Earlier this year, the announcement of the Biden administration’s harm reduction-focused drug initiative fueled inflammatory news headlines and trending social media posts about “free crack pipes.” Weeks of stigmatizing myths and misinformation about harm reduction programs followed, weakly countered by fact-checking attempts emphasizing that the Biden initiative does not, in fact, include crack pipes.
But all of the reporting seemed to miss one crucial point: Free crack pipes—and many other harm reduction strategies—work. Decades of research backs programs that provide people who use drugs with resources that make drug use safer, including syringes, test strips, and, yes, pipes.
What is harm reduction?
Harm reduction operates from the understanding that there will always be people who use drugs and that they deserve health care, assistance, and support free of discrimination and stigma. Importantly, harm reduction doesn’t seek to eliminate drug use but instead seeks to minimize the harm it can cause.
Although syringe services programs get the bulk of media attention, harm reduction includes a variety of tools and services designed to reduce the negative impacts of drug use on individuals and communities.
Safer drug use
Safer use includes supplies that reduce common injuries or infections related to drug use, such as safer smoking and sterile injection supplies, substance contamination testing, and safe disposal kits.
Overdose prevention
Overdose prevention includes access to and training on overdose reversal medications like naloxone (Narcan) and supervised consumption sites, also called overdose prevention centers, where people use drugs under the supervision of trained staff.
Infection prevention
These services include education and health care to detect, treat, and prevent the transmission of bloodborne infections such as hepatitis B, hepatitis C, and HIV.
The science of harm reduction
The first harm reduction programs in the U.S. were syringe exchange programs piloted in the late 1980s that provided access to sterile syringes and safe disposal of used syringes. In the decades since, data from cities around the U.S. and dozens of other countries has demonstrated the programs’ effectiveness at reducing the negative impacts of drug use. But public policy and public opinion have not always aligned with the science. These initiatives are frequently misrepresented and sensationalized by media outlets in ways that further stigmatize and harm people who use drugs. For all the political focus on the devastating opioid epidemic, many politicians outright reject harm reduction, demonstrating a profound misunderstanding of the science behind both substance use disorders and effective drug policies. Here’s what we know about the benefits of harm reduction.
Reduces drug-related injuries and infections
The most compelling evidence for harm reduction is that it reduces drug-related injuries. Syringe services programs are associated with significant reductions in bloodborne infections, including an 80 percent reduction in drug use-related HIV infections. Studies in the U.S. and Europe have found dramatic reductions in both hepatitis B and hepatitis C infections in syringe services program participants. As for “free crack pipes,” safer crack kit initiatives in Vancouver and Mexico City found a significant reduction in risky behaviors, including the use of unsafe supplies, and a decrease in drug-related health issues like cuts, burns, and mouth sores.
Reduces exposure to contaminants
Drugs that have been contaminated or contain unknown substances can cause accidental overdose and serious injuries. Testing kits help prevent this by allowing people to test a drug for substances before consuming it. Testing strips can alert people to the presence of the synthetic opioid fentanyl, which accounted for two-thirds of all overdose deaths last year, preventing the unwitting consumption or overconsumption of the highly potent drug.
Prevents overdose deaths
In addition to contamination and fentanyl testing, supervised consumption services and overdose reversal medications like Narcan help reduce the risk of overdoses and overdose deaths among people with substance use disorders.