Legalizing Harm Reduction

Abstract

The opioid use disorder and overdose crisis continues to challenge our agencies, institutions, and the laws underpinning our public health, healthcare, and criminal justice systems. The root causes of this crisis are complex and necessitate comprehensive changes to our social, health care, and criminal justice systems that would take significant time to implement. Yet, there are interventions that can be immediately implemented to curb overdoses and other adverse health outcomes associated with substance use. Harm reduction refers to public health strategies that seek to minimize the injury and illness associated with substance use as opposed to eliminating substance use itself. For example, in the context of opioid use, harm reduction strategies can include increased naloxone training and availability to prevent overdose or establishing syringe service programs to allow people who inject drugs to have access to unused syringes thereby reducing their risk of transmission of HIV, Hepatitis C, and skin injections from the sharing and reuse of needles. While these strategies have seen increased use in the United States as the opioid overdose crisis unfolded, they are implemented in a piecemeal fashion without adequate legal basis to ensure their efficacy in some jurisdictions. This article argues that it is long overdue for harm reduction strategies to be legalized with enabling authorities to ensure they are effective in practice. Part I provides background on harm reduction by describing select harm reduction strategies and the evidence base for them. Part II discusses the status of the harm reduction in the United States by describing four harm reduction strategies in more detail and the limitations of these strategies for being effective under existing legal frameworks in some jurisdictions. Part III concludes by outlining changes in law that are necessary to legalize harm reduction that would create a path towards legalization of drugs.