Fifty years after President Richard Nixon declared a “War on Drugs,” harm reduction strategies to prevent overdoses remain controversial in the United States, NPR reports.

These strategies include safe injection sites. They are facilities where people can use clean needles to inject drugs under the supervision of medical personnel, who can revive them in case of an overdose.

Many of the nation’s addiction researchers say the drug war model, which often treats people who use illegal substances as criminals, is ineffective.
“The best outcomes come when you treat the substance use disorder [as a medical condition] as opposed to criminalizing that person and putting them in jail or prison,” said National Institute on Drug Abuse Director Dr. Nora Volkow.

Earlier this month, local leaders in Scott County, Indiana, voted to shut down a needle exchange program that helped dramatically slow a major HIV outbreak among people using intravenous drugs. West Virginia legislators approved a similar measure, which will go into effect in July.

Public health experts told NPR that much of the harm reduction occurring in the U.S. happens underground. Churches, nonprofits and activist groups are illegally providing services, including clean needles.