Then (2015), Chasing the Scream
The Fentanyl-Naloxone Race: Has Harm Reduction Kept Pace?
Hari's harm reduction chapter focused on needle exchanges, safe injection sites, and treatment access. Naloxone distribution was a developing policy at the time of writing. He documented the political resistance to making naloxone available without prescription.
confirmed
US drug overdose deaths: 52,404 in 2015 (when Hari published) → 107,500 in 2023 (primarily fentanyl). Naloxone (naloxone nasal spray) became over-the-counter in all 50 states; FDA approved OTC nasal spray in March 2023. Community naloxone distribution programs distribute millions of doses annually. OnPoint NYC (opened November 2021) reversed 1,200+ overdoses without a death as of 2025. Despite this: fentanyl's extreme potency means a single misjudged dose is fatal; contaminated supply reaches people who are not connected to harm reduction services; overdose deaths remain at historically high levels despite naloxone availability. Harm reduction has saved tens of thousands of lives; the underlying crisis has not abated. The race between harm reduction infrastructure and fentanyl's lethality is ongoing and not yet won.
Sources
- CDC WONDER overdose mortality data (2023)
- FDA over-the-counter naloxone nasal spray approval (March 2023)
- OnPoint NYC, Annual Impact Report (2025)