How is harm reduction policy implemented in local contexts? Three examples from Denmark (2026)

Harm reduction is an important public health factor for people who use drugs. It is recommended by United Nations agencies and implemented in many countries around the world. In this article, we present a study of local harm reduction policies in Denmark. Historically, harm reduction has developed at the local level due to local stakeholders' concerns about the health of people who use drugs. Therefore, it is a key site for studying harm reduction policies. In Denmark, harm reduction policy implementation is delegated to 98 municipalities. National legislation obliges municipalities to implement some harm reduction services and makes it optional for them to implement others. The latter services include heroin-assisted treatment (HAT) and drug consumption rooms (DCRs). In this article, we present a study of local harm reduction policy processes in relation to implementation of HAT and DCRs - or not - in three municipalities in Denmark based on document analysis and qualitative interviews with local stakeholders. One municipality had implemented a DCR, one has implemented HAT, and one had implemented neither. Analytically we apply Kingdon's multiple streams approach to policy analysis and Stone's ideas about moral and emotional engagement in policy processes. We show how local problem constructions and justifications influence the implementation of harm reduction services, and that moral engagement with core policy values like equity in such processes. We conclude that the Danish harm reduction model, which at the same time makes it optional for municipalities to implement certain harm reduction services and gives them a monopoly on implementing them, creates geographical differences in access to harm reduction services in Denmark. To characterize harm reduction in Denmark on the basis of national policy and legislation would therefore be a misrepresentation, local differences need to be taken into account. [Author's abstract]