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Annual Review of Public Health

Volume 46, 2025

Harm Reduction: The Neglected Pillar of US Drug Policy

  • Brendan Saloner1, Daliah Heller2, Corey S. Davis3 and Susan G. Sherman4
  • 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; email: [email protected] 2Drug Use Initiatives, Vital Strategies, New York, NY, USA 3Harm Reduction Legal Project, Network for Public Health Law, Edina, Minnesota, USA 4Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
  • Vol. 46:369-387 (Volume publication date April 2025)
  • First published as a Review in Advance on December 17, 2024
  • Copyright © 2025 by the author(s).
    This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See credit lines of images or other third-party material in this article for license information.

Abstract

Harm reduction programs provide tools that enable people who use drugs to do so more safely in a nonstigmatizing environment without the goal of them necessarily seeking treatment or abstinence. Most harm reduction programs in the United States distribute sterile syringes and naloxone and safely dispose of used syringes and other drug use supplies. Many also provide drug checking services, and other safer use supplies. These programs exist on a limited scale and often face restrictions on their funding and scope of operations. While research demonstrates the effectiveness of existing programs in preventing infectious disease transmission and fatal overdose, there is less evidence about conditions that support the effective expansion and sustainment of existing models. Other harm reduction interventions such as overdose prevention centers and safer supply programs have promising international evidence but are prohibited or severely restricted under US law. In this review, we summarize the evidence for harm reduction interventions, describe the policy environment in which they exist, and provide recommendations to better align drug policy with existing and emerging evidence in the US context.

Keyword(s): harm reduction policy, overdose, overdose prevention centers, people who use drugs, PWUD, safer supply programs, syringe services programs
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Literature Cited

  1. 1.
    Act Relating to a Harm-Reduction Criminal Justice Response to Drug Use, Sec. 1. 18 V.S.A. § 4256 ( 2024.). https://legislature.vermont.gov/Documents/2024/Docs/ACTS/ACT178/ACT178%20As%20Enacted.pdf
  2. 2.
    Allen ST, O'Rourke A, Johnson JA, Cheatom C, Zhang Y, et al. 2022.. Evaluating the impact of naloxone dispensation at public health vending machines in Clark County, Nevada. . Ann. Med. 54:(1):2692–700
     [Google Scholar]
  3. 3.
    Andresen MA, Boyd N. 2010.. A cost-benefit and cost-effectiveness analysis of Vancouver's supervised injection facility. . Int. J. Drug Policy 21:(1):70–76
     [Crossref] [Google Scholar]
  4. 4.
    Aspinall EJ, Nambiar D, Goldberg DJ, Hickman M, Weir A, et al. 2014.. Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. . Int. J. Epidemiol. 43:(1):235–48
     [Crossref] [Google Scholar]
  5. 5.
    Baca CT, Grant KJ. 2005.. Take-home naloxone to reduce heroin death. . Addiction 100:(12):1823–31
     [Crossref] [Google Scholar]
  6. 6.
    Behrends CN, Lu X, Corry GJ, LaKosky P, Prohaska SM, et al. 2022.. Harm reduction and health services provided by syringe services programs in 2019 and subsequent impact of COVID-19 on services in 2020. . Drug Alcohol Depend. 232::109323
     [Crossref] [Google Scholar]
  7. 7.
    Bernard CL, Owens DK, Goldhaber-Fiebert JD, Brandeau ML. 2017.. Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: a model-based analysis. . PLOS Med. 14:(5):e1002312
     [Crossref] [Google Scholar]
  8. 8.
    Bigg D. 2002.. Data on take home naloxone are unclear but not condemnatory. . BMJ 324:(7338):678
     [Crossref] [Google Scholar]
  9. 9.
    Bluthenthal RN, Heinzerling KG, Anderson R, Flynn NM, Kral AH. 2008.. Approval of syringe exchange programs in California: results from a local approach to HIV prevention. . Am. J. Public Health 98:(2):278–83
     [Crossref] [Google Scholar]
  10. 10.
    Bluthenthal RN, Kral AH, Lorvick J, Watters JK. 1997.. Impact of law enforcement on syringe exchange programs: a look at Oakland and San Francisco. . Med. Anthropol. 18:(1):61–83
     [Crossref] [Google Scholar]
  11. 11.
    Boyd N. 2013.. Lessons from INSITE, Vancouver's supervised injection facility: 2003–2012. . Drugs 20:(3):234–40
     [Google Scholar]
  12. 12.
    Bruzelius E, Cerdá M, Davis CS, Jent V, Wheeler-Martin K, et al. 2023.. Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use: evidence from 44 US states. . Int. J. Drug Policy 114::103980
     [Crossref] [Google Scholar]
  13. 13.
    Bullinger LR, Boy A. 2023.. Association of expanded child tax credit payments with child abuse and neglect emergency department visits. . JAMA Netw. Open. 6:(2):e2255639
     [Crossref] [Google Scholar]
  14. 14.
    Burnside A. 2022.. No more double punishments: lifting the ban on SNAP and TANF for people with prior felony drug convictions. Policy Brief, Cent. Law Soc. Policy (CLASP), Washington, DC:. https://www.clasp.org/wp-content/uploads/2022/04/2022Apr_No-More-Double-Punishments.pdf
    [Google Scholar]
  15. 15.
    Burris S, Blankenship KM, Donoghoe M, Sherman S, Vernick JS, et al. 2004.. Addressing the “risk environment” for injection drug users: the mysterious case of the missing cop. . Milbank Q. 82:(1):125–56
     [Crossref] [Google Scholar]
  16. 16.
    Cataife G, Dong J, Davis CS. 2021.. Regional and temporal effects of naloxone access laws on opioid overdose mortality. . Subst. Abuse 42:(3):329–38
     [Crossref] [Google Scholar]
  17. 17.
    Caulkins JP, Pardo B, Kilmer B. 2019.. Supervised consumption sites: a nuanced assessment of the causal evidence. . Addiction 114:(12):2109–15
     [Crossref] [Google Scholar]
  18. 18.
    CDC (Cent. Dis. Control Prev.). 1999.. Ten great public health achievements—United States, 1900–1999. MMWR 48:241–43
     [Google Scholar]
  19. 19.
    CDC (Cent. Dis. Control Prev.). 2024.. Injuries and violence are leading causes of death | Injury Center. . WISQARS. https://www.cdc.gov/injury/wisqars/animated-leading-causes.html
    [Google Scholar]
  20. 20.
    CDC (Cent. Dis. Control Prev.). 2024.. National HIV Behavioral Surveillance (NHBS). . CDC HIV Data. https://www.cdc.gov/hiv-data/nhbs/index.html
    [Google Scholar]
  21. 21.
    Cerdá M, Krawczyk N, Keyes K. 2023.. The future of the United States overdose crisis: challenges and opportunities. . Milbank Q. 101:(S1):478–506
     [Crossref] [Google Scholar]
  22. 22.
    Chalfin A, Del Pozo B, Mitre-Becerril D. 2023.. Overdose prevention centers, crime, and disorder in New York City. . JAMA Netw. Open. 6:(11):e2342228
     [Crossref] [Google Scholar]
  23. 23.
    Chamberlain JM, Klein BL. 1994.. A comprehensive review of naloxone for the emergency physician. . Am. J. Emerg. Med. 12:(6):650–60
     [Crossref] [Google Scholar]
  24. 24.
    Ciccarone D. 2019.. The triple wave epidemic: supply and demand drivers of the US opioid overdose crisis. . Int. J. Drug Policy 71::183–88
     [Crossref] [Google Scholar]
  25. 25.
    Cioffi CC, Hibbard PF, Hagaman A, Tillson M, Vest N. 2023.. Perspectives of researchers with lived experience in implementation science research: opportunities to close the research-to-practice gap in substance use systems of care. . Implement. Res. Pract. 4::26334895231180635
     [Crossref] [Google Scholar]
  26. 26.
    Colbert S. 2023.. The drug-dealers leading a public-health revolution. . Economist, Sept. 8
    [Google Scholar]
  27. 27.
    Davis C. 2019.. Federal restrictions on funding for syringe services programs. Fact Sheet, Netw. Public Health Law, Edina, MN:. https://www.networkforphl.org/news-insights/federal-restrictions-on-funding-for-syringe-services-programs/
    [Google Scholar]
  28. 28.
    Davis C, Carr D. 2017.. State legal innovations to encourage naloxone dispensing. . J. Am. Pharm. Assoc. 57:(2S):S180–84
     [Crossref] [Google Scholar]
  29. 29.
    Davis C, Larkin K. 2023.. Evidence for fentanyl test strips. Fact Sheet, Netw. Public Health Law, Edina, MN:. https://www.networkforphl.org/resources/evidence-for-fentanyl-test-strips/
    [Google Scholar]
  30. 30.
    Davis C, Webb D, Burris S. 2013.. Changing law from barrier to facilitator of opioid overdose prevention. . J. Law Med. Ethics 41:(1):33–36
     [Crossref] [Google Scholar]
  31. 31.
    Davis CS, Carr DH. 2017.. The law and policy of opioids for pain management, addiction treatment, and overdose reversal. . Indiana Health L. Rev. 14:. https://doi.org/10.18060/3911.0027
    [Google Scholar]
  32. 32.
    Davis CS, Carr DH. 2022.. Repealing state drug-paraphernalia laws—the need for federal leadership. . N. Engl. J. Med. 387:(15):1344–46
     [Google Scholar]
  33. 33.
    Davis CS, Carr DH, Samuels EA. 2019.. Paraphernalia laws, criminalizing possession and distribution of items used to consume illicit drugs, and injection-related harm. . Am. J. Public Health 109:(11):1564–67
     [Google Scholar]
  34. 34.
    Davis CS, Joshi S, Rivera BD, Cerdá M. 2023.. Changes in arrests following decriminalization of low-level drug possession in Oregon and Washington. . Int. J. Drug Policy 119::104155
     [Google Scholar]
  35. 35.
    Davis CS, Lieberman AJ, O'Kelley-Bangsberg M. 2022.. Legality of drug checking equipment in the United States: a systematic legal analysis. . Drug Alcohol Depend. 234::109425
     [Google Scholar]
  36. 36.
    Davis CS, Ruiz S, Glynn P, Picariello G, Walley AY. 2014.. Expanded access to naloxone among firefighters, police officers, and emergency medical technicians in Massachusetts. . Am. J. Public Health 104:(8):e7–9
     [Google Scholar]
  37. 37.
    Davis CS, Southwell JK, Niehaus VR, Walley AY, Dailey MW. 2014.. Emergency medical services naloxone access: a national systematic legal review. . Acad. Emerg. Med. 21:(10):1173–77
     [Google Scholar]
  38. 38.
    DeBeck K, Kerr T, Bird L, Zhang R, Marsh D, et al. 2011.. Injection drug use cessation and use of North America's first medically supervised safer injecting facility. . Drug Alcohol Depend. 113:(2–3):172–76
     [Google Scholar]
  39. 39.
    Dellplain M. 2024.. Future of DULF compassion club will hinge on judicial review. . HealthyDebate, March 5
    [Google Scholar]
  40. 40.
    Doleac JL, Mukherjee A. 2022.. The effects of naloxone access laws on opioid abuse, mortality, and crime. . J. Law Econ. 65:(2):211–38
     [Google Scholar]
  41. 41.
    D'Orsogna MR, Böttcher L, Chou T. 2023.. Fentanyl-driven acceleration of racial, gender and geographical disparities in drug overdose deaths in the United States. . PLOS Glob. Public Health 3:(3):e0000769
     [Google Scholar]
  42. 42.
    Earp BD, Lewis J, Hart CL. 2021.. Racial justice requires ending the war on drugs. . Am. J. Bioethics 21:(4):4–19
     [Google Scholar]
  43. 43.
    Eur. Monit. Cent. Drugs Drug Addict. 2023.. Harm reduction—the current situation in Europe. Eur. Drug Rep., Eur. Union Drugs Agency, Lisbon, Port:. https://www.emcdda.europa.eu/publications/european-drug-report/2023/harm-reduction_en
    [Google Scholar]
  44. 44.
    Evoy KE, Hill LG, Davis CS. 2021.. Considering the potential benefits of over-the-counter naloxone. . Integr. Pharm. Res. Pract. 10::13–21
     [Google Scholar]
  45. 45.
    Fair Just Prosec. 2019.. Harm reduction responses to drug use. Brief, Fair and Just Prosecution. https://www.fairandjustprosecution.org/staging/wp-content/uploads/2019/08/FJP_Brief_HarmReduction.pdf
    [Google Scholar]
  46. 46.
    Fast D, Small W, Wood E, Kerr T. 2008.. The perspectives of injection drug users regarding safer injecting education delivered through a supervised injecting facility. . Harm Reduct. J. 5::32
     [Crossref] [Google Scholar]
  47. 47.
    FBI (Fed. Bur. Investig.). 2020.. Crime in the United States, 2019. . Uniform Crime Reporting. https://ucr.fbi.gov/crime-in-the-u.s/2019/crime-in-the-u.s.-2019
    [Google Scholar]
  48. 48.
    Fellner J. 2009.. Race, drugs, and law enforcement in the United States symposium. . Stanf. L. Policy Rev. 20:(2):257–92
     [Google Scholar]
  49. 49.
    Fernandes RM, Cary M, Duarte G, Jesus G, Alarcão J, et al. 2017.. Effectiveness of needle and syringe programmes in people who inject drugs—an overview of systematic reviews. . BMC Public Health 17:(1):309
     [Crossref] [Google Scholar]
  50. 50.
    Fernández-Viña MH, Prood NE, Herpolsheimer A, Waimberg J, Burris S. 2020.. State laws governing syringe services programs and participant syringe possession, 2014–2019. . Public Health Rep. 135:(1_suppl):128S–37S
     [Crossref] [Google Scholar]
  51. 51.
    Fleming MD, Evans JL, Graham-Squire D, Cawley C, Kanzaria HK, et al. 2022.. Association of shelter-in-place hotels with health services use among people experiencing homelessness during the COVID-19 pandemic. . JAMA Netw. Open 5:(7):e2223891
     [Crossref] [Google Scholar]
  52. 52.
    Frank RG, Humphreys K, Pollack H. 2018.. Does naloxone availability increase opioid abuse? The case for skepticism. . Health Affairs Forefront, March 19. https://doi.org/10.1377/forefront.20180316.599095
    [Google Scholar]
  53. 53.
    Freking K. 2023.. U.S. homelessness up 12 percent to highest reported level as rents soar and pandemic aid lapses. . PBS NewsHour, Dec. 15. https://www.pbs.org/newshour/economy/u-s-homelessness-up-12-percent-to-highest-reported-level-as-rents-soar-and-pandemic-aid-lapses
    [Google Scholar]
  54. 54.
    Gaddis A, Kennedy MC, Nosova E, Milloy M-J, Hayashi K, et al. 2017.. Use of on-site detoxification services co-located with a supervised injection facility. . J. Subst. Abuse Treat. 82::1–6
     [Crossref] [Google Scholar]
  55. 55.
    Gartry CC, Oviedo-Joekes E, Laliberté N, Schechter MT. 2009.. NAOMI: the trials and tribulations of implementing a heroin assisted treatment study in North America. . Harm Reduct. J. 6:(1):2
     [Crossref] [Google Scholar]
  56. 56.
    Gertner AK, Domino ME, Davis CS. 2018.. Do naloxone access laws increase outpatient naloxone prescriptions? Evidence from Medicaid. . Drug Alcohol Depend. 190::37–41
     [Crossref] [Google Scholar]
  57. 57.
    Gibson B, See K, Vargas Estrella B, Rivera S. 2023.. OnPoint NYC: making history, saving lives. Rep. , OnPoint NYC, New York:. https://onpointnyc.org/wp-content/uploads/2023/12/ONPOINTNYC_OPCREPORT_small-web1.pdf
    [Google Scholar]
  58. 58.
    Giglio RE, Mantha S, Harocopos A, Saha N, Reilly J, et al. 2023.. The nation's first publicly recognized overdose prevention centers: lessons learned in New York City. . J. Urban Health 100:(2):245–54
     [Crossref] [Google Scholar]
  59. 59.
    Giulini F, Keenan E, Killeen N, Ivers J-H. 2023.. A systematized review of drug-checking and related considerations for implementation as a harm reduction intervention. . J. Psychoact. Drugs 55:(1):85–93
     [Crossref] [Google Scholar]
  60. 60.
    Gozdzialski L, Wallace B, Hore D. 2023.. Point-of-care community drug checking technologies: an insider look at the scientific principles and practical considerations. . Harm Reduct. J. 20:(1):39
     [Crossref] [Google Scholar]
  61. 61.
    Greer D. 2024.. Founders of B.C. drug ‘compassion club’ file Charter challenge. . CBC, Oct. 15. https://www.cbc.ca/news/canada/british-columbia/dulf-drug-compassion-club-charter-challenge-1.7352605
    [Google Scholar]
  62. 62.
    Hagan H, McGough JP, Thiede H, Hopkins S, Duchin J, Alexander ER. 2000.. Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. . J. Subst. Abuse Treat. 19:(3):247–52
     [Crossref] [Google Scholar]
  63. 63.
    Hamilton L, Davis CS, Kravitz-Wirtz N, Ponicki W, Cerdá M. 2021.. Good Samaritan laws and overdose mortality in the United States in the fentanyl era. . Int. J. Drug Policy 97::103294
     [Crossref] [Google Scholar]
  64. 64.
    Hauf P. 2022.. Biden admin to fund crack pipe distribution to advance “racial equity. .” Washington Free Beacon, Feb. 7. https://freebeacon.com/biden-administration/biden-admin-to-fund-crack-pipe-distribution-to-advance-racial-equity/
    [Google Scholar]
  65. 65.
    Hayes BT, Favaro J, Davis CS, Gonsalves GS, Beletsky L, et al. 2021.. Harm reduction, by mail: the next step in promoting the health of people who use drugs. . J. Urban Health 98:(4):532–37
     [Crossref] [Google Scholar]
  66. 66.
    Health Can. 2023.. Safer supply. . Government of Canada. https://www.canada.ca/en/health-canada/services/opioids/responding-canada-opioid-crisis/safer-supply.html
    [Google Scholar]
  67. 67.
    Inst. Med. (US) Comm. Fed. Regul. Methad. Treat. 1995.. Federal Regulation of Methadone Treatment, ed. RA Rettig, A Yarmolinsky . Washington, DC:: Natl. Acad. Press
     [Google Scholar]
  68. 68.
    Inst. Med. (US) Comm. Subst. Abuse Cover. Stud. 1992.. A century of American narcotic policy. . In Treating Drug Problems: Volume 2: Commissioned Papers on Historical, Institutional, and Economic Contexts of Drug Treatment, ed. DR Gerstein, HJ Harwood , 162. Washington, DC:: Natl. Acad. Press
     [Google Scholar]
  69. 69.
    Irwin A, Jozaghi E, Bluthenthal RN, Kral AH. 2017.. A cost-benefit analysis of a potential supervised injection facility in San Francisco, California, USA. . J. Drug Issues 47:(2):164–84
     [Crossref] [Google Scholar]
  70. 70.
    Irwin A, Jozaghi E, Weir BW, Allen ST, Lindsay A, Sherman SG. 2017.. Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facility. . Harm Reduct. J. 14:(1):29
     [Crossref] [Google Scholar]
  71. 71.
    Joshi S, Rivera BD, Cerdá M, Guy GP Jr., Strahan A, et al. 2023.. One-year association of drug possession law change with fatal drug overdose in Oregon and Washington. . JAMA Psychiatry 80:(12):1277–83
     [Crossref] [Google Scholar]
  72. 72.
    Kalicum J, Nyx E, Kennedy MC, Kerr T. 2024.. The impact of an unsanctioned compassion club on non-fatal overdose. . Int. J. Drug Policy 131::104330
     [Crossref] [Google Scholar]
  73. 73.
    Kerr T, Small W, Moore D, Wood E. 2007.. A micro-environmental intervention to reduce the harms associated with drug-related overdose: evidence from the evaluation of Vancouver's safer injection facility. . Int. J. Drug Policy 18:(1):37–45
     [Crossref] [Google Scholar]
  74. 74.
    Kerr T, Tyndall M, Li K, Montaner J, Wood E. 2005.. Safer injection facility use and syringe sharing in injection drug users. . Lancet 366:(9482):316–18
     [Crossref] [Google Scholar]
  75. 75.
    KFF. 2024.. Opioid overdose deaths and opioid overdose deaths as a percent of all drug overdose deaths. . State Health Facts. https://www.kff.org/other/state-indicator/opioid-overdose-deaths/
    [Google Scholar]
  76. 76.
    Khorrami P, Sommers BD. 2021.. Changes in US Medicaid enrollment during the COVID-19 pandemic. . JAMA Netw. Open 4:(5):e219463
     [Crossref] [Google Scholar]
  77. 77.
    Kochanek KD, Murphy SL, Xu J, Arias E. 2024.. Mortality in the United States, 2022. NCHS Data Brief 492 , Natl. Cent. Health Stat., Hyattsville, MD:. https://www.cdc.gov/nchs/data/databriefs/db492.pdf
    [Google Scholar]
  78. 78.
    Kral AH, Anderson R, Flynn NM, Bluthenthal RN. 2004.. Injection risk behaviors among clients of syringe exchange programs with different syringe dispensation policies. . J. Acquir. Immune Defic. Syndr. 37:(2):1307–12
     [Crossref] [Google Scholar]
  79. 79.
    Kravitz-Wirtz N, Davis CS, Ponicki WR, Rivera-Aguirre A, Marshall BDL, et al. 2020.. Association of Medicaid expansion with opioid overdose mortality in the United States. . JAMA Netw. Open 3:(1):e1919066
     [Crossref] [Google Scholar]
  80. 80.
    Lambdin BH, Davidson PJ, Browne EN, Suen LW, Wenger LD, Kral AH. 2022.. Reduced emergency department visits and hospitalisation with use of an unsanctioned safe consumption site for injection drug use in the United States. . J. Gen. Intern. Med. 37:(15):3853–60
     [Crossref] [Google Scholar]
  81. 81.
    Lambdin BH, Davis CS, Wheeler E, Tueller S, Kral AH. 2018.. Naloxone laws facilitate the establishment of overdose education and naloxone distribution programs in the United States. . Drug Alcohol Depend. 188::370–76
     [Crossref] [Google Scholar]
  82. 82.
    LAPPA (Legis. Anal. Public Policy Assoc.). 2022.. Drug paraphernalia: summary of state laws. Rep. , LAPPA, Washington, DC:. https://legislativeanalysis.org/wp-content/uploads/2022/09/Drug-Paraphernalia-Summary-of-State-Laws-FINAL.pdf
    [Google Scholar]
  83. 83.
    LAPPA (Legis. Anal. Public Policy Assoc.). 2022.. Syringe service programs: summary of state laws. Rep. , LAPPA, Washington, DC:. https://legislativeanalysis.org/wp-content/uploads/2023/11/Syringe-Services-Programs-Summary-of-State-Laws.pdf
    [Google Scholar]
  84. 84.
    LAPPA (Legis. Anal. Public Policy Assoc.). 2023.. Model fentanyl/xylazine test strip and other drug checking equipment act. Rep. , LAPPA, Washington, DC:. https://legislativeanalysis.org/wp-content/uploads/2023/12/Model-Fentanyl-Xylazine-Test-Strip-and-Other-Drug-Checking-Equipment-Act.pdf
    [Google Scholar]
  85. 85.
    Ledlie S, Garg R, Cheng C, Kolla G, Antoniou T, et al. 2024.. Prescribed safer opioid supply: a scoping review of the evidence. . Int. J. Drug Policy 125::104339
     [Crossref] [Google Scholar]
  86. 86.
    Lieberman A, Davis C. 2023.. Legal interventions to reduce overdose mortality: overdose good Samaritan laws. Fact Sheet, Netw. Public Health Law, Edina, MN:. https://www.networkforphl.org/resources/legal-interventions-to-reduce-overdose-mortality-overdose-good-samaritan-laws/
    [Google Scholar]
  87. 87.
    Love M, Sibilla N. 2023.. Accessing SNAP and TANF benefits after a drug conviction: a survey of state laws. Rep. , Collat. Conseq. Resour. Cent. https://ccresourcecenter.org/national-snap-tanf-drug-felony-study/
    [Google Scholar]
  88. 88.
    Maghsoudi N, Tanguay J, Scarfone K, Rammohan I, Ziegler C, et al. 2022.. Drug checking services for people who use drugs: a systematic review. . Addiction 117:(3):532–44
     [Crossref] [Google Scholar]
  89. 89.
    Maxwell S, Bigg D, Stanczykiewicz K, Carlberg-Racich S. 2006.. Prescribing naloxone to actively injecting heroin users: a program to reduce heroin overdose deaths. . J. Addict. Dis. 25:(3):89–96
     [Crossref] [Google Scholar]
  90. 90.
    McDonald R, Strang J. 2016.. Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. . Addiction 111:(7):1177–87
     [Crossref] [Google Scholar]
  91. 91.
    McNair R, Monaghan M, Montgomery P. 2023.. Heroin assisted treatment for key health outcomes in people with chronic heroin addictions: a context-focused systematic review. . Drug Alcohol Depend. 247::109869
     [Google Scholar]
  92. 92.
    Megerian CE, Bair L, Smith J, Browne EN, Wenger LD, et al. 2024.. Health risks associated with smoking versus injecting fentanyl among people who use drugs in California. . Drug Alcohol Depend. 255::111053
     [Google Scholar]
  93. 93.
    Meyer M, Strasser J, Köck P, Walter M, Vogel M, Dürsteler KM. 2022.. Experiences with take-home dosing in heroin-assisted treatment in Switzerland during the COVID-19 pandemic—Is an update of legal restrictions warranted?. Int. J. Drug Policy 101::103548
     [Google Scholar]
  94. 94.
    Meyerson BE, Lawrence CA, Miller L, Gillespie A, Raymond D, et al. 2017.. Against the odds: syringe exchange policy implementation in Indiana. . AIDS Behav. 21:(4):973–81
     [Google Scholar]
  95. 95.
    Miech RA, Johnston LD, Patrick ME, O'Malley PM, Bachman JG. 2023.. National survey results on drug use, 1975–2023: secondary school students. Monit. Fut. Rep., Univ. Mich. Inst. Soc. Res., Ann Arbor:. https://monitoringthefuture.org/wp-content/uploads/2023/12/mtf2023.pdf
    [Google Scholar]
  96. 96.
    Milloy M-J, Wood E, Reading C, Kane D, Montaner J, Kerr T. 2010.. Elevated overdose mortality rates among First Nations individuals in a Canadian setting: a population-based analysis. . Addiction 105:(11):1962–70
     [Google Scholar]
  97. 97.
    Mizan N. 2022.. Fact-check: Is fentanyl the leading cause of death among American adults?. Austin American-Statesman, Oct. 2. https://www.statesman.com/story/news/politics/politifact/2022/10/02/fact-check-fentanyl-leading-cause-of-death-among-adults/65417990007/
    [Google Scholar]
  98. 98.
    Moreno S, Chen S. 2023.. Why more states are decriminalizing fentanyl test strips. . Axios, April 20. https://www.axios.com/2023/04/20/red-states-drug-use-fentanyl-test-strips
    [Google Scholar]
  99. 99.
    Nam J, Kwon SJ. 2024.. Expansion of child tax credits and mental health of parents with low income in 2021. . JAMA Netw. Open 7:(2):e2356419
     [Google Scholar]
  100. 100.
    Nassau T, Al-Tayyib A, Robinson WT, Shinefeld J, Brady KA. 2020.. The impact of syringe services program policy on risk behaviors among persons who inject drugs in 3 US cities, 2005–2015. . Public Health Rep. 135:(1_suppl):138S–48S
     [Google Scholar]
  101. 101.
    Natl. Harm Reduct. Coalit. 2024.. Principles of harm reduction. . National Harm Reduction Coalition. https://harmreduction.org/about-us/principles-of-harm-reduction/
    [Google Scholar]
  102. 102.
    Nicholas P, Churchill A. 2012.. The Federal Bureau of Narcotics, the States, and the Origins of Modern Drug Enforcement in the United States, 1950–1962. . Contemp. Drug Problems 39:(4):595–640
     [Google Scholar]
  103. 103.
    NY State Dep. Health. 2018.. Medicaid harm reduction services benefit. . New York State Department of Health. https://www.health.ny.gov/diseases/aids/consumers/prevention/medicaid_harm_reduction.htm
    [Google Scholar]
  104. 104.
    Off. ASPE (Assist. Secr. Plan. Eval.). 2011.. Drug testing welfare recipients: recent proposals and continuing controversies. ASPE Issue Brief, US Dep. Health Hum. Serv., Washington, DC:. https://aspe.hhs.gov/reports/drug-testing-welfare-recipients-recent-proposals-continuing-controversies-0
    [Google Scholar]
  105. 105.
    Off. Natl. Drug Control Policy. 2022.. 2022 national drug control strategy. Rep. , White House Exec. Off. Pres., Washington, DC:. https://www.whitehouse.gov/wp-content/uploads/2022/04/National-Drug-Control-2022Strategy.pdf
    [Google Scholar]
  106. 106.
    Olfson M, Wall M, Barry CL, Mauro C, Mojtabai R. 2018.. Impact of Medicaid expansion on coverage and treatment of low-income adults with substance use disorders. . Health Aff. 37:(8):1208–15
     [Google Scholar]
  107. 107.
    Ondocsin J, Ciccarone D, Moran L, Outram S, Werb D, et al. 2023.. Insights from drug checking programs: practicing bootstrap public health whilst tailoring to local drug user needs. . Int. J. Environ. Res. Public Health 20:(11):5999
     [Google Scholar]
  108. 108.
    Or. Health Auth. Overs. Account. Counc. 2023.. Funding and delivery of measure 110 substance use disorder services shows progress, but significant risks remain. Rep. 2023–39, Or. Secr. State, Salem:. https://sos.oregon.gov/audits/Documents/2023-39.pdf
    [Google Scholar]
  109. 109.
    Ovalle D. 2024.. Philadelphia nonprofit loses latest bid to open supervised drug-use center. . Washington Post, April 4. https://www.washingtonpost.com/health/2024/04/03/drug-use-center-philadelphia-justice-department/
    [Google Scholar]
  110. 110.
    Packham A. 2022.. Syringe exchange programs and harm reduction: new evidence in the wake of the opioid epidemic. . J. Public Econ. 215::104733
     [Google Scholar]
  111. 111.
    Palamar JJ, Fitzgerald N, Carr TH, Cottler LB, Ciccarone D. 2024.. National and regional trends in fentanyl seizures in the United States, 2017–2023. . Int. J. Drug Policy. . https://doi.org/10.1016/j.drugpo.2024.104417
    [Google Scholar]
  112. 112.
    Pamplin JR II, King C, Cooper C, Bennett AS, Elliott L, et al. 2023.. Pathways to racial disparities in the effects of Good Samaritan laws: a mixed methods pilot study. . Drug Alcohol Depend. 249::110823
     [Google Scholar]
  113. 113.
    Pamplin JR II, Rouhani S, Davis CS, King C, Townsend TN. 2023.. Persistent criminalization and structural racism in US drug policy: the case of overdose Good Samaritan laws. . Am. J. Public Health 113:(S1):S43–48
     [Google Scholar]
  114. 114.
    Park JN, Tardif J, Thompson E, Rosen JG, Lira JAS, Green TC. 2023.. A survey of North American drug checking services operating in 2022. . Int. J. Drug Policy 121::104206
     [Google Scholar]
  115. 115.
    Parris J. 2024.. Idaho Senate advances legislation to end needle exchange program. . KTVB, March 20. https://www.ktvb.com/article/news/local/208/idaho-senate-advances-legislation-end-needle-exchange-program/277-7d57a6f3-dd8d-4be7-96af-acb088735390
    [Google Scholar]
  116. 116.
    Rhodes T. 2009.. Risk environments and drug harms: a social science for harm reduction approach. . Int. J. Drug Policy 20:(3):193–201
     [Google Scholar]
  117. 117.
    Rich JD, Strong L, Towe CW, McKenzie M. 1999.. Obstacles to needle exchange participation in Rhode Island. . J. Acquir. Immune Defic. Syndr. 21:(5):396–400
     [Google Scholar]
  118. 118.
    Rouhani S, Zhang L, Winiker AK, Sherman SG, Bandara S. 2024.. Emerging models of de facto drug policy reforms in the United States. . Drug Alcohol Depend. 260::111341
     [Google Scholar]
  119. 119.
    Roux P, Jauffret-Roustide M, Donadille C, Briand Madrid L, Denis C, et al. 2023.. Impact of drug consumption rooms on non-fatal overdoses, abscesses and emergency department visits in people who inject drugs in France: results from the COSINUS cohort. . Int. J. Epidemiol. 52:(2):562–76
     [Google Scholar]
  120. 120.
    Russell E, Johnson J, Kosinski Z, Kaplan C, Barnes N, et al. 2023.. A scoping review of implementation considerations for harm reduction vending machines. . Harm. Reduct. J. 20:(1):33
     [Google Scholar]
  121. 121.
    Russell E, Sisco E, Thomson A, Lopes J, Rybak M, et al. 2023.. Rapid analysis of drugs: a pilot surveillance system to detect changes in the illicit drug supply to guide timely harm reduction responses—eight syringe services programs, Maryland, November 2021–August 2022. . MMWR 72:(17):458–62
     [Google Scholar]
  122. 122.
    Sacco LN. 2014.. Drug enforcement in the United States: history, policy, and trends. Rep. 43749 , Congr. Res. Serv., Washington, DC:
     [Google Scholar]
  123. 123.
    SAMHSA (Subst. Abuse Ment. Health Serv. Adm.). 2022.. Harm reduction grant program. . Grants Dashboard. https://www.samhsa.gov/grants/grant-announcements/sp-22-001
    [Google Scholar]
  124. 124.
    Schlüter B-S, Alburez-Gutierrez D, Bibbins-Domingo K, Alexander MJ, Kiang MV. 2024.. Youth experiencing parental death due to drug poisoning and firearm violence in the US, 1999–2020. . JAMA 331:(20):1741–47
     [Google Scholar]
  125. 125.
    Schultz B. 2023.. Philly's progressive prosecutor, facing impeachment trial, has authority on transit crimes diverted. . Associated Press, Dec. 19. https://apnews.com/article/philadelphia-district-attorney-septa-prosecutor-79be3e6e7f3b7d0c8050b65703be776e
    [Google Scholar]
  126. 126.
    Scott G, Irwin K, eds. 2009.. Recommended best practices for effective syringe exchange programs in the United States: results of a consensus meeting. Rep. , NYC Dep. Health Ment. Hyg., Long Island City, NY:
     [Google Scholar]
  127. 127.
    Semaan S, Fleming P, Worrell C, Stolp H, Baack B, Miller M. 2011.. Potential role of safer injection facilities in reducing HIV and hepatitis C infections and overdose mortality in the United States. . Drug Alcohol Depend. 118:(2–3):100–10
     [Google Scholar]
  128. 128.
    Smart R, Haffajee RL, Davis CS. 2022.. Legal review of state emergency medical services policies and protocols for naloxone administration. . Drug Alcohol Depend. 238::109589
     [Google Scholar]
  129. 129.
    Smart R, Pardo B, Davis CS. 2021.. Systematic review of the emerging literature on the effectiveness of naloxone access laws in the United States. . Addiction 116:(1):6–17
     [Google Scholar]
  130. 130.
    Spencer MR, Garnett MF, Minino AM. 2024.. Drug overdose deaths in the United States, 2002–2022. NCHS Data Brief 491 , Natl. Cent. Health Stat., Hyattsville, MD:. https://www.cdc.gov/nchs/data/databriefs/db491.pdf
    [Google Scholar]
  131. 131.
    Stancliff S, Agins B, Rich JD, Burris S. 2003.. Syringe access for the prevention of blood borne infections among injection drug users. . BMC Public Health 3:(1):37
     [Google Scholar]
  132. 132.
    Stein R. 2016.. Life expectancy in U.S. drops for first time in decades, report finds. . NPR, Dec. 8. https://www.npr.org/sections/health-shots/2016/12/08/504667607/life-expectancy-in-u-s-drops-for-first-time-in-decades-report-finds
    [Google Scholar]
  133. 133.
    Stewart RE, Cardamone NC, Loscalzo E, French R, Lovelace C, et al. 2023.. “ There's absolutely no downside to this, I mean, except community opposition:” a qualitative study of the acceptability of vending machines for harm reduction. . Harm. Reduct. J. 20:(1):25
     [Google Scholar]
  134. 134.
    Suen LW, Davidson PJ, Browne EN, Lambdin BH, Wenger LD, Kral AH. 2022.. Effect of an unsanctioned safe consumption site in the United States on syringe sharing, rushed injections, and isolated injection drug use: a longitudinal cohort analysis. . J. Acquir. Immune Defic. Syndr. 89:(2):172–77
     [Google Scholar]
  135. 135.
    Sumnall HR, Atkinson A, Montgomery C, Maynard O, Nicholls J. 2023.. Effects of media representations of drug related deaths on public stigma and support for harm reduction. . Int. J. Drug Policy 111::103909
     [Google Scholar]
  136. 136.
    Tan M, Park C, Goldman J, Biello KB, Buxton J, et al. 2024.. Association between willingness to use an overdose prevention center and probation or parole status among people who use drugs in Rhode Island. . Harm. Reduct J. 21:(1):54
     [Google Scholar]
  137. 137.
    Tse WC, Djordjevic F, Borja V, Picco L, Lam T, et al. 2022.. Does naloxone provision lead to increased substance use? A systematic review to assess if there is evidence of a ‘moral hazard’ associated with naloxone supply. . Int. J. Drug Policy 100::103513
     [Google Scholar]
  138. 138.
    US Dep. Health Hum. Serv. 1998.. Research shows needle exchange programs reduce HIV infections without increasing drug use. Press Release, April 20. https://web.archive.org/web/20120601020747/http://archive.hhs.gov/news/press/1998pres/980420a.html
    [Google Scholar]
  139. 139.
    US Dep. Treas. 2024.. Economic impact payments. . Policy Issues. https://home.treasury.gov/policy-issues/coronavirus/assistance-for-american-families-and-workers/economic-impact-payments
    [Google Scholar]
  140. 140.
    US FDA (Food Drug Adm.). 2023.. FDA approves first over-the-counter naloxone nasal spray. FDA News Release, March 29. https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray
    [Google Scholar]
  141. 141.
    Wagner KD, Bovet LJ, Haynes B, Joshua A, Davidson PJ. 2016.. Training law enforcement to respond to opioid overdose with naloxone: impact on knowledge, attitudes, and interactions with community members. . Drug Alcohol Depend. 165::22–28
     [Google Scholar]
  142. 142.
    Wagner NM, Kempe A, Barnard JG, Rinehart DJ, Havranek EP, et al. 2022.. Qualitative exploration of public health vending machines in young adults who misuse opioids: a promising strategy to increase naloxone access in a high risk underserved population. . Drug Alcohol Depend. Rep. 5::100094
     [Google Scholar]
  143. 143.
    Walley AY, Xuan Z, Hackman HH, Quinn E, Doe-Simkins M, et al. 2013.. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. . BMJ 346::f174
     [Google Scholar]
  144. 144.
    Wash. State Health Care Auth., Health Manag. Assoc. 2023.. Safe supply work group preliminary report. Rep. , Wash. State Health Care Auth., Washington, USA:
     [Google Scholar]
  145. 145.
    Wheeler E, Davidson PJ, Jones TS, Irwin KS. 2012.. Community-based opioid overdose prevention programs providing naloxone—United States. , 2010.. MMWR 61:(6):101–5
     [Google Scholar]
  146. 146.
    Wilson C. 2024.. Oregon governor signs bill criminalizing drug possession. . Oregon Public Broadcasting, April 1. https://www.opb.org/article/2024/04/01/drug-possession-oregon-kotek-sign-bill/
    [Google Scholar]
  147. 147.
    Wodak A, Cooney A. 2006.. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. . Subst. Use Misuse 41:(6–7):777–813
     [Google Scholar]
  148. 148.
    Wood E, Tyndall MW, Zhang R, Montaner JSG, Kerr T. 2007.. Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. . Addiction 102:(6):916–19
     [Google Scholar]
  149. 149.
    Yang C, Favaro J, Meacham MC. 2021.. NEXT harm reduction: an online, mail-based naloxone distribution and harm-reduction program. . Am. J. Public Health 111:(4):667–71
     [Google Scholar]
  150. 150.
    Zibbell JE, Asher AK, Patel RC, Kupronis B, Iqbal K, et al. 2018.. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. . Am. J. Public Health 108:(2):175–81
     [Google Scholar]
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