Harm Reduction Belongs Everywhere
In our everyday lives, we all take risks—some big and some small. We can’t eliminate risk from the world, so rather than abstain from all activities that carry risk, we often take steps to make those risks more manageable. For example, yesterday I put on SPF moisturizer in the morning, scheduled my son’s vaccinations in the afternoon and chose to drink less wine than I wanted in the evening.
In other words, I practiced harm reduction. I have access to information about my daily risks and to tools and behaviors I can employ to help my family stay safer from harm. That’s something I didn’t think too deeply about until I made a career shift from leading coalitions making the business case for LGBTQ+ rights to joining the R Street Institute to build a new coalition, Safer From Harm, to unite and amplify communities engaged in harm reduction across the country.
Harm reduction grew from people who injected drugs sharing strategies to prevent HIV and Hepatitis C. It is a compassionate response to the failed War on Drugs that has driven mass incarceration, harmed communities and made the nation’s drug supply the most unsafe it has ever been. Today, people around the world are applying harm reduction to other topics, from cigarettes to cannabis to sexual health.
While the details differ across issues, the concept is the same: People take risks—some bigger than others, some legal and some categorized as illegal. Telling people to “just stop” often doesn’t work, and prohibitions make things worse by fueling even more unsafe substances, products and behaviors. Instead, we can provide judgment-free information about the continuum of risk for various behaviors and offer practical tools people can use to mitigate those risks.
And it’s a lot of people: In 2021 in America, nearly half a million people died from smoking cigarettes. More than 100,000 died from opioid use. More than 50,000 died from stimulant use. And more than 36,000 received an HIV diagnosis. We can’t ban or stigmatize our way out of these numbers.
So, what does harm reduction look like in practice?
Making the opioid overdose-reversing drug naloxone available over the counter and encouraging competition to increase available products and achieve community saturation.
Expanding access to medications for opioid use disorder.
Supporting syringe services programs, which can bridge people into treatment and are highly cost-effective.
Decriminalizing fentanyl test strips in holdout states so people who use drugs can check for fentanyl.
Giving adult smokers access to less harmful products, like e-cigarettes.
Ensuring that people at risk for HIV can access PrEP and PEP for prevention.
As I learn more, I’m convinced that harm reduction demands an integrated approach across these issues, which are intertwined in people’s lives, mental health, physical well-being and economic status.
A few examples:
Veterans die from opioid-related overdoses at roughly twice the rate of the general population. They smoke at higher rates and quit at lower rates, and smoking increases their odds of opioid misuse.
LGBTQ+ people are more likely to misuse opioids and to smoke cigarettes than their peers. Substance use is associated with higher risk of HIV, and people living with HIV are more likely to die from smoking than from AIDS-related causes.
Black men are experiencing the biggest increase in overdose deaths in recent years, and their cigarette smoking rates are high. Prohibitions on drugs and some cigarette sales disproportionately harm Black Americans via negative police interactions.
People in rural counties are 31 percent more likely to die from psychostimulants (like methamphetamine) and 13 percent more likely to die from opioids than those in urban counties. Their cigarette smoking rates are almost 5 percent higher, and their odds of quitting are 75 percent lower. Rural Americans who smoke have higher odds of medical opioid use, which in turn is linked to the use of illegal narcotics.
It’s time to get over our instinct to tell people to “just quit” whatever they’re doing, which too often really means—whether we intend it to or not—“serves you right” or “quit or die.” Together, we can change the conversation and urge policymakers to give people access to information and tools that can improve and save their lives.
All of this is why I am honored to be building our Safer From Harm coalition. I hope you’ll join us.