It is currently difficult to contest Andrew Lee Ball’s 2007 statement that ‘Few terms in the world of drug policy evoke such extremes of emotion as “harm reduction”’. According to Ball, ‘Drug policy conservatives shudder, believing that traditional values and drug control will be undermined. Drug legalizers see opportunities for radical law reform. Somewhere in between, service providers and community advocates hold to a hope for more pragmatic, evidence-based interventions.’ He is also right to believe that these ‘emotions are stirred by the lack of a clear definition’, and ‘complicated further by a dynamic discourse that has often generated more heat than light’.

While the principle of harm reduction as generally understood today can arguably be traced back to the UK in the 1920s, the term itself, or variants such as harm minimization, risk minimization and risk reduction, only came into use in the mid to late 1980s. Then some of those involved in working with individuals engaging in IDU in a number of industrialized countries across Europe, Oceania and parts of North America began to recognize the risks associated with drug injection and the spread of HIV/AIDS and other blood-borne infections such as hepatitis C. The result was a variety of modest localized initiatives designed to reduce risk behaviours. From its narrow origins in public health, harm reduction has developed over the years into a far broader and at times apparently nebulous approach incorporating various responses to many aspects of both illicit and licit drug use. Accordingly, the term has been used variously to describe a ‘principle, concept, ideology, policy, strategy, set of interventions, target and movement’. The phrase in general then remains broad and fluid, and is inevitably given different meanings by different actors addressing in varying capacities problems associated with the use of psychoactive substances.