Harm reduction has become increasingly influential in drug policy and practice, but has developed primarily around adult drug use. Theoretical, practical, ethical and legal issues pertaining to children and adolescents under the age of majority – both relating to their own use and the effects of drug use among parents or within the family – are less clear. This commentary proposes a sub-field of drug policy at the intersection of harm reduction and childhood which we refer to as ‘child-centred harm reduction’. We provide a definition and conceptual model, as well as illustrative questions that emerge through a child-centred harm reduction lens. Many people in different countries are already working on these kinds of issues, whose work needs greater recognition, analysis and support. In beginning to name and define this sub-field we hope to improve this situation, and inspire further international debate, collaboration, and innovation.
Protecting children and young people from substance use is considered a global health priority (Degenhardt, Stockings, & Patton, 2016; Hall, Patton, & Stockings, 2016), reflected in the 2030 Sustainable Development Agenda, specifically Goal 3 aimed at ensuring healthy lives and promoting well-being at all ages (United Nations, 2015), and subject to a dedicated article in the UN Convention on the Rights of the Child (Article 33). Substance use disorders among parents are also a major concern for child wellbeing, from early development into adolescence (Barnard & McKeganey 2004; Giacomello, 2022). Responding to drug use and related harms among children and parents are broad, interdisciplinary challenges, across types of drugs, forms of drug use, types of harms as well as socio-economic and legal determinants.
Harm reduction is an influential approach to drug policy and practice that ‘encompasses interventions, programmes and policies that seek to reduce the health, social and economic harms of drug use’ (Rhodes & Hedrich, 2010 p. 19). While a universal definition is lacking, harm reduction is distinguished by its focus on incremental positive change regarding targeted harms, which neither presupposes nor precludes abstinence as a goal. NGOs further emphasise a commitment to human rights and social justice, necessitating the separation of drug use harms from drug policy harms, and highlighting the role of policy and legal frameworks as a driver of vulnerability (e.g. HRI, n.d; HRC, n.d). Harm reduction is a cornerstone of HIV and overdose prevention, endorsed by every relevant UN agency in this regard (United Nations, 2019). It is also increasingly influential for other forms of drug use and drug related harms. However, harm reduction has primarily developed around adult drug use, obscuring theoretical, practical, ethical and legal issues pertaining to children and adolescents under the age of majority – both relating to their own use and the effects of drug use among parents or within the family.