Abstract
Moral injury is typically defined as the psychological, social, and spiritual harm that follows perceived violations of deeply held moral beliefs or obligations. In the arena of substance use, the concept has begun to appear not only as an outcome of trauma-related coping, but also as a direct feature of substance use disorder itself, especially where drug-seeking, intoxication-related conduct, betrayal, neglect, violence, and parental failure collide with a person’s moral commitments (Van Denend et al., 2022). At the policy level, this framework raises a pressing question: can permissive drug policy, or the misuse of harm reduction policy as an ideology of normalisation, intensify moral injury in users, families, neighbourhoods, and front-line workers? Existing evidence does not justify a wholesale rejection of harm reduction because major agencies such as the World Health Organization and the United Nations Office on Drugs and Crime treat it as one part of a broader public-health response. A policy practice rightly placed and utilised in a continuum of care that should sit alongside prevention, treatment, recovery, and social reintegration (United Nations Office on Drugs and Crime [UNODC], 2024; World Health Organization [WHO], 2014). However, the literature does support a narrower but serious claim: where harm reduction is detached from the continuum of care, specifically, recovery-oriented care, and tacitly underwrites cultural normalisation, or becomes a substitute for demand reduction and treatment, it can contribute to an environment in which drug-related harms are socially managed rather than genuinely reduced, with downstream moral and communal consequences (Erickson & Hathaway, 2010; UNODC, 2024; WHO, 2014).