Stigma is not the solution to the drug crisis

The United States has the world’s highest rate of overdose deaths. According to the Centers for Disease Control, more than 100,000 Americans have died from overdose each year since 2021—more than from gun shots and car crashes combined. By 2023, scholars Alison Athey, Beau Kilmer, and Julie Cerel reported in the American Journal of Public Health (AJPH), one in four Americans knew someone who died by overdose. Over two-thirds of these fatalities—nearly 200 per day— involved synthetic opioids, mainly fentanyl, per the National Institute on Drug Abuse. And meth-related deaths and disease are spiking as new, even more powerful and toxic forms of methamphetamine flood the market (as reported in AJPH by researchers Rachel A. Hoopsick and R. Andrew Yockey in 2023).There is significant debate about the best way to respond to this crisis. In recent years, drug policy has swung away from punitive drug-war tactics and toward public health-based harm reduction approaches. Harm reduction rests on the premise that while all drug use entails risks, attempts to eliminate it entirely have failed. Indeed, using punishment to try to deter drug use and eliminate illegal drug markets has itself caused significant harm, including by spurring the development of new synthetic drugs like fentanyl.

Some media outlets fuel public alarm, cultivating fear and heightening the desire to "get tough" on people who use drugs.

Advocates argue that since drugs cannot be made to go away, policy should focus on reducing the harms associated with their use. Harm reduction policies begin by “meeting drug users where they are,” without judgment, and helping them avoid some of the worst possible outcomes associated with continued drug use. Distributing naloxone, a medication used to reverse overdoses, for example, saves lives and helps to explain the recent downtick in overdose deaths. Similarly, providing sterile syringes to people who inject drugs has dramatically reduced the spread of HIV/AIDS and hepatitis C. Harm reduction approaches also include medicine-assisted treatment for opiate use disorder—maintaining dependent users on methadone, buprenorphine, or diamorphine (prescription heroin)—an approach that research shows is the most effective treatment available and reduces the risk of overdose by half.Since the 1990s, harm reduction policies have spread to dozens of countries around the globe. Their effectiveness is now widely recognized, including by the World Health Organization, the American Medical Association, the American Public Health Association, the Centers for Disease Control, and the National Academy of Sciences. To be sure, harm reduction policies do not reduce all of the harm and violence associated with illicit drug markets. Nor do they provide a solution to the marginalization and dispossession that underlie the most destructive forms of drug misuse. But they can, and do, reduce the disease and death caused by illicit drugs.