FOR IMMEDIATE RELEASE
Wednesday, July 15, 2026
Contact:
Jillian McKoy, jpmckoy@bu.edu
Michael Saunders, msaunder@bu.edu
##
Why Is Harm Reduction Misunderstood on College Campuses?
A new study found that students and staff involved with collegiate recovery programs held very different definitions and perceptions of harm reduction and its role in these programs, suggesting opportunities to reframe this public health approach in collegiate settings in a way that builds common ground and meets students’ varying substance use needs and recovery goals.
As collegiate recovery programs (CRPs) continue to expand on college campuses across the United States, so too does the opportunity to incorporate approaches supportive of harm reduction into these programs in order to provide vital, evidence-based support to students navigating diverse recovery journeys and goals. But a lack of understanding of what harm reduction actually means has led to differing perspectives about this approach and how—or whether—it should be integrated into CRPs, according to a new study led by Boston University School of Public Health (BUSPH) researchers.
As it relates to drug use, harm reduction is a public health approach that focuses on keeping people who use drugs safe and alive even if they continue to use drugs. It largely gained traction during the height of the HIV/AIDS crisis in the US, in the form of services such as syringe needle exchange programs and bleach kits to combat the spread of HIV. Emphasizing the prevention of negative consequences associated with drug use rather than the prevention of substance use, harm reduction has expanded over the years to include interventions such as naloxone distribution kits and fentanyl test strips, as well as broader ideological commitments to treat people who use drugs with compassion and respect, recognizing that not everyone is ready or able to quit.
But more than 40 years later, there is still no universally accepted definition of this public health approach. Published in the journal Emerging Adulthood , the new study found that this ambiguity led to five varying definitions of harm reduction among CRP program directors, administrators, staff, and students—categorized as traditional, alternative pathway , preventative , humanistic , and skeptical, and these varying conceptualizations shaped the participants’ perspectives on the possibilities and challenges of integrating harm reduction into CRPs.
“Harm reduction has evolved from its origins in HIV prevention to encompass overdose prevention, behavioral change, public health, and social justice, so different groups emphasize different aspects,” says study senior author Dr. Noel Vest , assistant professor of community health sciences at BUSPH. “Our study found that these differing definitions directly shaped whether stakeholders viewed harm reduction as compatible with CRPs. In many cases, disagreements were less about specific interventions and more about what people meant by the term ‘harm reduction.’”
While drug overdose deaths among young adults declined significantly for the third consecutive year in 2025 (along with national rates), drug overdoses remain a leading cause of death among young people, and data also suggest that two-thirds of adults with opioid use disorder begin using drugs before age 25. Furthermore, the Trump administration’s recent funding cuts to clean needle programs threaten to stymie the progress that has been made. Alternative harm reduction services in collegiate settings could offset this loss among recovering students, and understanding how people involved with or influential over CRPs perceive these services can inform how CRPs can continue to evolve and expand to meet students’ needs—without increasing drug use or crime .
“There is evidence to support the idea that harm reduction strategies, such as naloxone and fentanyl test strip distribution, are effective approaches to achieving intended public health outcomes,” says corresponding author Ms. Isabel Redman , research project coordinator in the Department of Community Health Sciences and an incoming doctoral student at BUSPH, who co-lead the study with Ms. Erin Major, PhD student in health services research at BUSPH. “But different major organizations maintain their own official definitions of harm reduction, and these varying definitions among CRP staff and students reflect these broader perspectives.”
For the study, the BUSPH team examined perspectives on harm reduction in 60 interviews in fall 2023 with 8 program directors, 4 administrators, 33 students, and 15 staff members across 5 CRPs in the US.
Among the definitions/conceptualizations identified:
Several overlapping themes and considerations emerged from these five perspectives of harm reduction and its potential role in CRPs, including space on campuses for both abstinence-only and safe/reduced drug use, as well as overdose prevention education and systems-level changes to promote compassionate treatment towards people who use drugs. These overlapping viewpoints signal potential opportunities to create a harm reduction approach that blends multiple perspectives and goals, and places harm reduction on a spectrum, says Ms. Redman.
“Some participants also held multiple viewpoints on harm reduction simultaneously, suggesting that these varying perspectives are not necessarily mutually exclusive,” she says. “Some participants also described that their views on harm reduction changed over time, indicating that beliefs on harm reduction are not stagnant.”
A reframing of harm reduction should emphasize education and awareness of this approach to students—ideally in adolescence before they reach college, Dr. Vest says, or at least early in their college experience, such as in new student orientations.
“Public health has long embraced harm reduction through evidence-based strategies like seat belts, sunscreen, and condoms—interventions that reduce risk without requiring people to eliminate the underlying behavior,” says Dr. Vest. “Brief educational interventions that clarify what harm reduction is, and perhaps more importantly what it is not, could help reduce misconceptions and build common ground. Rather than focusing on narrow concepts, conversations should center on shared goals like reducing overdose, fostering peer support, supporting student well-being, and helping students move toward healthier lives.”
Future research should focus on developing and testing educational interventions that improve understanding of harm reduction among collegiate recovery stakeholders. Establishing a shared understanding of harm reduction may reduce misconceptions and support more informed decision-making about its role within collegiate recovery. The researchers also note that this study should be repeated among other populations, including the general public, to see if similar misconceptions about harm reduction arise.
“ Continuing the conversation, with a focus on common purpose, will help us to better understand the different dimensions of harm reduction and how it may be operationalized to improve student health,” Ms. Redman says.
About Boston University School of Public Health
Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.
Emerging Adulthood
Survey
Animals
Possible Futures for Harm Reduction in Collegiate Recovery Programs: Exploring Stakeholder Perspectives