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    Cities shift focus from harm reduction

    By Robyn Oster
    September 2025

    As overdose deaths climbed several years ago, public health officials throughout the U.S. stepped up harm reduction efforts.

    • More states authorized needle exchanges, naloxone and fentanyl test strips were widely distributed, and the federal government dedicated funds to harm reduction for the first time.
    • The strategy worked, with overdoses dropping.

    But: Now, states and communities across the country are turning away from harm reduction strategies, facing backlash to the approach and urgency to address homelessness and “disorder” on their streets.

    Some examples:

    • San Francisco’s new mayor, who campaigned on promising to address addiction and disorder, announced this spring that the city would step away from harm reduction and instead embrace a “recovery first” approach that aims to get more people into treatment and recovery. He banned city-funded distribution of safe smoking supplies in public places like parks. A year earlier, voters approved a measure stipulating that some recipients of public assistance who repeatedly refused drug treatment could lose cash benefits.
    • Philadelphia stopped funding syringe services programs, put restrictions on mobile teams that distribute naloxone and provide wound care, and stepped up police sweeps in Kensington (a neighborhood known for its open-air drug markets).
    • Santa Ana, California, shut down its syringe exchanges.
    • West Virginia legislators in 2021 said needle exchange programs had to limit distribution to one sterile syringe for each turned in and could only serve clients with state IDs.
    • Nebraska lawmakers last year voted against permitting local governments to establish syringe exchanges.
    • Federally, President Trump’s executive order rejects harm reduction efforts and directs federal agencies to explore laws to civilly commit people with substance use disorder who cannot care for themselves.

    Why it’s important: Harm reduction is a key component of a public health response to addiction.

    • Research shows it does not encourage drug use, as opponents often suggest.
    • Eliminating harm reduction efforts is likely to exacerbate, rather than solve, issues related to substance use, overdose, homelessness, etc.

    Read more: Cities Move Away From Strategies That Make Drug Use Safer