Blue cities are moving away from so-called harm reduction strategies to combat overdose deaths from hard drug use. Within the past few years many civic leaders have decided that drug use was inevitable. They then concluded that a better strategy than interdiction may be to adopt policies to reduce the harm caused by drugs rather than try to reduce use of drugs. Opinions differ about the success or failure of these policies. Harm reduction appears to reduce death rates, while critics complain the policy encourages drug use.
As fentanyl propelled overdose deaths to ever more alarming numbers several years ago, public health officials throughout the United States stepped up a blunt, pragmatic response. Desperate to save lives, they tried making drug use safer.
To prevent life-threatening infections, more states authorized needle exchanges, where drug users could get sterile syringes as well as alcohol wipes, rubber ties and cookers. Dipsticks that test drugs for fentanyl were distributed to college campuses and music festivals. Millions of overdose reversal nasal sprays went to homeless encampments, schools, libraries and businesses. And in 2021, for the first time, the federal government dedicated funds to many of the tactics, collectively known as harm reduction.
Overdose deaths peaked in 2023 at 110,000 and fell to around 80,000 last year. It is easy to extrapolate and say harm reduction saved 30,000 lives, possibly more with the growth trajectory of hard drug use experienced over the past dozen years. That estimate is likely rather naïve, however. Overdose deaths are a function of drug use, which critics suspect rose in response to harm reduction campaigns. In July President Trump echoed what many others believe when he said harm reduction, “only facilitate illegal drug use and its attendant harm.”
But his words, implicitly linking harm reduction to unsafe streets, echoed a sentiment that had already been building in many places, including some of the country’s most liberal cities.
San Francisco’s new mayor, Daniel Lurie… banned city-funded distribution of safe-use smoking supplies such as pipes and foil in public places like parks.
Philadelphia stopped funding syringe services programs, which the C.D.C. has called “proven and effective” in protecting the public and first-responders as well as drug users.
Santa Ana, Calif., shut down its syringe exchanges; Pueblo, Colo., tried to do the same but a judge blocked enforcement of the ordinance.
Harm reduction is a hodgepodge of different initiatives, from needle exchanges, to providing safer drug paraphernalia, to Narcan stockpiling, to decriminalization drug use in a few West Coast cities. Critics and Republican politicians from Red States, believe harm reduction is little more than being soft on quality of life crimes.
Harm reduction supporters reject the notion that protecting people from the worst consequences of drugs encourages use.
There is room for debate about the degree to which harm reduction encourages drug use and whether it increases or decreases deaths. Harm reduction is a mix of numerous ideas, some of which reduce harm while others may increase drug use. There is less argument about whether harm reduction decreases quality of life for those around drug users. In city after city the public has grown weary of open-air drug sales, drug use in public, drug users in a stupor laying on the sidewalk and drug syringes and needle strew about public spaces. The disenchantment with harm reduction probably has as much to do with the public growing tired of negative externalities of permissive drug laws where their kids once played.
Read more at NYT: Cities Move Away From Strategies That Make Drug Use Safer