{"id":20269,"date":"2025-11-15T18:39:47","date_gmt":"2025-11-15T17:39:47","guid":{"rendered":"https:\/\/drugprevent.org.uk\/ppp\/?p=20269"},"modified":"2025-12-07T18:07:22","modified_gmt":"2025-12-07T17:07:22","slug":"harm-reduction-harms-the-homeless","status":"publish","type":"post","link":"https:\/\/drugprevent.org.uk\/ppp\/2025\/11\/harm-reduction-harms-the-homeless\/","title":{"rendered":"\u201cHarm Reduction\u201d Harms the Homeless"},"content":{"rendered":"
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\u00a0 OPINION PIECE<\/span><\/strong> by Wesley J. Smith\u00a0– November 12, 2025\u00a0<\/span><\/span><\/dd>\n<\/dl>\n<\/header>\n

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The\u00a0New England Journal of Medicine<\/em>\u00a0is again promoting failed progressive public policies. This time, it is \u201charm reduction.\u201d From \u201cThe Erosion of Harm Reduction,\u201d by\u00a0Joshua Barocas, M.D.<\/strong><\/span><\/p>\n

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Unlike the targets of many other recent attacks on public health and medicine in the United States, harm reduction is not a formal bureaucracy, but a philosophy and an approach to health care. As defined by the Drug Policy Alliance, it is \u201ca set of ideas and interventions that seek to reduce the harms associated with both drug use and punitive drug policies.\u201d Harm reduction is embodied in syringe-services programs (SSPs), naloxone distribution, overdose education, overdose-prevention centers [i.e. \u201csafe injection sites\u201d], and decriminalization of drugs.<\/span><\/p><\/blockquote>\n

Barocas decries the Trump Administration\u2019s executive order that limits such policies:<\/span><\/p>\n

Perhaps most concerning, an executive order focused on homelessness and civil commitment issued on July 24, 2025, prohibits federal SAMHSA discretionary grants from being used to fund harm-reduction activities, proposes a freeze on federal funding to organizations that provide \u201cdrug paraphernalia,\u201d and threatens legal action against harm-reduction organizations. The executive order states that these approaches \u201conly facilitate illegal drug use and its attendant harm.\u201d<\/span><\/p><\/blockquote>\n

The Streets of San Francisco<\/span><\/h2>\n

My wife, the\u00a0Las Vegas Review-Journal<\/em>\u00a0columnist Debra J. Saunders, covered San Francisco\u2019s harm reduction drug policies extensively back when she worked for the\u00a0San Francisco Chronicle<\/em>. It started with \u201cneedle exchange,\u201d which she initially supported as a means of preventing the spread of HIV. The idea was for addicts to \u201cexchange\u201d dirty needles \u2014 a prime source of HIV transmission \u2014 for clean ones. The rule was: no used needle, no free clean replacement. Unfortunately, the program led to greater drug abuse. \u201cHarm reduction\u201d zealots eventually dropped the exchange requirement, which resulted in dangerous used needles littering San Francisco\u2019s sidewalks and even children\u2019s playgrounds.<\/span><\/p>\n

Debra noticed the decay and decided to investigate. I\u2019ll let her describe it. From a 2019\u00a0Review-Journal<\/em>\u00a0column:<\/span><\/p>\n

In 2015, I learned that San Francisco had abandoned the \u201cneedle exchange\u201d model \u2014 clinics would dispense one new needle in exchange for each used needle \u2014 in favor of needle \u201caccess.\u201d Which means free needles.<\/span><\/p>\n

So I walked into a downtown clinic and walked out with a \u201cstarter kit\u201d of 20 needles in a paper bag filled with other paraphernalia meant to make it safer to shoot up. It was that easy.<\/span><\/p>\n

You see, it had become too much to expect the city\u2019s many junkies to return used needles to get free needles. (It also was too much to expect drug users to buy their own needles, which had been legalized.)<\/span><\/p>\n

Instead the Special City, as some call it, put out drop boxes in the hope that the civic-minded would use them. How did that work out? Just look at the sidewalks. It\u2019s not working.<\/span><\/p><\/blockquote>\n

Can You Imagine?<\/span><\/h2>\n

San Francisco was allowing harm reducers to give away \u201cstarter kits\u201d to people so they could begin injecting drugs! That\u2019s harm\u00a0causation<\/em>.<\/span><\/p>\n

Policies have consequences. Those of San Francisco\u2019s\u00a0homelessness\u00a0\u201charm reduction\u201d protocols were dire. Human feces befouled the streets, to the point that a \u201cpoop map\u201d was published to warn people about unsanitary messes. The downtown commercial center imploded. Once-thriving shopping hubs\u00a0closed. Union Square became a ghost town.\u00a0Squalor\u00a0ruled blocks of Market Street. A total \u201charm reduction\u201d catastrophe.<\/span><\/p>\n

The Good Doctor Barocas<\/span><\/h2>\n

But don\u2019t tell that to the good doctor Barocas, who concludes his\u00a0NEJM<\/em>\u00a0piece thusly:<\/span><\/p>\n

Harm reduction is evidence-based health care that is rooted in public health principles. There is no single best form of harm reduction \u2014 this model depends on the availability of an array of services that meet patients where they are. Undermining harm reduction and cutting related programs isn\u2019t merely a funding decision; it is an assault on an approach to health care that prioritizes evidence, compassion, and dignity \u2014 values that are central to the medical profession. Such actions are in keeping with other moves by the federal government that encroach on clinical practice and the professional judgment of clinicians and undermine the autonomy of patients. Like many other aspects of public health and medical care, harm reduction is being dangerously and rapidly eroded.<\/span><\/p><\/blockquote>\n

I don\u2019t think that \u201cpersonal autonomy\u201d and \u201chuman dignity\u201d entail shooting up harmful substances, defecating in public, living (and dying) on the streets, or engaging in the many other behaviors associated with drug abuse (and mental illness) that have ruined too many of America\u2019s formerly world-class cities.<\/span><\/p>\n

Helping drug abusers as well as we can is an ethical imperative. The question therefore becomes: Do we love our addicted countrymen\u00a0enough<\/em>\u00a0to insist that they diligently engage in programs to restore themselves to lives of dignity and self-respect? Harm reduction isn\u2019t that. Indeed, the more we take that path, the worse things get. Facilitating drug abuse \u2014 which is what \u201charm reduction\u201d does \u2014\u00a0causes<\/em>\u00a0terrible harm, often to the people it purports to help and certainly to the communities in which they reside.<\/span><\/p>\n

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