NACCHO and Balanced Imperfection
are pleased to announce
Harm Reduction Hacks in Focus:
SPACE
HACKS
hacks for creating functional
harm reduction spaces
Space Hacks is the culmination of surveys, qualitative interviews, and community collaboration. Balanced Imperfection initiated the project by researching various aspects of space management, trauma-informed care, transformative and restorative justice models, and de-escalation techniques. This groundwork informed the development of a survey tailored for frontline staff and individuals with experience in harm reduction settings.
Following the analysis of 180 completed surveys, Balanced Imperfection conducted detailed interviews with twelve leaders in the harm reduction field, who collectively offered 261 years of combined expertise, shaped by extensive national and international involvement in harm reduction. These leaders had managed diverse fixed-site harm reduction facilities, including drop-ins, overdose prevention sites, syringe access services, and medication-assisted treatment programs. Interviews, held between March 15 and May 16, 2024, ranged from 67 to 128 minutes each, resulting in 939 minutes of insightful discussions. Their experiences, predominantly from the Northeast and Pacific coast, were pivotal in shaping Space Hacks, which integrates their insights into best practices across prevention, immediate response, and long-term strategies. This collaborative effort was finalized through a community editing process by harm reduction experts, ensuring Space Hacks provides a comprehensive PDF resource for practitioners and organizations in the field.
The Space Hacks is being finalised and will be availiable soon!
The Project
NACCHO, with funding from the CDC, collaborated with Balanced Imperfection to develop guidance for fixed-site harm reduction programs on responding to escalated situations. It contains policy and protocol resources for harm reduction programs such as stand alone and embedded fixed site outdoor, drop in, or other Syringe Services Programs (SSPs), Recovery Community Organizations (RCOs), and Overdose Prevention Centers (OPCs).
In the true spirit of harm reduction, this resource emphasizes non-punitive de-escalation intervention and prevention, drawing inspiration from restorative and transformative justice practices.
The guidance aligns with the SAMHSA Harm Reduction Framework, emphasizing equity, rights, and social justice, and aims to equip communities and participants with the tools necessary to prevent and better respond to challenging situations. This effort supports capacity building and technical assistance for Local Health Departments and harm reduction programs.
-
“People who cause harm are often also survivors of harm. If we want to address the roots of violence, we have to honour both truths.”
Danielle Sered -
"Opponent’s of syringe service programs and harm reduction in general typically remark that it “sends the wrong message.” The message they are referring to is, “We love you and want you to be safe.”
Christopher Abert -
“When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help. That's the message he is sending.”
Thich Nhat Hanh -
"Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
Fred Rogers -
“As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
-
"Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
Dominique de Villepin -
"I describe my experiences as a nurse volunteer at the overdose prevention site as “being in the right place at the right time doing the right thing.” And that’s exactly where I want to be as a nurse: working outside the system to make a real difference in people’s lives, showing up in the community when it matters most and challenging rules that directly contribute to the overdose crisis, and exposing government inaction by being part of the solution on the ground. For me, this is what nursing is all about."
Marilou Gagnon -
"One of the most important things we can do as advocates is to define & make concrete the vague terms used by politicians. What does it mean to “take a public health approach”? What you mean when you say “treatment”? Politicians rarely know. Our job is to make it plain for them."
Jonathan Giftos -
“Many of the harm reduction leaders interviewed talked about the importance of not having too many policies and involving your participants in the development of policies—especially those that impact them directly.”
-
"There isn’t a way things should be. There’s just what happens, and what we do."
Terry Pratchett -
"What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured."
Kurt Vonnegut Jr. -
"We have to be ready and able to reach clients where they are, not where we want them to be”
-
"The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
Judith Lewis Herman -
"One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult. "
-
"If you question harm reduction works, I can’t help but wonder if you have ever actually seen what happens in these spaces. We promote health safety and dignity, and it works. It is simple, beautiful and changes peoples lives."
Haven Wheelock -
“Boundaries help me to give all that I can and still come back tomorrow.”
-
“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
Audre Lorde -
“One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
Charles M. Blow -
"Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
Martin Luther King Jr. -
"Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
Fred Rogers -
“The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
Mayor Jim Kenney -
“In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
-
"Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
Gabor Maté -
“Identify five things that you can see, four things that you can touch, three things that you can hear, two things that you can smell and one thing that you can taste.”
-
We need to play that game where we require politicians to finish every sentence denouncing supervised injection facilities with the phrase, “and that is why I think injecting alone in a McDonald’s bathroom is better.”
Jonathan Giftos -
"We live in a world in which we need to share responsibility. It's easy to say "It's not my child, not my community, not my world, not my problem." Then there are those who see the need and respond. I consider those people my heroes."
Fred Rogers -
"Letting go gives us freedom, and freedom is the only condition for happiness. If, in our heart, we still cling to anything - anger, anxiety, or possessions - we cannot be free."
Thich Nhat Hanh -
"We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
Jules Netherland
- “People who cause harm are often also survivors of harm. If we want to address the roots of violence, we have to honour both truths.”
- "Opponent’s of syringe service programs and harm reduction in general typically remark that it “sends the wrong message.” The message they are referring to is, “We love you and want you to be safe.”
- “When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help. That's the message he is sending.”
- "Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
- “As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
- "Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
- "I describe my experiences as a nurse volunteer at the overdose prevention site as “being in the right place at the right time doing the right thing.” And that’s exactly where I want to be as a nurse: working outside the system to make a real difference in people’s lives, showing up in the community when it matters most and challenging rules that directly contribute to the overdose crisis, and exposing government inaction by being part of the solution on the ground. For me, this is what nursing is all about."
- "One of the most important things we can do as advocates is to define & make concrete the vague terms used by politicians. What does it mean to “take a public health approach”? What you mean when you say “treatment”? Politicians rarely know. Our job is to make it plain for them."
- “Many of the harm reduction leaders interviewed talked about the importance of not having too many policies and involving your participants in the development of policies—especially those that impact them directly.”
- "There isn’t a way things should be. There’s just what happens, and what we do."
- "What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured."
- "We have to be ready and able to reach clients where they are, not where we want them to be”
- "The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
- "One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult. "
- "If you question harm reduction works, I can’t help but wonder if you have ever actually seen what happens in these spaces. We promote health safety and dignity, and it works. It is simple, beautiful and changes peoples lives."
- “Boundaries help me to give all that I can and still come back tomorrow.”
- “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
- “One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
- "Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
- "Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
- “The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
- “In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
- "Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
- “Identify five things that you can see, four things that you can touch, three things that you can hear, two things that you can smell and one thing that you can taste.”
- We need to play that game where we require politicians to finish every sentence denouncing supervised injection facilities with the phrase, “and that is why I think injecting alone in a McDonald’s bathroom is better.”
- "We live in a world in which we need to share responsibility. It's easy to say "It's not my child, not my community, not my world, not my problem." Then there are those who see the need and respond. I consider those people my heroes."
- "Letting go gives us freedom, and freedom is the only condition for happiness. If, in our heart, we still cling to anything - anger, anxiety, or possessions - we cannot be free."
- "We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
The Hacks
We have divided the hacks into logical sections for ease of navigation, but you also have the option of viewing the hacks as one big collection… we’ve even included the option to view a random hack for you if you just want to allow serendipity to guide you.
Featured Hacks
These featured hacks highlight creative, practical solutions from harm reduction leaders on the ground. From DIY tools to clever workarounds, each one reflects the ingenuity, care, and real-world experience that keeps this movement alive.
Policy Creation Hacks
Featured in: Featured, Hacks for Preventing Escalation
Creating effective policies in harm reduction work means grounding them in your mission, being thoughtful about their impact, and ensuring they’re both practical and inclusive. The tips below offer a starting point for organisations looking to build policies that reflect their values, meet external requirements, and genuinely support the people they serve and work with.
Consent Culture
Featured in: Featured, Section 2: Using Space Hacks
The concept of “consent culture” emerged from the sex positive movement of the 1980s and 90s. It was a response to the concept of “rape culture”, a term that had been coined to describe the experience that many people—especially women, queer and trans people—have of sexual violence and harassment.
-
“Many of the harm reduction leaders interviewed talked about the importance of not having too many policies and involving your participants in the development of policies—especially those that impact them directly.”
-
“When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help. That's the message he is sending.”
Thich Nhat Hanh -
"We live in a world in which we need to share responsibility. It's easy to say "It's not my child, not my community, not my world, not my problem." Then there are those who see the need and respond. I consider those people my heroes."
Fred Rogers -
"Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
Dominique de Villepin -
"Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
Fred Rogers -
"Letting go gives us freedom, and freedom is the only condition for happiness. If, in our heart, we still cling to anything - anger, anxiety, or possessions - we cannot be free."
Thich Nhat Hanh -
"Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
Martin Luther King Jr. -
"We have to be ready and able to reach clients where they are, not where we want them to be”
-
"One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult. "
-
"Opponent’s of syringe service programs and harm reduction in general typically remark that it “sends the wrong message.” The message they are referring to is, “We love you and want you to be safe.”
Christopher Abert -
“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
Audre Lorde -
"There isn’t a way things should be. There’s just what happens, and what we do."
Terry Pratchett -
"I describe my experiences as a nurse volunteer at the overdose prevention site as “being in the right place at the right time doing the right thing.” And that’s exactly where I want to be as a nurse: working outside the system to make a real difference in people’s lives, showing up in the community when it matters most and challenging rules that directly contribute to the overdose crisis, and exposing government inaction by being part of the solution on the ground. For me, this is what nursing is all about."
Marilou Gagnon -
“As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
-
“Identify five things that you can see, four things that you can touch, three things that you can hear, two things that you can smell and one thing that you can taste.”
-
"Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
Gabor Maté -
“In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
-
“People who cause harm are often also survivors of harm. If we want to address the roots of violence, we have to honour both truths.”
Danielle Sered -
"If you question harm reduction works, I can’t help but wonder if you have ever actually seen what happens in these spaces. We promote health safety and dignity, and it works. It is simple, beautiful and changes peoples lives."
Haven Wheelock -
"Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
Fred Rogers -
We need to play that game where we require politicians to finish every sentence denouncing supervised injection facilities with the phrase, “and that is why I think injecting alone in a McDonald’s bathroom is better.”
Jonathan Giftos -
"We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
Jules Netherland -
“The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
Mayor Jim Kenney -
"One of the most important things we can do as advocates is to define & make concrete the vague terms used by politicians. What does it mean to “take a public health approach”? What you mean when you say “treatment”? Politicians rarely know. Our job is to make it plain for them."
Jonathan Giftos -
"What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured."
Kurt Vonnegut Jr. -
"The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
Judith Lewis Herman -
“One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
Charles M. Blow -
“Boundaries help me to give all that I can and still come back tomorrow.”
- “Many of the harm reduction leaders interviewed talked about the importance of not having too many policies and involving your participants in the development of policies—especially those that impact them directly.”
- “When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help. That's the message he is sending.”
- "We live in a world in which we need to share responsibility. It's easy to say "It's not my child, not my community, not my world, not my problem." Then there are those who see the need and respond. I consider those people my heroes."
- "Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
- "Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
- "Letting go gives us freedom, and freedom is the only condition for happiness. If, in our heart, we still cling to anything - anger, anxiety, or possessions - we cannot be free."
- "Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
- "We have to be ready and able to reach clients where they are, not where we want them to be”
- "One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult. "
- "Opponent’s of syringe service programs and harm reduction in general typically remark that it “sends the wrong message.” The message they are referring to is, “We love you and want you to be safe.”
- “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
- "There isn’t a way things should be. There’s just what happens, and what we do."
- "I describe my experiences as a nurse volunteer at the overdose prevention site as “being in the right place at the right time doing the right thing.” And that’s exactly where I want to be as a nurse: working outside the system to make a real difference in people’s lives, showing up in the community when it matters most and challenging rules that directly contribute to the overdose crisis, and exposing government inaction by being part of the solution on the ground. For me, this is what nursing is all about."
- “As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
- “Identify five things that you can see, four things that you can touch, three things that you can hear, two things that you can smell and one thing that you can taste.”
- "Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
- “In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
- “People who cause harm are often also survivors of harm. If we want to address the roots of violence, we have to honour both truths.”
- "If you question harm reduction works, I can’t help but wonder if you have ever actually seen what happens in these spaces. We promote health safety and dignity, and it works. It is simple, beautiful and changes peoples lives."
- "Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
- We need to play that game where we require politicians to finish every sentence denouncing supervised injection facilities with the phrase, “and that is why I think injecting alone in a McDonald’s bathroom is better.”
- "We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
- “The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
- "One of the most important things we can do as advocates is to define & make concrete the vague terms used by politicians. What does it mean to “take a public health approach”? What you mean when you say “treatment”? Politicians rarely know. Our job is to make it plain for them."
- "What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured."
- "The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
- “One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
- “Boundaries help me to give all that I can and still come back tomorrow.”