US cities moving away from strategies for safer drug use

As fentanyl propelled overdose deaths to ever more alarming numbers several years ago, public health officials throughout the United States stepped up a blunt, pragmatic response.

- Jan Hoffman

WASHINGTON - Desperate to save lives, they tried making drug use safer.

To prevent life-threatening infections, more states authorized needle exchanges, where drug users could get sterile syringes as well as alcohol wipes, rubber ties and cookers. Dipsticks that test drugs for fentanyl were distributed to college campuses and music festivals. Millions of overdose reversal nasal sprays went to homeless encampments, schools, libraries and businesses.

And in 2021, for the first time, the federal government dedicated funds to many of the tactics, collectively known as harm reduction.

The strategy helped. By mid-2023, overdose deaths began dropping. In 2024, there were an estimated 80,391 drug overdose deaths in the US, down from 110,037 in 2023, according to provisional data from the Centers for Disease Control and Prevention (CDC).

Yet now, across the country, states and communities are turning away from harm reduction strategies.

In July, President Donald Trump, vowing to end "crime and disorder on America's streets", issued a far-flung executive order that included a blast at harm reduction programmes which, he said, "only facilitate illegal drug use and its attendant harm".

But his words, implicitly linking harm reduction to unsafe streets, echoed a sentiment that had already been building in many places, including some of the country's most liberal cities.

San Francisco's new mayor, Mr Daniel Lurie, a Democrat who campaigned on a pledge to tackle addiction and street chaos, announced this spring that the city would step away from harm reduction as its drug policy and instead embrace "recovery first", aspiring to get more people into treatment and long-term recovery.

He banned city-funded distribution of safe-use smoking supplies such as pipes and foil in public places like parks.