Abstract
Harm reduction policies and attitudes in the United States have advanced substantially in recent years but still lag behind more advanced jurisdictions in Europe and elsewhere. The Obama administration, particularly in its last years, embraced some harm reduction policies that had been rejected by previous administrations but shied away from more cutting edge interventions like supervised consumption sites and heroin-assisted treatment. The Trump administration will undermine some of the progress made to date but significant state and local control over drug policies in the US, as well as growing Republican support for pragmatic drug policies, motivated in part by the opioid crisis, ensures continuing progress for harm reduction.
Highlights
Even as the United States emerged as the global pioneer in legalizing and regulating cannabis, it lags well behind much of western Europe and other regions in embracing harm reduction policies regarding other illicit drugs
The healthcare reform advanced by President Trump and Republican leaders in Congress in March 2017 would have significantly restricted access to treatment for people struggling with opioid addiction [34], but failed to move forward
Support for opening supervised consumption sites has grown rapidly, in recent years, with harm reduction and drug policy reform advocates providing much of the impetus, and the opioid crisis providing a sense of urgency
Summary
Background Even as the United States emerged as the global pioneer in legalizing and regulating cannabis, it lags well behind much of western Europe and other regions in embracing harm reduction policies regarding other illicit drugs. Policies vary greatly among US states and even among cities within the same state, thereby making it difficult to generalize about the country as a whole, but some trends are apparent: spreading support for legalizing syringe access, even in relatively conservative parts of the country; rapid expansion of programs and policies to reduce overdose fatalities; growing law enforcement interest in harm reduction approaches to policing drug users and markets; and, belatedly, support for initiating legal drug consumption rooms in a few of the more politically progressive cities.
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