One of the most important steps when considering the development of harm reduction services is to think about expectations, including what boundaries you’d like to set for behavior. In organizations, these boundaries are often formalized as policy. 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.

Too many policies, warn long time harm reduction leaders, are difficult to enforce, sets people up for failure, and ensures that policies are routinely broken.

Many harm reduction leaders articulated that it’s better to have fewer rules that are more broad, and which allow for flexibility and adaptability as the situation arises.

In harm reduction programs there are usually three components for creating policies, procedures, and programs: ethics, experience, and evidence.

To build policies in line with harm reduction best practices and ethics, they must always be grounded in the principles of harm reduction.

From these principles, harm reduction leaders can address some of the more ethically challenging aspects of providing services to vulnerable, stigmatized populations who have historically been the recipients of “services” that actually reinforce the structural violence they face.

Leaders in harm reduction report that testing policies and procedures against the Principles of Harm Reduction is a way to avoid reinforcing structural violence and to build programs in line with harm reduction best practices. As a part of these principles, ensuring that drug users and others receiving services are included in decisions is essential for policy creation in harm reduction.

After checking for alignment with the Principles of Harm Reduction, the next most important test of any potential policy or procedure is its basis in the practical experiences of folks working on the ground and the lives of participants. Policies should never be created that would exclude them from services, undermine the value they get from services, or cause undue hardship for those directly providing services because of the practical realities of service provision or participant’s lives. Put plainly, this means that policies in harm reduction organizations should be vetted by the opinions of both participants and staff who would be directly impacted by them.

Finally, the best policies and procedures in harm reduction rely on peer-reviewed evidence. Peer-reviewed evidence means that something has been evaluated and critiqued by researchers and experts in the same field before the information is published.

In harm reduction, of course, practice has always preceded research. Activists whose intuition told them that reducing harm was better than letting people die were handing out syringes before the research caught up to them. At the same time, harm reduction has also always followed research—for example, abandoning practices such as bleaching syringes that have not shown strong peer reviewed evidence of utility. Evidence from within the agency, in the form of program evaluation, is also used by harm reductionists to edit and improve programs and policies.

Other potential influences on potential policies include laws, insurers, funders, and/or board members, so try to ensure policies are in concert with their needs and expectations as well.