New data from the Centers for Disease Control and Prevention suggests overdose deaths in the United States may finally be declining. This trend gives those working in drug policy, harm reduction and related community outreach our first cause for hope in a long time.
As with any public health issue, the reasons overdose deaths have slowed are many and complicated. However, these data tell us we’ve been doing something right: experts primarily attribute the decline in overdose deaths to the expansion of harm reduction tools — distribution of sterile syringes and naloxone, for example — and evidence-based treatment. On International Overdose Awareness Day (August 31), we urge our leaders and lawmakers to embrace this momentum and prioritize the pragmatic, life-saving approach.
Unfortunately, in 2024, we have witnessed the opposite as harm reduction has come under attack. Idaho repealed its law authorizing the distribution of sterile syringes. We have seen the rise of laws targeting people who share or have illicit substances. For example, governments have scheduled novel (sometimes harmless or potentially helpful) substances without evaluating their effects and further criminalized exposing others (even unknowingly) to fentanyl via drug-induced homicide and first-responder “protection” bills.
These law enforcement-heavy policies are of questionable benefit and may make it harder to save lives. The iron law of prohibition tells us that overcriminalization incentivizes manufacturers to innovate new and more potent substances. At the same time, busts can make the supply less transparent and thus more dangerous for consumers. Time in jail or prison increases the risk for a range of health consequences, including overdose and hepatitis C. Both factors increase overdose risk.
Furthermore, criminal records often prevent people who use drugs from finding jobs and stable housing, hindering and complicating even the most desired recovery journeys. And these consequences have lasting effects on a person’s life.
One of us (Amanda Hall) is a native of Appalachian Kentucky, a region that was ground zero for the prescription opioid epidemic and continues to be struck by the overdose crisis. She received two five-year sentences for selling two of her prescribed pills. The resulting incarceration meant living in a Kentucky prison hours away from family who lacked the financial means to visit. It meant missing her children’s first words and first steps. This is not time that can be reclaimed, and the loss still causes heartache more than a decade later.
It is time for us to do better. We have a chance, but only if we hold our policymakers accountable.
When implemented correctly, harm reduction can save lives. It is a pragmatic approach, with sufficient support and without overregulation. It has garnered some support at the highest levels from lawmakers on both sides of the aisle.
However, there is still work to do. We need more naloxone distribution, primarily by community-based organizations that understand their clients’ wants and needs. We need sterile equipment to reduce the spread of infectious diseases. We need further reaching and lower barrier access to evidence-based treatment such as methadone, a gold-standard medication for opioid use disorder.
U.S. voters must take a careful and objective look at harm reduction — free from the fear-mongering narratives that have popped up in recent years. We aren’t going to fix our overdose crisis by only talking about the border. And we can’t arrest our way out of this public health crisis. Instead, our elected officials must learn from the small but promising success suggested by the emerging data and show us they will work to reduce demand and minimize harm.
Fifty-plus years of a war on drugs have cost taxpayers trillions of dollars and done little to stem the suffering associated with illicit drug use. Instead, it has made the supply more dangerous and entangled people who use drugs within the prison system instead of providing them with access to the resources they need to make healthier, safer choices.
When policy prioritizes prohibition and interdiction, focusing only on supply and not demand, it risks derailing the potential of millions of people who use drugs. We can give them — and our communities — a fighting chance by turning our attention to harm reduction and treatment. And in doing so, more effectively reduce the risk of overdose.
