Harm Reduction in 2026: What Has Actually Changed

“OnPoint NYC reversed over 1,200 overdoses without a single on-site death between November 2021 and 2025. The US had no legal safe injection site for over forty years after the first opened in Canada.”

In November 2021, OnPoint NYC opened in East Harlem, the first legally sanctioned overdose prevention center in the United States. It serves an average of 500 clients daily and by 2025 had reversed over 1,200 overdoses through naloxone administration without a single on-site overdose death.

Harm reduction policy has expanded significantly since 2015. Naloxone availability has improved dramatically: available without prescription in every US state, with naloxone nasal spray (nasal naloxone) receiving OTC approval in 2023. Fentanyl test strips, allowing users to check supply for the most dangerous adulterant, have been legalized in most states and distributed through syringe service programs.

What has not changed: the federal legal framework still classifies safe injection sites as illegal under the Controlled Substances Act's 'crack house' statute. The DOJ under the Trump administration did not challenge OnPoint NYC operationally, but the legal uncertainty has prevented most jurisdictions from opening similar facilities.

Hari's argument, that harm reduction is not only more humane but more effective than enforcement, has been confirmed by every facility permitted to operate. The policy constraint is not the evidence.

Sources

• OnPoint NYC Organizational Reports (2025)
• Hari Chasing the Scream (2015)
• CDC Drug Overdose (2023)