{"id":19901,"date":"2025-10-04T17:38:05","date_gmt":"2025-10-04T16:38:05","guid":{"rendered":"https:\/\/drugprevent.org.uk\/ppp\/?p=19901"},"modified":"2025-10-21T20:59:21","modified_gmt":"2025-10-21T19:59:21","slug":"cities-move-away-from-strategies-that-make-drug-use-safer","status":"publish","type":"post","link":"https:\/\/drugprevent.org.uk\/ppp\/2025\/10\/cities-move-away-from-strategies-that-make-drug-use-safer\/","title":{"rendered":"Cities Move Away From Strategies That Make Drug Use Safer"},"content":{"rendered":"

by Jan Hoffman – P<\/strong>ublished Aug. 25, 2025<\/span><\/p>\n

Jan Hoffman<\/strong> is a health reporter for The New York Times covering drug addiction and health law.<\/span><\/p>\n

San Francisco, Philadelphia and others are retreating from \u201charm reduction\u201d strategies that have helped reduce deaths but which critics, including Trump, say have contributed to pervasive public drug use.<\/span><\/p>\n

Safe drug-consumption materials distributed in the Tenderloin district of San Francisco, including naloxone, pipes and plastic straws.Credit…Mike Kai Chen for The New York Times<\/span><\/p>\n

As fentanyl propelled overdose deaths to ever more alarming numbers several years ago, public health officials throughout the United States stepped up a blunt, pragmatic response. Desperate to save lives, they tried making drug use safer.<\/span><\/p>\n

To prevent life-threatening infections, more states authorized needle exchanges, where drug users could get sterile syringes as well as alcohol wipes, rubber ties and cookers. Dipsticks that test drugs for fentanyl were distributed to college campuses and music festivals. Millions of overdose reversal nasal sprays went to homeless encampments, schools, libraries and businesses. And in 2021, for the first time, the federal government dedicated\u00a0funds\u00a0to many of the tactics, collectively known as harm reduction.<\/span><\/p>\n

The strategy helped. By mid-2023, overdose deaths began dropping. Last year, there were an estimated 80,391 drug overdose deaths in the United States, down from 110,037 in 2023,\u00a0according to provisional data\u00a0from the Centers for Disease Control and Prevention.<\/span><\/p>\n

Now, across the country, states and communities are\u00a0turning away from\u00a0harm reduction strategies.<\/span><\/p>\n

Last month, President Trump, vowing to end \u201ccrime and disorder on America\u2019s streets,\u201d issued a far-flung\u00a0executive order\u00a0that included a blast at harm reduction programs which, he said, \u201conly facilitate illegal drug use and its attendant harm.\u201d<\/span><\/p>\n

But his words, implicitly linking harm reduction to unsafe streets, echoed a sentiment that had already been building in many places, including some of the country\u2019s most liberal cities.<\/span><\/p>\n

San Francisco\u2019s new mayor, Daniel Lurie, a Democrat who campaigned on a pledge to tackle addiction and street chaos, announced this spring that the city would step away from harm reduction as its drug policy and instead embrace\u00a0\u201crecovery first,\u201d\u00a0aspiring to get more people into treatment and long-term recovery. He\u00a0banned city-funded distribution of safe-use smoking supplies\u00a0such as pipes and foil in public places like parks. A year earlier, San Francisco voters had signaled their restiveness with pervasive drug use by approving a\u00a0measure stipulating\u00a0that some recipients of public assistance who repeatedly refused drug treatment could lose cash benefits.<\/span><\/p>\n

Philadelphia stopped funding\u00a0syringe services programs, which the\u00a0C.D.C. has called \u201cproven and effective\u201d\u00a0in protecting the public and first-responders as well as drug users. The city put\u00a0restrictions on mobile medical\u00a0teams that distribute overdose reversal kits and provide wound care for people who inject drugs, and stepped up police sweeps in Kensington, a neighborhood long known for its open-air drug markets and a focal point of the city\u2019s harm reduction efforts.<\/span><\/p>\n

Santa Ana, Calif., shut down its syringe exchanges;\u00a0Pueblo, Colo., tried to do the same but a judge blocked enforcement\u00a0of the ordinance.<\/span><\/p>\n

Mayor Daniel Lurie of San Francisco, center, often walks through the Tenderloin district, where people experiencing addiction, mental illness and homelessness gather.Credit…Mike Kai Chen for The New York Times<\/span><\/p>\n

Republican-dominated states have also been retreating from the approaches. In 2021, West Virginia legislators said that\u00a0needle exchange programs\u00a0had to limit distribution to one sterile syringe for each used one turned in and could only serve clients with state IDs. Last year,\u00a0Nebraska lawmakers\u00a0voted against permitting local governments to establish exchanges.<\/span><\/p>\n

\u201cHarm reduction\u201d is a decades-old concept, grounded in the reality that many people cannot or will not stop using drugs. Since the 1980s, when AIDS activists began distributing sterile syringes to drug users\u00a0to slow the spread\u00a0of diseases, the expression has moved to the mainstream of addiction medicine and public health.<\/span><\/p>\n

Over time, it has become shorthand for a wide range of approaches. Some are broadly popular and will certainly continue. In April, the White House\u2019s office of drug control policy released\u00a0priorities\u00a0reaffirming support for drug test strips and naloxone, the overdose reversal medication that has become an essential item in first-aid kits in homes, restaurants and school nurse offices.<\/span><\/p>\n

But critics contend that making drug use safer, with distribution of supplies and pamphlets directing how to use them, normalizes drug use and undercuts people\u2019s motivation to quit and seek abstinence.<\/span><\/p>\n

\u201cThe more you\u2019re sort of funding and feeding the addiction, you\u2019re going to get more addiction,\u201d Art Kleinschmidt, now the head of the federal agency that oversees grants for substance abuse, said on a\u00a0podcast\u00a0last year. Such programs, he said, \u201cdefinitely are breeding dependency.\u201d<\/span><\/p>\n

Others\u00a0argue for nuance.<\/span><\/p>\n

\u201cHarm reduction is neither the singular solution to the overdose crisis nor a primary cause of public drug use and disorder,\u201d said Dr. Aaron Fox, president of the\u00a0New York Society of Addiction Medicine. \u201cIt\u2019s one component of a spectrum of services necessary to prevent overdose deaths and improve the health of people who use drugs. But if communities want long-term solutions to homelessness, they need to work on expanding access to housing.\u201d<\/span><\/p>\n

Harm reduction supporters reject the notion that protecting people from the worst consequences of drugs encourages use.<\/span><\/p>\n

\u201cI don\u2019t think the availability of sterile supplies really makes a difference about whether someone is going to start or continue using drugs,\u201d said Chelsea L. Shover, an epidemiologist at the University of California, Los Angeles, who oversees\u00a0Drug Checking Los Angeles, which tests the contents of drugs for individuals and public health agencies. \u201cBut I do think it will make a difference in terms of whether that person is going to be alive in a week or a month or a year, during which time they might get into recovery, whatever that may mean for them.\u201d<\/span><\/p>\n

Some addiction experts fear that a retreat from harm reduction will reverse the falloff in deaths from injection-related diseases.<\/span><\/p>\n

\u201cHepatitis C and H.I.V. numbers will go up, and more people are going to die,\u201d said Dr. Kelly Ramsey, a\u00a0harm reduction consultant\u00a0who practices addiction medicine at a South Bronx clinic.<\/span><\/p>\n

While overdose deaths have fallen, it is unclear whether drug use itself has also slowed. In neighborhoods across the country, from\u00a0Portland, Maine,\u00a0to\u00a0Portland, Ore., many residents complain that the harm to them from drug use, including crime and\u00a0syringe street litter, has not been reduced.<\/span><\/p>\n

Mr. Trump particularly called out a type of harm reduction known as \u201csafe consumption sites\u201d \u2014 sometimes labeled \u201coverdose prevention centers.\u201d They are supervised locations where people can inject drugs without fatally overdosing, found in Europe, Canada and Mexico. Often drug users can test their supplies right away and staff members can quickly administer overdose reversal medication if needed.<\/span><\/p>\n

There are only three in the United States, and they make for easy political targets. In addition to many Republicans, prominent Democratic governors, including Gavin Newsom of California, Kathy Hochul of New York and Josh Shapiro of Pennsylvania, oppose them. The Pennsylvania\u00a0senate voted\u00a0to ban them. One, in Rhode Island, is protected by state and local law. But the other\u00a0two, in New York City, which provide treatment referrals and support services,\u00a0operate\u00a0in a legal gray zone and could face federal scrutiny.<\/span><\/p>\n

Opponents of harm reduction offer few specifics about how to get more people to stop using drugs and into treatment. Mr. Trump\u2019s order directs the health secretary and the attorney general to explore laws to civilly commit addicted people who cannot care for themselves into residential treatment \u201cor other appropriate facilities.\u201d But it is silent about how such programs would be paid for.<\/span><\/p>\n

The administration has already made major cuts to the Substance Abuse and Mental Health Services Administration, the federal agency that awards grants for prevention, treatment and recovery. It has slashed the agency\u2019s staff and the grants it gives for a wide variety of prevention, intervention and treatment services.<\/span><\/p>\n

Cuts to Medicaid included in the sweeping domestic policy bill enacted this summer are also likely to affect many people\u2019s access to treatment and states\u2019 ability to cover it. Robert F. Kennedy Jr., the health secretary, who is in recovery from a substance use disorder, has focused on nutrition, chronic disease and vaccines during his first six months in office and has said little about plans to address the drug crisis.<\/span><\/p>\n

The battle over whether harm reduction should remain a primary goal or be secondary to getting users into treatment and restoring order to public streets has been joined most intensively in San Francisco.<\/span><\/p>\n

There, ample social services and ferociously expensive housing had contributed to a large population living on the streets, many struggling with mental illness and addiction. Then, by 2020, fentanyl and Covid had slammed into the city.<\/span><\/p>\n

At public meetings this spring, angry residents\u00a0brandished signs, some reading \u201cHarm Reduction Saves Lives\u201d and others \u201cDrug Enablism Kills.\u201d<\/span><\/p>\n

Although the city has adhered to regulations for state-funded Housing First programs, which offer permanent housing for homeless people without requiring them to be drug-free, Mr. Lurie recently presided over the opening of the city\u2019s\u00a0first\u00a0transitional\u00a0sober living residence, with 54 units for adults committed to abstinence.<\/span><\/p>\n

The drive to adjust the city\u2019s drug policy to recovery first has been led by\u00a0Matt Dorsey, a member of the San Francisco Board of Supervisors, who is in recovery from a substance use disorder.<\/span><\/p>\n

In an interview, Mr. Dorsey said he supports aspects of harm reduction, including the distribution of safe supplies. But he sees the strategy as more of a floor than a ceiling. \u201cWe need to make clear that the objective of our drug policy is a healthy, self-directed life free of illicit drug use,\u201d he said.<\/span><\/p>\n

The difficult challenge, he said, was how to attend to the rights of pedestrians who daily confront drug use, while also trying to \u201chelp people addicted to life-threatening drugs.\u201d<\/span><\/p>\n

To pay for additional treatment and services, he said, city officials are working on ballot measures to redirect tax revenue.<\/span><\/p>\n

\u201cPart of what gives me confidence that we will ultimately find the funding,\u201d Mr. Dorsey added, \u201cis that the alternative is unthinkable.\u201d<\/span><\/p>\n

 <\/p>\n

Source: https:\/\/www.nytimes.com\/2025\/08\/25\/health\/harm-reduction-san-francisco-trump.html<\/span><\/strong><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

by Jan Hoffman – Published Aug. 25, 2025 Jan Hoffman is a health reporter for The New York Times covering drug addiction and health law. San Francisco, Philadelphia and others are retreating from \u201charm reduction\u201d strategies that have helped reduce deaths but which critics, including Trump, say have contributed to pervasive public drug use. Safe […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68,141,119,14,36,19],"tags":[],"class_list":["post-19901","post","type-post","status-publish","format-standard","hentry","category-drug-use-various-effects","category-harm-reduction-research","category-prevalence","category-social-affairs","category-treatment-addiction","category-usa"],"_links":{"self":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/19901","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/comments?post=19901"}],"version-history":[{"count":1,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/19901\/revisions"}],"predecessor-version":[{"id":19902,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/19901\/revisions\/19902"}],"wp:attachment":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/media?parent=19901"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/categories?post=19901"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/tags?post=19901"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}