Harm Reduction: The Other War

“The harm reduction movement didn't argue that drugs were good. It argued that people who use drugs don't deserve to die from preventable causes, and that the state has an obligation to prevent that.”

Harm reduction is the set of policies and practices that aim to reduce the negative consequences of drug use without requiring abstinence as the goal. Safe injection sites allow users to inject drugs under medical supervision, with naloxone available and clean equipment provided. Needle exchanges distribute sterile syringes to prevent HIV and hepatitis transmission. Heroin maintenance programs provide pharmaceutical-grade heroin to users who have not responded to other treatment, in a clinical setting with medical oversight.

These programs do not require drug users to stop using drugs. They require, instead, that drug users not die from preventable causes while they remain users, either from overdose, from infected equipment, or from contaminated supply.

Chasing the Scream documents the political resistance to harm reduction as a feature of the drug war's moral logic: if addiction is a moral failure, reducing the harm of addiction without requiring cessation is complicity in that failure. The abstinence-only model, which informed US drug treatment policy through at least the 1990s, treated harm reduction as sending the wrong message.

The evidence accumulated against this position. Safe injection sites in Vancouver, Sydney, and Amsterdam documented reductions in overdose deaths and HIV transmission without documented increases in drug use in surrounding communities. The Frankfurt model, documented in Chasing the Scream, produced dramatic reductions in street crime as users no longer needed to steal to afford their drugs. The Swiss heroin maintenance program produced the outcomes Hari summarizes: crime down 60 percent, employment doubled, program cost less than imprisonment.

As of 2025, the first sanctioned safe injection site in the United States, OnPoint NYC, opened in November 2021, had reversed over 1,200 overdoses without a single death on-site. US harm reduction policy has shifted substantially since Hari wrote. The resistance to it, in some political quarters, remains essentially unchanged.

Sources

• Hari, Chasing the Scream (2015)
• EMCDDA, European Drug Reports (2020-2024)
• Wikipedia, Harm Reduction