doctor talking with young man about opioid use disorder treatment
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Summary: Decades of evidence show the best approach to treatment for opioid use disorder (OUD) is harm reduction. In the U.S., harm reduction initiatives implemented in 2022 resulted in the first significant reduction in fatal opioid overdose since 1999, which occurred between 2023 and 2024, with the trend continuing into 2025.

Key Points:

Why is Harm Reduction the Best Approach to Treatment for Opioid Use Disorder (OUD)?

In our article “What Should I Know About Harm Reduction in Opioid Addiction Treatment” we provided a brief history of harm reduction, described the three primary goals of the approach, then outlined the four core principles that guide all harm reduction initiatives. We ended part one with the encouraging news about the first significant allocation of federal funding for harm reduction programs: an initiative called HEAL: Helping to End Addiction Long-Term.

The HEAL initiative provided 36 million dollars for research and pilot programs and eight areas key to bringing harm reduction services to people in need:

  1. Education
  2. Overdose prevention/reversal
  3. Medication-assisted treatment (MAT)
  4. Needle & syringe programs
  5. Drug consumptions rooms
  6. Drug checking programs
  7. Housing support
  8. Legal services

We’ll discuss each of the program areas below, and describe how they can help meet the objective that drives all harm reduction programs in the U.S.: reverse the ongoing, upward trend in drug addiction and overdose called the opioid crisis, which has claimed over a million lives since 1999.

Harm Reduction Policies and Programs

We describe the fundamental principles and theoretical foundation for harm reduction in part one of this article. Now we’ll share how we – meaning treatment providers alongside local, state, and federal government entities – plan to apply these principles in public policies and programs with the help of funding provided initiative like HEAL.

These eight program areas – while not the sum total of harm reduction efforts nationwide – represent the priorities for effective harm reduction as established by the non-profit advocacy group Harm Reduction International (HRI), many of which are endorsed by the Office of National Drug Control Policy (ONDCP) and appear in our revised National Drug Control Strategy. Harm reduction was explicitly endorsed at the federal level in 2022, with core components of harm reduction conserved in more recent revisions to the policy in 2025.

1. Education and Awareness

Education programs provide people the real information about drugs, drug use, and addiction treatment. In the context of harm reduction, education classes include specific information on opioid use and opioid use disorder (OUD), including the harms associated with OUD and how to address them. In addition, harm reduction education programs include offering workshops and classes about how to access social services, including vocational programs, housing support, adult education, general health care, and addiction treatment.

Another component of education and awareness around harm reduction is sharing basic information about harm reduction to people with no direct connection to drug use or the opioid crisis. We understand that at first blush, some parts of harm reduction – needle and syringe programs and drug consumption rooms, for instance – may seem unusual, counterproductive, or too progressive. Educating the public about why their tax dollars should go to these programs is important in maintaining support for ongoing funding and commitment to harm reduction.

2. Overdose Prevention and Reversal Programs

Education about drug use and the risks of opioid use and opioid overdose is the best tool we have to prevent overdose, because effective education can prevent the behavior that leads to illicit drug use before it happens.

Harm reduction programs spend significant time and energy on advocating a medication called Narcan, which contains the medication naloxone. When administered correctly and in time, Narcan can reverse an opioid overdose and dramatically reduce the likelihood of death. It’s a lifesaving drug, which, thanks to federal funding and the new national drug control policy, is now readily available nationwide from both pharmacies and public/community health clinics.

Making Narcan easily available to people who use opioids – or their friends or loved ones – means they have access to the same medication emergency medical personnel like paramedics use when they respond to an overdose call. When the Food and Drug Administration (FDA) approved Narcan for over-the-counter sale on March 2023, it was an important step that harm reduction experts have been recommending for years.

Let’s make that clear for anyone reading this who uses opioids or has friends or loved ones who use opioids: you can now get Narcan from a pharmacy without a prescription. Having Narcan on hand can save a life. Therefore, we recommend considering finding Narcan and keeping it close: it saves lives.

3. Medication-Assisted Treatment (MAT) Programs

Medication-assisted treatment (MAT) for opioid use disorder (OUD), also known as opioid agonist therapy, involves the use of three medications for opioid use disorder (MOUD): buprenorphine (Suboxone), Methadone, and Naltrexone.

While Naltrexone completely blocks the action of opioids in the brain and prevents both the analgesic and euphoric properties of opioids, buprenorphine and methadone act in a slightly different manner. They occupy opioid receptors, which reduces cravings, decreases the severity of withdrawal symptoms, and helps people with opioid use disorder (OUD) reach a physical, emotional, and psychological space where they can engage in treatment and start on the road to recovery.

The Substance Abuse and Mental Health Service Administration (SAMHSA) and the World Health Organization (WHO) consider MAT the gold standard treatment for people with opioid use disorder.

Treatment with medication for opioid use disorder (MOUD), in combination with counseling and other forms of psychosocial support, is associated with reduced opioid use, increased time-in-treatment, improved family, vocational, academic, and social function, decreased involvement with the criminal justice system, and reduced premature mortality.

4. Clean Needle/Syringe Programs

These programs can cause significant controversy and often lead to robust resistance from people who haven’t researched how or why they work. Needle and syringe programs provide clean needles/syringes for people who use illicit, intravenous drugs such as heroin. Opponents assert they promote and condone illicit intravenous drug use. However, evidence shows these programs are effective for the following reasons:

  1. Safe/clean needle/syringe programs prevent the spread of infectious diseases, including hepatitis C and HIV, by offering sterile needles/syringes to people at risk of reusing or sharing share needles/syringes.
  2. These programs get people who inject drugs off the street and out of unsanitary shooting galleries common to illicit IV drug use. They provide a safe atmosphere where people who use illicit IV drugs can talk about drug use – and the desire to enter treatment – in an atmosphere characterized by openness and understanding.
  3. Clean needle/syringe sites are most often managed by harm reduction advocates who help connect IV drug users to essential support, such as treatment for OUD, and lifesaving medication like Narcan.

5. Drug Consumption Rooms

This component of harm reduction also receives stiff resistance in the U.S. However, like clean needle/syringe programs, experts on treatment – including the  American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) – fully support their use. A drug consumption room is a safe, clean place where a person can access and utilize safe supplies under direct supervision who help connect IV drug users to treatment programs, offer emergency medical assistance if needed.

Research indicates drug consumption rooms decrease transmission of infectious disease, decrease drug-related criminal activity, crime associated with drug use, and decrease rates of fatal overdose. Data collected at the only two drug consumption sites in the U.S. – both in New York City – report the following data, after two years of operation:

  • 6,375 total participants
  • 201,381 visits to safe injection rooms
  • 1,825 overdose reversals
  • Over 3 million units of hazardous drug waste (used needles, etc.) collected

For a counterpoint position on this component of harm reduction, read this article – “Rethinking “Harm Reduction,” which includes problems identified in this aspect of harm reduction in San Francisco, and how the problems can be solved. The takeaway from the article, in the words of the author:

 “Harm reduction works best when it is recovery oriented.”

6. Fentanyl Testing/Checking Services

Drug testing services are now an integral component of harm reduction services. Over the past several years, the DEA reports an escalating presence of dangerous substances such as fentanyl and xylazine in illicit drugs like heroin, methamphetamine, and cocaine. Drug testing/checking programs individuals to test a substance for the presence of dangerous substances like fentanyl.

7. Housing

Evidence shows that access to safe and stable housing can reduce drug use, drug addiction, and fatal drug overdose. In some cases, housing support for people with substance use disorder (SUD) requires abstinence, but others do not. Research indicates shows that programs like Housing First – a program that has no sobriety or abstinence requirements for access – can help decrease drug consumption and promote overall wellbeing for people in recovery who experience housing instability.

8. Legal Services

In the context of harm reduction, legal services are necessary on at least two levels: the personal and the public. On the individual level, attorneys or legal aid groups support people in the criminal justice system with various needs. They can help them with charges related to drug use, and advocate for access to evidence-based treatment. In the public sphere, attorneys and legal aid groups help overturn laws, policies, or programs that stigmatize people with substance use disorder, and can help facilitate the transition from a punitive system to a supportive, reform-based system that provides access to a comprehensive array of harm reduction programs and services.

Harm Reduction: Essential to Managing Opioid Overdose and Opioid Use Disorder (OUD)

The Substance Abuse and Mental Health Services Administration (SAMHSA) is currently in the process of writing a Harm Reduction Framework to establish a set of best practices to guide harm reduction programs around the country. This is a crucial step in implementing the harm reduction priorities identified in the National Drug Control Strategy published in 2022 by the Office of National Drug Control Policy.

At Crownview Co-Occurring Institute, we advocate reducing harm caused by opioid use disorder in individuals, families, and communities. Keep an eye on this blog for more information about treatment for co-occurring mental health and substance use disorders. Our next article on the topic of harm reduction will include an overview of the latest harm reduction efforts in California.