Real-world evidence disproves those claims. Needle exchanges have been shown to reduce infections, according to the C.D.C. In fact, needle exchange programs can reduce overdoses and drug use over time, by acting as hubs that educate people on safe practices and connect them to addiction treatment.
Much of this evidence has existed for decades. But it was not until recently that many more policymakers embraced harm reduction approaches.
A softer touch
What changed? Three things, experts say.
First, lawmakers grew desperate to reduce overdose deaths, which have climbed for decades and surpassed 100,000 annually for the first time in 2021. Old ideas, like harsh criminal penalties, were clearly insufficient. So lawmakers turned to alternatives they once dismissed, seeking any kind of solution.
Second, the overdose crisis is now so widespread that many more people, including members of Congress, know someone hurt by it. “Every single member of the House and Senate has grieving constituents coming in, having buried kids or brothers or sisters or moms or dads,” Keith Humphreys, a Stanford University drug policy expert, said. “That creates incentives, both emotional and political, to try things that otherwise would be unacceptable.”
And third is the role of race and class. Previous drug crises disproportionately hurt marginalized populations — such as Black people during the 1980s crack epidemic and poor white people during the 1990s-2000s meth epidemic. White, wealthy people had little exposure to these problems. Stereotypes about drug use flourished. A punitive approach, aimed at keeping drugs away from as-yet-unaffected communities, took hold.
The current overdose crisis has more directly hit white people of all classes, including lawmakers. As uncomfortable as it may be that policymakers can be more apt to act — and do so compassionately — when a problem personally affects them, it’s often true.
Limits in support
Harm reduction is still far from gaining universal acceptance. Last year, Senate Republicans criticized the potential inclusion of crack pipes in safe smoking kits from federally funded programs. Some conservative states, like West Virginia, have restricted or blocked needle exchange programs. Many lawmakers of both parties reject more controversial ideas, like supervised injection sites. In Texas, the House’s fentanyl test strip bill is mired in a Senate committee, despite Gov. Greg Abbott voicing support for the idea.
