“Harm reduction” is a phrase previous administrations have used sparingly, if at all, when discussing drug policy. But the Biden administration not only uses it often regarding the escalating epidemic of overdose deaths, which claimed more than 100,000 lives last year; it has made it the centerpiece of its national drug control strategy.
That bold move deserves recognition. By explicitly emphasizing the term and providing funding for programs once regarded as too controversial, the administration is normalizing harm reduction and paving the way for its widespread adoption across the United States.
Harm reduction recognizes that people engaging in harmful behavior may not be ready to quit but need help in the meantime. For example, individuals with the disease of addiction may not be ready to enter treatment or may not have treatment easily available. Instead of penalizing or shaming them, harm reduction focuses on reducing overdose deaths and preventing the spread of infectious diseases such as HIV and hepatitis.
Some local and state health departments have piloted these programs. In 2015, when I was Baltimore’s health commissioner, I issued a blanket prescription for everyone in our city to obtain naloxone, the opioid overdose reversal drug. Our team provided naloxone to outreach workers, police officers and family members of drug users; in three years, bystanders reversed over 2,000 overdoses. We also operated a needle exchange van that prevented nearly 2,000 HIV infections in a 10-year period.
Despite proven successes, harm reduction programs drew unfounded criticism that they condone drug use. This is why it’s so important to see them being embraced by federal leaders.
Health and Human Services Secretary Xavier Becerra recently referenced them during an appearance at Aspen Ideas: Health, naming harm reduction as part of the administration’s efforts that “broke glass.” He explained that rather than waiting for people with addiction to overdose, public health officials can help reduce their risk. “If we can stop them from doing the harm,” he said, “when they finally get on track, they’ll be ready to get back into life.”
Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy (ONDCP), told me in an interview that the administration is “prioritizing harm-reduction practices because these are proven, cost-effective and evidence-based methods that work to save lives.” He added, “They meet people where they are instead of expecting them to come to us in health-care settings, because otherwise it might be too late.”
Gupta specifically cited expansion of naloxone access and syringe service programs, as well as distribution of test strips to detect whether drugs are contaminated with fentanyl, a synthetic opioid up to 50 times stronger than heroin that can lead to overdose death within minutes. Many users inadvertently take fentanyl and die.
Six years ago, I tried to incorporate fentanyl testing as part of Baltimore’s outreach programs, but it was deemed too contentious. Now, incredibly, it’s a signature part of the Biden administration’s plan.
“We have to prioritize preventing people from overdosing and dying,” Gupta said. “That’s why, for the first time, the federal government removed restrictions to allow grantees the flexibility to use grant dollars to purchase fentanyl test strips. This way, people can be aware of what they’re taking and have naloxone available and accessible if they overdose."
Michael Botticelli, the ONDCP director under President Barack Obama, commends his successor. He was a strong proponent of naloxone access and also successfully advocated for Congress to remove its prohibition on using federal funds to operate syringe service programs.
“We can’t underestimate the importance of naming harm reduction and elevating it as a top-line strategy,” he told me. “It sends a strong signal to states that this is an important priority, especially since the administration is putting funding behind it.” (Botticelli and I both advise the Behavioral Health Group, which provides treatment for patients with opioid use disorder.)
If anything, Botticelli wishes the administration would go even further. “The federal government needs to create legal space for states and cities to pilot overdose prevention sites,” he says, referring to safe injection facilities operated across Europe and Canada that have been shown to reduce overdose deaths. Gupta didn’t take a position on such sites, citing ongoing litigation at the Justice Department. But he said he remains “interested in understanding and evaluating the clinical effectiveness of all emerging harm reduction practices.”
The urgency cannot be overstated. “Our projections show that if we do nothing, we could have 165,000 deaths a year due to overdose by 2025,” Gupta said. “On the other hand, if we implement our strategy, we can cut that number in half. Literally, tens of thousands of lives could be saved.”
He is right. We need to do everything possible to prevent overdoses while also encouraging treatment. After all, if someone dies today, that person has no chance of a better tomorrow.