Harm Reduction as Our Resistance: Preventing Overdose by Building Systems of Care

On International Overdose Awareness Day, we reflect on the impact of overdose on our communities and demand responses rooted in care, dignity, and self-determination, not carceral punishment. Overdose prevention means rejecting the criminalization of people who use drugs and those deeply impacted by HIV.

Although overdose fatalities have decreased in recent years, this progress has been endangered by the federal government’s extensive defunding of community-based overdose prevention services and unscientific reconstructions of mental health and substance use disorder services. These efforts distinctly threaten the ability of Black, brown, Indigenous, and LGBTQ+ people who use drugs to access resources and support, while simultaneously exposing them to reinvigorated criminal legal punishment aimed at people who are unhoused or living with chronic illnesses.

People living with and deeply impacted by HIV, particularly those who use drugs, are already targeted by intersecting modes of criminalization. In ten states, people living with HIV or viral hepatitis who share used syringes, needles, or other drug equipment face heightened felony-level punishment due to their health status. These penalties add on to existing drug and drug equipment possession and distribution laws. 

Earlier this year, Louisiana became the tenth state to impose enhanced penalties related to needle or syringe sharing. The new law significantly narrowed the state's HIV exposure statute – a hard-fought victory in the movement against HIV criminalization – but it did not eliminate criminalization. It also added a specific enhancement for syringe and needle sharing, further codifying the stigma faced by people living with HIV who use drugs.  

These criminal penalties and their enforcement do not make us safer or healthier. Rather, they discourage engagement with public health and healthcare systems, push people to engage in less safe behaviors like using drugs alone, and disrupt treatment and prevention care. 

Harm reduction has emerged from the realities facing people living with and deeply impacted by HIV. It is rooted in generations of Black, brown, Indigenous, working-class, queer, transgender, sex worker, and drug user communities who fought to build care alternatives to keep themselves and their loved ones healthy and safe that are centered on the dignity and autonomy of all people.

The tradition of harm reduction as resistance to carcerality existed through the height of the AIDS epidemic when ACT UP activists launched a program to publicly distribute sterile syringes in 1991. They created an option for their community to protect themselves in the face of a historic public health crisis, while the government failed to provide adequate public health solutions and doubled down on drug war punishments. Necessity ultimately justified their exoneration during their criminal prosecution.

That legacy continues today, as harm reduction programs continue to operate throughout the country despite federal, state, and local opposition. After a local ordinance in Lewis County, Washington, shut down a mobile syringe services program, advocates sued to rescind the ordinance and ensure access to syringe services, medication for opioid use disorder, and other care. The court agreed that the community-based program offers health services in response to the needs of people impacted by chronic illnesses and allowed the suit to continue. With the ordinance’s eventual repeal, the program can provide care despite the elaborate tactics of punishment aimed at people who use drugs and other communities deeply impacted by HIV. 

But harm reduction is more than a set of behaviors to reduce one’s risk of health harms. It also has a broader aim: It requires a focus on dismantling these oppressive systems and radically reconfiguring care networks and strategies. It is a commitment to addressing the root causes of violence, discrimination, and subjugation through racist, classist, sexist, and ableist systems. Harm reduction is abolition in practice.

As we remember people who have been affected by overdose, we are called to fundamentally reimagine our response to the overdose crisis and other health challenges. We cannot build our liberation by accepting laws and policies that devalue the lives of Black, brown, Indigenous, LGBTQ+, and working-class people who use drugs. 

We must embrace the radical vision of harm reduction that mandates dignifying and fulfilling care for people who have been targeted by structural violence. We must demand care that advances our collective liberation and respect the inherent dignity of all people.