Considering water, sanitation, and hygiene as a valuable component of harm reduction.

Abstract

Harm reduction strategies effectively minimize the immediate health consequences of drug use, such as syringe exchange and overdose prevention. However, the critical role of access to adequate Water, Sanitation, and Hygiene (WASH) services in mitigating these consequences remains underemphasized. This paper argues for the consideration of WASH services as an essential framework within the ongoing evolution of harm reduction, particularly for marginalized people who use drugs (PWUD) facing housing insecurity and limited access to public infrastructure. Lack of access to WASH services forces PWUD into high-risk practices, such as open defecation and using unsafe water for drug preparation and wound cleaning. WASH insecurity among PWUD is strongly associated with elevated risks of skin and soft tissue infections -a leading cause of hospitalization-as well as other infectious diseases, and the exacerbation of chronic conditions (e.g., HIV, Hepatitis C). Beyond direct morbidity, WASH insecurity diminishes dignity, contributing to social exclusion, hygiene-related stigma, and increased vulnerability to gender-based and other structural violence. Drawing on current evidence, this perspective article underscores the necessity of systemic intervention. Harm reduction programs are increasingly called to incorporate WASH items and services, including mobile hygiene units operating under principles of "radical hospitality," and advocate for broader policy solutions like 24/7 public restroom access and Housing First models with integrated WASH facilities. In sum I argue that integrating WASH is not merely a matter of basic amenity; it is a crucial, high-impact strategy for upholding the human rights of PWUD, substantially reducing preventable drug-related harms, and fostering greater social equity.