hacks for Preventing Escalation
Though largely unsupported by scientific evidence, the dangers of needle stick injury loom large in the popular imagination. As a result, the emotional response to needle stick injury can be intense even if, statistically, the risks are quite low. For this reason, if no other, it’s essential that harm reduction organizations be prepared for how they might deal with such an eventuality.
Hacks for Empathetic Active Listening
Featured in: Featured, De-Escalation In the Moment
Once you have grounded yourself during an escalated situation, next engage in active listening with the person who is agitated. This can seem counterintuitive or difficult when you are dealing with somebody who is, for example, screaming at you, and it may feel like you’re rewarding them for being completely irrational. But it is key to getting them more centered and grounded so they’re less agitated and less likely to become a danger to themselves or others.
-
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 -
"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 -
"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 -
“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. "
-
“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
Audre Lorde -
“Boundaries help me to give all that I can and still come back tomorrow.”
-
"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 -
"Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
Martin Luther King Jr. -
"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 -
"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 -
“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.”
-
“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 -
“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.”
-
"Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
Dominique de Villepin -
“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 -
"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 -
"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 -
"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 have to be ready and able to reach clients where they are, not where we want them to be”
-
"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 -
“As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
-
“One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
Charles M. Blow -
“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 -
"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
- 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.”
- "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."
- "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."
- “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. "
- “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
- “Boundaries help me to give all that I can and still come back tomorrow.”
- "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."
- "Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
- "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."
- "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."
- “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.”
- “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.”
- “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.”
- "Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
- “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.”
- "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."
- "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.”
- "Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
- "We have to be ready and able to reach clients where they are, not where we want them to be”
- "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."
- “As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
- “One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
- “The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
- "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.”