Opioid overdose deaths and opioid-related harms have reached unprecedented levels, particularly as compounds such as xylazine and fentanyl have infiltrated the drug supply. Harm reduction strategies are especially relevant in this climate, as they aim to reduce drug-related harms independently of whether an individual chooses to enter treatment or abstain from opioid use. Assessment of harm reduction strategies should consider targets beyond substance use. The purpose of this narrative review is to summarize existing harm reduction strategies in the United States and elsewhere and to describe how outcomes of these strategies could be assessed. Strategies designed to reduce opioid-related harms include syringe exchange programs, overdose education and naloxone distribution, supervised consumption sites, injectable opioid agonist treatment, safer supply programs, drug checking, and decriminalization. Outcomes besides abstinence that could be considered include reductions in substance use patterns that are associated with a high likelihood of negative consequences (e.g., solitary use and polydrug use), reductions in severity of opioid use disorder or early remission of opioid use disorder, improved quality of life and psychological health, improvements in community functioning including linkage and adherence to treatment, and reductions in the incidence of infectious disease. As opioid overdose deaths and related harms continue to rise, harm reduction strategies have become critically important. Harm reduction strategies for opioid use disorder should be considered in the context of outcomes that extend beyond measuring drug use, to capture benefits such as reduced mortality and greater well-being and quality of life.

阿片类药物过量死亡和与阿片类药物相关的危害已达到前所未有的水平，特别是当甲苯噻嗪和芬太尼等化合物渗透到药物供应中时。减少危害策略在这种环境下尤其重要，因为它们的目标是减少与毒品相关的危害，无论个人选择接受治疗还是戒除阿片类药物。减少危害策略的评估应考虑物质使用以外的目标。本叙述性审查的目的是总结美国和其他地方现有的减少危害战略，并描述如何评估这些战略的结果。旨在减少阿片类药物相关危害的策略包括注射器交换计划、过量教育和纳洛酮分发、监督消费场所、注射阿片类激动剂治疗、更安全的供应计划、药物检查和非刑事化。除了戒断之外，还可以考虑的结果包括减少与极有可能产生负面后果（例如单独使用和多种药物使用）相关的物质使用模式、减少阿片类药物使用障碍的严重程度或早期缓解阿片类药物使用障碍、提高质量生活和心理健康的改善、社区功能的改善（包括治疗的联系和坚持）以及传染病发病率的降低。随着阿片类药物过量死亡和相关危害持续上升，减少危害策略变得至关重要。针对阿片类药物使用障碍的减害策略应在超出衡量药物使用范围的结果的背景下考虑，以获取诸如降低死亡率、提高福祉和生活质量等益处。