Harm Reduction in Social Work Practice with People Who Use Drugs: Ethical Frameworks and Intervention Strategies

Abstract

The intersecting crises of opioid-related overdose mortality, rising stimulant use, persistent injection-related infectious disease, and the human costs of criminalised drug policy have produced an urgent need for evidence-informed, ethically grounded social work response to substance use. This paper examines ethical frameworks and intervention strategies grounded in the harm-reduction tradition for practice with people who use drugs. Through a comprehensive literature review and theoretical synthesis, this study explores the intersection of social work values, harm-reduction philosophy, and the lived realities of drug-using individuals and communities. Key findings indicate that harm-reduction approaches characterised by pragmatism, respect for autonomy, and a commitment to meeting people where they are produce robust reductions in overdose mortality, blood-borne virus transmission, and structural marginalisation, while remaining fully compatible with the long-term goal of recovery for those who pursue it. The paper proposes a six-step ethical decision-making framework that integrates harm-reduction principles with established social work ethics, and identifies critical intervention strategies including needle and syringe services, opioid agonist and other medication-assisted treatment, motivational interviewing and engagement, peer-support and recovery-oriented systems, and advocacy for drug policy reform. Implications for social work education, agency policy, and structural advocacy are discussed, with emphasis on confronting the stigma, criminalisation, and structural inequities that continue to drive avoidable drug-related harm.