Purpose of Review <p>This article explores the history, philosophy, and applications of harm reduction strategies for opioid use disorder (OUD). By addressing foundational principles and evidence-based interventions, the review aims to provide a comprehensive understanding of harm reduction’s role in mitigating the health and social harms associated with opioid use.</p> Recent Findings <p>Harm reduction strategies such as syringe service programs, naloxone distribution, drug testing, and supervised consumption sites have demonstrated efficacy in reducing myriad opioid related harms. Recent data underscore the importance of tailoring these interventions to address the evolving drug supply, including fentanyl contamination, and extending access to marginalized populations. Legal and social barriers continue to limit widespread adoption in many cases.</p> Summary <p>Harm reduction is a vital approach for addressing OUD, combining pragmatic care with social justice. Expanding the reach of these strategies through evidence-based implementation and policy reform can reduce stigma, improve health outcomes, and foster equitable access to care.</p>