During a class called “Harm Reduction and Health,” I was asked to reflect on my first exposure to the harmful effects of drugs and alcohol. Like many of my classmates, my memory drifted back to D.A.R.E.—the Drug Abuse Resistance Education program. I vividly remember a sheriff’s deputy warning us of the dangers of drug use, holding up mugshots of people arrested for substance use. One student recalled a field trip to a prison, where guards told them they’d end up in orange jumpsuits if they used, bought, or sold drugs. Another described how an officer visited his school with a suitcase full of drug paraphernalia—protected behind glass—and how baffled he was by the display: a spoon, pills with smiling faces, and star-shaped eyes.
These stories—individual yet eerily familiar—represent a shared cultural experience shaped by fear-based messaging. While D.A.R.E. was created with the goal of preventing early drug use, it ultimately became out of step with evolving realities. Today’s synthetic drug supply is more potent and deadly than what previous generations faced, requiring a more nuanced and compassionate public health response. In San Francisco, the narrative around substance use is shifting. Agencies like the San Francisco AIDS Foundation are leading the way by offering training that promotes non-stigmatizing, person-first language—language that recognizes people who use drugs as human beings deserving of dignity and care.
This shift in language is more than symbolic—it reflects a broader approach known as harm reduction. Harm reduction is a public health strategy that aims to minimize the negative consequences of drug use without requiring abstinence. It meets people “where they are,” offering clean syringes, fentanyl test strips, naloxone, and referrals to care. These are not only acts of compassion—they are acts of evidence-based prevention. So why, despite decades of research, are some California lawmakers pushing to roll back access to these life-saving supplies?
A 2016 report from then–U.S. Surgeon General Dr. Vivek Murthy, Facing Addiction in America, strongly affirms the effectiveness of harm reduction. The report argues that embedding prevention, treatment, and recovery into the broader healthcare system improves outcomes across the board. Likewise, the Substance Abuse and Mental Health Services Administration (SAMHSA) describes harm reduction as a “critical” strategy for engaging people who use drugs and connecting them to essential services. These are not fringe ideas—they are mainstream public health best practices grounded in years of research and endorsed by major institutions.
Despite this, San Francisco’s leadership is shifting course. Mayor Daniel Lurie has publicly questioned the City’s harm reduction strategy, criticizing syringe access programs as “enabling” rather than healing. The San Francisco Department of Public Health has a long track record of supporting community-based harm reduction services. Yet under Lurie’s administration, access is being restricted. As of April 2025, individuals must speak with a counselor and agree to treatment before receiving supplies—abandoning the principle of anonymous, barrier-free access that has been foundational to the city’s efforts. As Tyler TerMeer, CEO of the San Francisco AIDS Foundation, warned, “Rather than prevent people from using drugs, this move may push people toward injection drug use, increasing the risk of fatal overdose and the transmission of HIV, hepatitis C, and other infectious diseases.”
While critics raise alarms about this new approach, the City has also launched new initiatives intended to support vulnerable populations without resorting to incarceration. One such initiative is a triage center that opened in February as part of Mayor Lurie’s broader effort to address the fentanyl crisis. The center offers people involved in drug-related activity an alternative to arrest by connecting them with services and shelter. Since its launch, more than 2,600 people have been “engaged” through the center. Over 80 individuals were placed in housing or shelter, and more than 450 received medical or social services. Programs like Journey Home—similar to the long-running Homeward Bound—help people return to family members who can provide stable housing, showing that alternatives to criminalization can work.
Still, the tension remains. Harm reduction is not just about supplies; it’s about preserving public health infrastructure that prevents the spread of infectious diseases and reduces the burden on emergency services. The stakes are high. According to the National Institute on Drug Abuse, quality treatment can reduce substance use by 40 to 60 percent and boost employment prospects significantly. Moreover, investing in treatment yields a $12 return for every $1 spent—far exceeding the cost of incarceration. These are not just statistics—they represent real opportunities to transform lives and communities.
On the frontlines, healthcare workers see this every day. “A lot of people I talk to want to quit, and we have lovely people with the addiction care team that help them through that journey,” says Gregory Andrews, a hospital employee at Zuckerberg San Francisco General. “People can feel very sick and miserable with opiate withdrawal. It’s dangerous to quit cold turkey. We meet people where they are at.” That philosophy—meeting people with empathy, not punishment—is the cornerstone of harm reduction.
If Mayor Lurie truly wants to lead the city into a new era of progress and healing, he must recognize that scaling back harm reduction is a step in the wrong direction. Limiting access to clean supplies and making them contingent on treatment erodes trust, deters people from seeking help, and puts lives at risk. Public health crises cannot be solved with shame or coercion. They require science, compassion, and the political courage to keep life-saving resources available to everyone—no questions asked.
“Harm reduction is a public health strategy that aims to minimize the negative consequences of drug use without requiring abstinence.”
That’s just stupid. Harm reduction may make a person more comfortable while they kill themselves and destroy the city, but it f*cks over everyone else and enables the addict.
A person struggling with an addiction to opioids may face life-threatening withdrawals if they quit cold-turkey without medically-assisted intervention such as methadone, Suboxone, or buprenorphine – legal medications that help a person wean off addictive opioids until they are completely abstinent. Harm reduction is a proven strategy that links people to treatment and eventually a life free from drug use. It is not to avoid consequences, but a way to eventually find freedom from the liquid handcuffs of a disease.