Over the past 18 months, the United States has been besieged by overlapping health challenges, stressing pockets of our health system to the point of failure and shining light on the need to balance public health with individual liberty. In 2020, roughly 93,000 people died from a drug overdose, 480,000 due to combustible cigarettes, and 375,000 of COVID-19. It’s tempting, as a society, to want to prevent these deaths by restricting individuals’ risky behaviors. And we’ve certainly seen some of that, with the overcriminalization of fentanyl and its analogs, bans on flavored tobacco products and rapid increase of COVID-19-related lockdowns early in the pandemic. However, such constraints run counter to the United States’ mandate to preserve individual freedoms, including our right to a joyful life. The philosophy of harm reduction represents an alternative approach that can preserve individual freedom while mitigating health risks.

Policies that try to restrict risky behaviors via prohibition and overcriminalization are often followed by unintended consequences. For example, a recent study found that after San Francisco banned flavored tobacco products, underage high school students’ odds of smoking combustible cigarettes doubled compared to youth in neighboring areas that lacked such a policy. Similarly, while lockdowns aimed at flattening the COVID-19 curve saved lives, they are not sustainable and come with their own set of harms to psychological and economic well-being. And when it comes to illicit drugs, incarceration itself appears to increase risk for overdose and infectious disease. These trade-offs make the net benefits of severe restrictions difficult to quantify.

The goal of harm reduction is to optimize well-being within the imperfect reality we actually inhabit. Because of this, it is relevant to a variety of behaviors and health outcomes, and it’s an approach that we have, as a nation, have gradually begun to embrace. Unfortunately, which harm reduction policies get prioritized often fall along partisan lines instead of being approached objectively. While the Biden-Harris administration earmarked a record $30 million in federal funding for opioid harm reduction, Democrats have generally been reluctant to recognize the potential of electronic nicotine delivery systems (also known as ENDS products) as a way to reduce tobacco-related death and illness. On the other hand, conservatives tend to oppose major new restrictions on tobacco and nicotine products, but they’re more likely than their left-leaning counterparts to favor abstinence-only sex education programs, which have been proven time and again to be ineffective and counterproductive.

Despite these divides, at the heart of harm reduction is something we should all be able to get behind, regardless of political affiliation: the preservation of autonomy. By meeting people where they’re at, we can promote better, more equitable health outcomes without infringing on individual freedoms. What’s more, because the most vulnerable among us face dual risks to health and liberty, harm reduction can support a fairer society. For example, people living in rural areas and LGBTQ+ people smoke at higher rates than the general population; and Black Americans — though less likely to smoke than white or Hispanic Americans — are more likely to use menthol products, which may be more harmful than alternatives. Along with this, these same groups often have significant structural barriers to care — which increases risk for tobacco-related disease and death — and face disproportionate fallout from prohibitive policies, further worsening disparities.

While most of the public health establishment would prefer people simply quit engaging in risky behaviors, research shows that giving them the tools to navigate risks more safely works. Studies from all over the United States indicate that, when equipped with fentanyl test strips, many people who use drugs respond to positive results by adjusting their behaviors to reduce the likelihood of overdose. Compared to abstinence-only until marriage programming, comprehensive sexual education increases condom use, reduces instances of sexually transmitted infections and unwanted pregnancies, and delays youths’ first sexual encounters. The availability of e-cigarettes gives smokers a safer –– although not risk-free –– alternative to combustible cigarettes that can improve perceived control over nicotine use and may help some people quit smoking altogether.

If we have learned anything from the past year-and-a-half, it’s that good public health measures not only save lives, but can help mitigate strains on the medical system and use limited funds more efficiently, bringing down long-term costs. However, these strategies must also remain outside the political and partisan worlds where practical solutions are often ignored. By accepting that the world is inherently risky and providing individuals with tools to navigate those risks more safely, harm reduction helps us create a society that is healthier, fairer and freer.

Image credit: deberarr

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