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By Carine Harb
Associate Editor, My Turn
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The opioid crisis is one of the most urgent public health challenges in the United States. According to the Centers for Disease Control and Prevention (CDC), the U.S. experienced a significant increase in drug overdose deaths—107,941 in 2022, up from 52,000 in 2015.
Although recent provisional CDC data suggests a slight decline in overdose deaths in 2023, the overall trend over the past decade shows a general rise.
Harm reduction strategies have been central to combating the opioid epidemic. Naloxone distribution programs have reversed thousands of overdoses, while needle exchange initiatives have curbed the spread of infectious diseases like HIV and hepatitis C.
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Some researchers caution that while harm reduction may saves lives, it must be part of a broader framework that includes addiction treatment and mental health services to address the root causes of substance use. Others argue these programs normalize drug use and divert resources away from abstinence-based treatment programs.
The question of whether harm reduction efforts are failing remains complex. To delve deeper into this evolving issue, Newsweek has reached out to medical experts for further insights.
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Daliah Heller, Vice President, Vital Strategies, Public Health Policy
Harm reduction efforts are succeeding. Over the past year, we began witnessing precipitous declines in overdose for the first time since fentanyl-driven deaths skyrocketed in 2020: deaths are now down nationally by 14% according to the most recent data from CDC.
This decline has been attributed in part to harm reduction efforts, including the expanded availability of naloxone for overdose reversal, improved low barrier access to medication treatment in the community, and the adoption of protective practices such as drug checking among people who are using drugs.
We are still working against the past several decades of punitive measures that drive drug-related health harms, and still much more is needed. Federal funding for harm reduction efforts amounts to less than 10% of the total annual allocation for substance use services, even after investments have almost doubled since 2020.
Incontrovertibly, harm reduction efforts such as syringe services and naloxone distribution save lives and increase access to treatment, backed by decades of evidence but still underused in the United States. As part of a robust health-based response, harm reduction efforts are indispensable for ending the overdose crisis.
Magdalena Cerdá, Professor, Director, The Center for Opioid Epidemiology and Policy, NYU Grossman School of Medicine
Two features of harm reduction efforts are particularly salient and important. First, naloxone, an opioid antagonist that rapidly and effectively reverses overdoses, has become much more widely available through multiple venues, including community-based distribution programs, emergency responders, pharmacies, and community settings like health clinics and schools. Second, drug checking supplies like fentanyl test strips have substantially expanded in the past few years, enabling people to check their drugs for fentanyl and change their drug use accordingly.
However, access to harm reduction services that we know are effective, such as naloxone, drug checking equipment and syringe service programs remains limited in many areas of the country. Black and Hispanic Americans, who are still experiencing increases in overdose, are less likely to have access to these services. Funding and expansion of these services to accessible locations in the community should be a continued priority to address the overdose crisis.
Brandon DL Marshall, Professor of Epidemiology, Brown University School of Public Health
Rather than skyrocketing, fentanyl overdose deaths have been trending downwards since September 2023, according to CDC data. This is a highly encouraging trend, and if sustained, would represent the largest decrease in overdose deaths since the modern opioid crisis began in the late 1990s.
We won't know exactly what's causing the decline until more data is available, but public health approaches are certainly playing a positive role. We know that naloxone, a lifesaving opioid overdose antidote, is available in communities across the United States, and is being distributed in record numbers by community-based organizations and is also available over-the-counter at many pharmacies.
Other harm reduction tools, like fentanyl test strips (which allow people to test their drugs for fentanyl) reduce overdose risk and are strongly supported by scientific evidence. Jurisdictions across the country are using new tranches of money from opioid settlements to scale up evidence-based harm reduction programs, including peer-based outreach and syringes services programs, which also serve as pathways into treatment and recovery for many people.
Far from failing, we need to increase investments in harm reduction programs and double down on a public health approach to the overdose crisis to keep our neighborhoods, friends, and loved ones safe.
David A. Fiellin, M.D., Professor of Medicine, Emergency Medicine and Public Health, Vice Chief, Director, Program in Addiction Medicine, Yale School of Medicine
The United States has seen an important decrease in overdose deaths despite the preponderance of fentanyl in the drug supply. This decrease in overdose deaths directly coincides with increased use of harm reduction services such as naloxone. The use of medications for opioid use disorder has not dramatically increased but is known to result in a 50% reduction overdose death among overdose survivors.
Rather than failing, harm reduction strategies, as articulated by Fiellin and colleagues in the New England Journal of Medicine is generating real benefits to patients and society.
Hannah Cooper, ScD, Rollins Chair of Substance Use Disorders Research, Emory University Rollins School of Public Health
Given that fentanyl overdose deaths are decreasing after years of increasing public health investment in harm reduction, it is clear that they are effective.
For the past 150 years, US responses to drug-related harms have tracked closely with the perceived race of affected populations. Overwhelmingly across these decades the US turns to non-punitive harm reduction approaches to address drug use when the public face of addiction is White.
We swing to criminal-legal approaches when the face of addiction is not. We have just spent a couple of decades living through a predominately White overdose mortality epidemic, and during these decades public health investment in harm reduction grew, as did public health policy approaches.
The racial composition of overdose decedents shifted in recent years, and rates are now higher among Black and Latinx people than they are among White people. Are we now going to question the harm reduction approaches, and swing back to punitive criminal-legal approaches? We need instead to increase investment in harm reduction policies and programs, and also make sure that they are tailored to the needs and strengths of BIPOC communities.
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