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.
A study published in 2023 found that OnPoint’s arrival did not increase crime or disorder. Drug use that used to take place outside and potentially in view of residents and children now takes place behind closed doors, in a safer and more controlled environment.
“If a toddler trips and falls, we scoop them up and comfort them,” Dr. Noguchi said. “We hug them when they’re scared and encourage them to try again and again and again, no matter how many times they fail.” She sees OnPoint as doing similar work, but for people who tend to garner far less sympathy.
The idea that people who use drugs should be treated humanely is the heart of harm reduction. Research shows that the more people participate in harm reduction activities — from syringe service programs and overdose prevention sites to taking legally prescribed heroin — the more likely they are to seek traditional forms of recovery. These approaches aren’t linked with increased youth drug use.
The challenge for harm reduction groups right now is convincing the public not to abandon practices that may look overly permissive, but were created because tougher approaches were failing.
I first started writing about the harm reduction movement not long after its birth in the 1980s as a response to AIDS. Back then, I worried that a softer approach might sometimes allow addiction to persist longer by preventing people from “hitting rock bottom.” Ultimately, though, it seemed clear that it was most important to keep people alive.
Many people still prefer to believe that only dire consequences can kick-start recovery. Images of harm reduction add to the problem. When you visit places like OnPoint, you typically see people who are physically unwell, often emaciated, sometimes with grievous wounds and other signs of distress. The success stories are less visible. Someone who has recovered often looks like anybody else.
To the uninformed, offering care without requiring immediate abstinence from drugs or treatment can seem like it’s encouraging drug use. In practice, it’s the opposite. People with addictions are aware that their habits are destructive. The problem is that they feel they have no hope of getting well. Unconditional kindness says: We value you, we think you matter, we think you deserve better. Feeling valued by others is what tends to prompt recovery.
Nationwide, harm reductionists are adopting strategies to preserve their organizations. One such strategy is simply not describing their work as harm reduction. Dr. Joshua Barocas, associate professor of medicine at the University of Colorado, who has recently criticized the attacks on harm reduction, says groups are adjusting the language they use in grant applications: “Many people are just using different words. It doesn’t change the intent of the work that they’re doing.”
Another approach is collective organizing, building on the movement’s origins in AIDS activism. Across the country, groups that once competed for funding are collaborating more and seeking creative ways to continue to help their clients.
The federal funding that was cut from OnPoint was intended to cover doctors who provide addiction treatment onsite. Decades of research now show that harm reduction efforts are not in tension with recovery. What does endanger lives is endlessly cutting funds for compassionate care.
Maia Szalavitz (@maiasz) is a contributing Opinion writer and the author, most recently, of “Undoing Drugs: How Harm Reduction Is Changing the Future of Drugs and Addiction.”
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