Why anonymity matters in harm reduction: what drug service users say about privacy and trust

What is it about?

Anonymity is a foundational principle of harm reduction practice, enabling people who use drugs to access services without fear of identification, criminalisation or stigma. This Finnish qualitative study examined how anonymity functions across four different service environments: street-based harm reduction services and online services operating within the Tor network, a technology that routes internet traffic to protect user identity. Data came from service user interviews and naturally occurring conversations within Tor network forums. The study applies the concept of relational anonymity, which recognises that anonymity is not simply a technical or administrative feature but is shaped by the relationships, contexts and social dynamics surrounding each service encounter. The analysis explores what anonymity means to service users in each setting, why they need it, and how different technological and relational forms of anonymity protection shape their willingness and ability to engage with harm reduction support.

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Why is it important?

As harm reduction services expand into digital and online environments, understanding what anonymity means in practice to people who use drugs is essential for designing services that genuinely reduce barriers to access. The Tor network represents an innovative frontier in harm reduction service delivery, with Finnish practitioners among the first globally to use it for professional outreach. The relational anonymity framework developed in this study moves beyond simplistic conceptions of anonymity as identity concealment to capture its social and contextual dimensions, producing theory applicable to the design of both digital and in-person harm reduction services. Fear of identification remains one of the most consistently documented barriers to harm reduction engagement, and evidence that addresses this barrier directly has immediate practical relevance for service commissioners and practitioners working in stigmatising legal and social environments.