Harm Reduction: Meeting Patients With Substance Use Disorders Where They Are
Harm Reduction: Meeting Patients With Substance Use Disorders Where They Are https://pediatricsnationwide.org/wp-content/uploads/2025/02/iStock_000016793985XLarge-1024x768.jpg 1024 768 Alaina Doklovic Alaina Doklovic https://pediatricsnationwide.org/wp-content/uploads/2023/11/100923RH0019-e1699635391623.jpg- February 04, 2025
- Alaina Doklovic

According to the U.S. Department of Health and Human Services, fewer than 10% of adolescents with a substance use disorder receive care. Of those 10%, many are not ready to engage in treatment. They are often brought in by a parent or guardian. Harm reduction is an opportunity to engage all adolescents, whether they are currently in treatment or not, about reducing risks associated with substance use.
Harm reduction is an evidence-based approach that incorporates health strategies such as prevention, risk reduction and safety awareness to motivate patients who use drugs to seek treatment. The goal is to decrease stigma associated with addiction or substance use, increase education, address potential comorbidities and connect patients with substance use disorders with support services.
“Harm reduction is meeting a patient where they are and helping them be the safest they can be with what they are willing to do at that particular time,” says Ashley Ebersole, MD, MS, FAAP, medical director of BC4Teens and adolescent medicine physician at Nationwide Children’s Hospital. “It is recognizing that treatment is not ‘one size fits all’ and that physicians must tailor their treatment to the specific patient or community.”
Harm reduction does not attempt to minimize or ignore drug use and the harm or danger that is associated with drug use. It recognizes that there are barriers to care, vulnerabilities to drug-related harm, and empowers adolescents with substance use disorders to support and educate one another.
Examples of harm reduction can include:
- Providing naloxone to reverse an opioid overdose
- Providing fentanyl test strips to verify substances are not contaminated or mixed
- Distributing clean needles/syringes
- Identifying safe injection sites
- Educating patients on safe sex practices, drinking and driving laws, vaccination requirements, or mental health challenges
- Identifying potential treatment options with methadone or buprenorphine
Giving out fentanyl test strips or naloxone helps decrease adolescent mortality rates from overdose.
“Often adolescents who overdose on fentanyl or other opioids were unaware they were even taking it in the first place,” says Dr. Ebersole. “This helps reduce the risk of overdose and puts adolescents back in the front seat.”
Educating patients on safe sex practices, using condoms or other birth control methods, human immunodeficiency virus (HIV) and sexually transmitted diseases can help reduce potential co-morbidities of substance use.
Talking to patients about treatment options for substance use disorders helps reach the 90% of adolescents who don’t receive care, says Dr. Ebersole. Even if patients themselves do not want to seek treatment, they may use the information to help a friend or family member. For example, if providers give out naloxone to someone in treatment, part of the 10%, they may use it to help save a loved one who may not be in care.
Pediatricians are in a unique position for prevention, screening and referral. By routinely discussing substance use as part of regular appointments and primary care, they have the opportunity to intervene early reach more patients. Even if a patient isn’t ready for a referral for treatment, knowing that they can talk with the pediatrician and that they can provide help is important to establish early and reiterate at every appointment.
“We need more adolescents to be referred for treatment. Once they walk through the door, we can start the process.” says Dr. Ebersole. “There are so many young people that just don’t know where to go. It may start with nicotine or marijuana use, but oftentimes these are gateway drugs. I just want people to know we are here to help.”
About the author
Alaina Doklovic is a Marketing Specialist for Research Communications at Nationwide Children’s Hospital. She received her BS in medical anthropology and English from The Ohio State University. Her passions for science and health, combined with her desire to help others, motivated her to pursue a career in which she could actively help improve patient outcomes and scientific research through writing.
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