United States: The case for compassion over tough love in addiction policy

Over the past four years, nearly 7,000 people have injected, smoked or otherwise used street drugs like fentanyl and cocaine at overdose prevention sites run by the nonprofit OnPoint in New York City. Almost 2,000 overdoses have been successfully reversed there. For the first time since 2018, overdose fatalities among Black and Hispanic New Yorkers have started to fall, dropping 29 percent in 2024.

The city’s acting health commissioner, Michelle Morse, credits OnPoint and other programs that use a philosophy known as harm reduction with helping drive the change.

Research overwhelmingly supports the effectiveness of harm reduction, which prioritizes saving lives and reducing the risks of drug use over trying to get people to stop using drugs. This can mean providing drug users with clean needles to stop the spread of infectious diseases, or supplying overdose antidotes, or offering treatment that doesn’t require abstinence.

In July 2025, President Trump issued an executive order directing the federal government to defund what he labeled “so-called ‘harm reduction’ or ‘safe consumption’ efforts that only facilitate illegal drug use.” OnPoint, which is America’s first city-supported overdose prevention site, lost over half a million dollars in grants, and other harm reduction organizations have already lost millions in federal support. Last week, the Trump administration informed thousands of addiction and mental health programs nationwide that it planned to immediately slash some $2 billion in grant funding, only to quickly reverse the decision. That’s all to say that the future of American harm reduction is uncertain and remains under threat. But ending it is exactly the wrong approach to preventing addiction and overdose deaths.

Critics argue that harm reduction enables addiction and crime, and threatens communities. Eri Noguchi, the associate executive director of the organization that runs the Graham School at Echo Park, an early childhood center located across the street from OnPoint in Harlem, disagrees. Since the site opened, OnPoint employees and volunteers have collected more than one million pieces of hazardous waste, like needle parts and broken glass pipes from local streets, parks and other public places. OnPoint also responds rapidly when neighbors report problems like litter or loitering and has built positive relationships with the police.