Harm Reduction for the Advocate

By Jai Abbott, Disability Justice Educational Intern at Mentor A Promise



Stop the Modern Drug War: Harm Reduction for the Advocate Patch Illustration by Sam Headley



Most existing harm reduction articles are made by people who use drugs for people who use drugs, and focus on spreading information and resources for those who are most impacted. This piece has a separate function, it aims to speak to people who don’t have a personal relationship with drug use, addiction, and related issues of policing, and spur those readers into action. Addiction is a combination of social, medical, and biological factors that impact the lives and experiences of those who use drugs. Addiction has existed as long as people have, and will likely continue to do so forever. Harm reduction asks how we can respond to drug use and addiction while acknowledging these external factors and maintaining autonomy.

Many people rely on substances in one way or another for parts of their lives, whether that be coffee, alcohol, cigarettes, weed, pills, or cocaine. Many of us are currently addicted to something and still manage to live happy and fulfilling lives (however that means to us). Action becomes necessary when the systems we create make drug use unnecessarily dangerous and uncomfortable, or otherwise puts up barriers between people who use drugs and their communities creating the lives that they want to lead.

But aren’t some drugs worse than others? Isn’t there a difference between my TikTok addiction and someone else’s heroin addiction? It’s inarguable that some drugs are more addictive than others, and have more dangerous health consequences, but for our purposes, the crucial aspect is not the substance itself, but how it impacts the people who use it, and their communities. For some people, there are ways to use all types of drugs in ways that are life enhancing, rather than diminishing.



An Introduction to Drug Prohibition

It’s been over fifty years since Nixon first declared his “War On Drugs” (https://www.vera.org/news/fifty-years-ago-today-president-nixon-declared-the-war-on-drugs.). A campaign which directly resulted in the incarceration of millions of Black Americans. Since this proclamation, the prison population has grown from 240,593 to 1.43 million, one out of five of which were convicted of a drug offense as their most serious crime (https://www.pbs.org/newshour/nation/50-year-war-on-drugs-imprisoned-millions-of-black-americans). Today, police make 1,500,000 drug arrests annually, and half a million people are currently imprisoned for exclusively drug crimes. 46% of all people incarcerated in federal prison are there because of drug convictions (https://drugabusestatistics.org/drug-related-crime-statistics/).

Drug arrests and convictions are decreasing however, with arrests around the selling of heroin, cocaine, and similar products dropping 53% in the last decade and cannabis distribution decreasing by 68% while possession charges drop 58%. This doesn’t mean, however, that the drug war is over, as someone is still arrested for a drug offense every 35 seconds, 85% of which are for possession alone (https://drugpolicy.org/drug-war-stats/.).

The opioid epidemic has led to increased conversations about the lives and motivations of those who use drugs, while drawing attention to some external factors, such as overprescription. This lens is flawed however, as it prioritizes an image of a white middle class addict, a population which is not the most at-risk for substance abuse. Further, this conception has limited room for critiques of the criminal justice system, or the societal conditions such as poverty that create the worst harms of addiction.



Who Uses Drugs?

Addiction can be found in every social class, race, gender, sexuality, age, and every other identity or social condition. Using the medical model, 16.7% of Americans over the age of 12 met the criteria for a substance use disorder in 2024. (https://americanaddictioncenters.org/rehab-guide/addiction-statistics-demographics)

Despite this fact, addiction is not equally distributed, nor are its effects. A lower socio-economic status increases the likelihood of alcohol related death by 66% for men and 78% for women. This is despite the fact that people with higher incomes are actually significantly more likely to consume alcohol. (https://adcare.com/addiction-demographics/socioeconomic-groups/) Use of opioids, both prescription and recreational, is highest among lower economic classes. Unhoused individuals are the most at risk, with 34.7% of unhoused people living in shelters meeting the criteria for substance use disorders. Mental illness is also a significant factor increasing the rate of drug use.

These statistics signify that people without sufficient social support are much more likely to use drugs excessively, and not have the resources to moderate or cease their usage if they desire. To restate: drug addiction, much like drug prohibition, is a race, class and disability issue, and can be improved through changes in resource allocation, not exclusively personal choice.



Harm Reduction Theory

Drug users are valuable members of our communities, regardless of whether they continue to use or not. We need to treat them as such, both interpersonally and within our social and political establishments. This is the fundamental belief of harm reduction. People who use drugs are important, and we should protect their autonomy and work to keep them safe. These are not mutually exclusive goals, they are inseparable.

According to the National Harm Reduction Coalition, principled harm reduction,

1. “Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them
2.  Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others
3. Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies
4. Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm
5. Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them
6. Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies which meet their actual conditions of use
7. Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm
8. Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use”

(https://harmreduction.org/about-us/principles-of-harm-reduction/)

In practice, this can be applied in many different ways, and varies based on location and political climate as practitioners personalize services for the communities that need them. Commonly, however, harm reduction utilizes techniques such as needle exchanges, providing uncontaminated drugs, safe injection sites, drug testing, overdose reversal, economic support, resource connection, and methods of community attachment. These are practical methods of addressing drug use with empathy, and, most importantly, they work.



Harm Reduction- By The Numbers

Probably the most radical approach to harm reduction is utilized in Portugal. Seemingly abandoning the carceral model entirely, in 2001, they decriminalized all drugs. While police force is still used somewhat regarding gang violence and drug related crime, arrests for exclusively drug use no longer occur. Instead drug abuse counselors are deployed, and meetings are encouraged- although crucially for preserving autonomy- are not mandatory.

People who use drugs in Portugal are recommended healthcare services, addiction treatments, and housing initiatives. Over twenty years, this has reduced overdose deaths by 20% and HIV and hepatitis cases have been cut in half. (https://www.npr.org/2024/02/24/1230188789/portugal-drug-overdose-opioid-treatment) During this same period, American drug deaths increased 500%.

Portugal’s strategy isn’t perfect. Its medical approach can be alienating to those who don’t think an abstinence based approach works for them. Portugal doesn’t use safe injection sites, or needle exchanges, and hasn’t widely distributed Naloxone (also known as Narcan) to reverse overdoses. (https://americanaddictioncenters.org/blog/portugals-harm-reduction-policies)

Overdose prevention sites (also known as safe injection sites or supervised injection sites) have demonstrated their efficacy. They’re associated with reduced overdose deaths, substance use related harm, and all-cause mortality for people who use drugs (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2794326). Needle exchanges alone are associated with a 50% reduction of HIV and HCV incidence (https://www.ajpmonline.org/article/S0749-3797(21)00389-5/pdf). Additionally, using overdose prevention sites actually saves money due to the costs associated with emergency services. Each overdose that was managed by Canada’s Supervised Consumption Services saved approximately 1600 Canadian Dollars, with savings of over $2.3 million over the course of the program.

(https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-022-00609-5.)

Housing is of course a harm reduction tactic. Using drugs while unhoused is significantly more dangerous than doing so in a safe environment. Overdose is more common among unhoused drug users than housed users of the same drugs (https://opioidprinciples.jhsph.edu/how-stable-housing-supports-recovery-from-substance-use-disorders/.). Additionally, being homeless itself is dangerous, exhausting, and alienating, which causes unhoused people to make riskier choices and rely on drugs more frequently. Housing First initiatives provide unconditional stable housing to people living on the streets. They do not require sobriety or other forms of compliance, but start by meeting individuals' safety needs first. As compared to other forms of housing support, Housing First initiatives are associated with “decreased homelessness, reductions in substance use, increased access to mental health and substance use services, and decreased criminal justice involvement. Housing First has also been shown to reduce healthcare, criminal legal system, and other public costs.” (https://opioidprinciples.jhsph.edu/how-stable-housing-supports-recovery-from-substance-use-disorders/. )

This all is to say that not only are the techniques involved in harm reduction compassionate and focused on autonomy and safety, they’re also more effective and cheaper than the methods conventionally used to respond to drug use in the United States.



Attacks on Harm Reduction

Despite consistent evidence of their efficacy in reducing the spread of death and disease, harm reduction programs have not been widely adopted by American cities dealing with heavy drug use. In fact, there have been consistent efforts to defund harm reduction initiatives and criminalize their practices.

Despite overseeing the largest open air drug market in the east coast, Philadelphia’s City Council voted 13-1 to ban overdose prevention sites from most of the city. (https://www.washingtonpost.com/health/2023/09/14/safe-injection-site-philadelphia-opioids/) Needle exchange programs nationally have been found not to have enough funding to even meet minimum benchmarks. ( https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2024.307583) Trump’s executive order “Ending Crime and Disorder on American Streets” ordered that the Substance Abuse and Mental Health Services Administration not use discretionary money to fund “harm reduction” or “safe consumption” efforts. (https://www.networkforphl.org/news-insights/the-july-2025-executive-order-and-the-state-of-harm-reduction-in-the-us/.)

The basis for many of these policies is the Crack House Statute, a section of the 1986 Anti Drug Abuse Act. This made it unlawful to

“(1) knowingly open, lease, rent, use, or maintain any place, whether permanently or temporarily, for the purpose of manufacturing, distributing, or using any controlled substance;

(2) manage or control any place, whether permanently or temporarily, either as an owner, lessee, agent, employee, occupant, or mortgagee, and knowingly and intentionally rent, lease, profit from, or make available for use, with or without compensation, the place for the purpose of unlawfully manufacturing, storing, distributing, or using a controlled substance.” (https://uscode.house.gov/view.xhtml?req=%28title%3A21+section%3A856+edition%3Aprelim%29. )

With these forms of anti harm reduction legislation, there has also been rises of carceral addiction policy. Homeless encampment sweeps are becoming more common, with attacks in areas such Philadelphia, NYC, and across the state of California gaining significant media attention. (https://newjerseymonitor.com/2023/12/25/homeless-residents-face-uncertainty-as-encampment-sweeps-gain-steam/.) With this comes an increase in policing, as well as wellness courts, which force drug users to choose between involuntary treatment and imprisonment. This policy, because it neglects the autonomy of drug users, is automatically contrary to the values of harm reduction, but becomes especially brutal considering that the treatment centers generally do not have enough beds to accommodate the practice. (https://www.kensingtonvoice.com/philly-mayor-announces-five-phase-kensington-plan-despite-care-continuum-that-doesnt-exist/. )

Prisons, however, seldom run out of space, resulting in the physical isolation of a disproportionately minoritized group of people from mainstream society.



What We Can Do- Rebel Harm Reduction

Harm reduction is important, and while its political attacks are damaging, they are not the end to what never was meant to be an exclusively political movement. As people who care about people who use drugs, here are a few things you can do on your own or in small groups.

1. Carry Naloxone

• Naloxone (also known as Narcan) is an over the counter nasal spray medication that is remarkably effective at reversing overdoses. It is extraordinarily safe and, contrary to some misconceptions, has no negative effect on someone who is not actually using drugs. You can identify an overdose if someone is
• Non responsive
• Has pinpoint pupils
• Has slow, shallow breathing
• Is making choking or gurgling sounds
• Has pale, blue, or cold skin, especially blue lips or hands

(https://www.canada.ca/en/health-canada/services/opioids/overdose.html. )


If you see someone in this condition, you can administer narcan through the nose, and call 911. Because of the changing drug supply, they may have ingested tranquilizers and not immediately rouse after narcan has been administered. This does not mean it is not working


You can get Naloxone at most drug stores or online and carry it in your backpack or purse. The Naloxone Finder (https://harmreduction.org/resource-center/harm-reduction-near-you/) can help you find it for free in your area Even if you think you’re unlikely to interact with someone who is overdosing, it’s much better to have it and not need it then need it and not have it.


You can also use fentanyl test strips if you’re using drugs or give them to people who do. A guide for test strips can be found here: https://www.massgeneralbrigham.org/en/about/newsroom/articles/fentanyl-test-strips


    2. Talk about to and about drug users without stigma

• Teach information about harm reduction to your communities. When drug addiction comes up in conversation, acknowledge the humanity and autonomy of drug users. Advocate for policies which support harm reduction (see next section)
• When interacting with drug users, do so with compassion. This should go without saying, but do not call the police on them unless there is imminent danger. Drug users, including unhoused drug users, are part of your community, be polite.

    3. Support organizations who do harm reduction work

Organizations such as The Everywhere Project provide direct support to unhoused people who use drugs in Philadelphia. They provide “access to hot food & to-go meals, access to weather appropriate clothing, hygiene supplies, access to safer use supplies, harm reduction education, wound care services, [and] treatment referrals” free of charge, so rely on donations to function. (https://www.everywhereproject.org/services.)


    4. Don’t be afraid to volunteer! Local harm reduction organizations are frequently understaffed and welcoming of passionate volunteers to distribute information and resources.



What We Can Do- Political Pressure

As a coalition, we have the ability to support policies that fight criminalization and support harm reduction practices. While individual policy concerns can vary depending on your location, here are a few general best practices.

    1. Keep up with harm reduction in your area.

    2. Follow local activists and organizations on social media, go to local events/teach-ins when possible, and prioritize your policy education.


    3. Call/write to your representatives

• What you ask for may depend on your area. In Philadelphia, for example, funding for syringe exchange programs, reversing the mobile services ban, and ending dangerous encampment sweeps are top priorities.
• City officials get a lot of calls from “tough on crime” constituents, they need to know that harm reduction policies are cheap, popular, as well as effective.

    4. Attend town halls/city council meetings

• This is a great way to show that residents are engaged on this issue, take a group, or even go by yourself to leave a comment. Share the information you learn on social media for people who couldn’t make it

    5. Attend protests. You can find local actions by following harm reduction organization on social media and checking their websites.


    6. Spread the word about harm reduction 

• both during organizing meetings, and to friends. Good organizing is coalitional, and that requires working with people who might not already know everything you do. You should also listen to people who are the most affected by drug policy whenever possible. Your advocacy will thank you.

Conclusion

Harm reduction is the notion that we don’t need to fear or paternalize people who use drugs. Drugs, and addiction are part of our lives and communities. It isn’t always comfortable and convenient, but these issues are too important to be erased. I, like many of you, come from a household where addiction was present, and love was present, and one thing did not discount the other.

At Mentor A Promise, we work with people who are harmed by housing policy every day. We find ways to support young people outside of what existing institutions say are possible. Empathetic drug response is a natural extension of this framework.

As advocates, we are not the people who most need the care that we believe is necessary to provide, but truthfully, we all benefit from honest and empathetic responses to drug use and the homelessness that frequently accompanies it. Policing doesn’t result in the safety outcomes that proponents claim. I respect and understand the anxiety some may have when approaching drug use as a neutral phenomenon. This framework does not discount the harm drugs use may cause in some of our lives and relationships, but it should not mean that we must sever these connections. In conscience and community, our ethic of care can only grow. I hope this piece has been helpful. I hope it inspires you to action. I hope we keep learning together.