Harm reduction grew from organizing by people who use drugs, sex workers and AIDS activists in the 1980s, when needle sharing spread HIV. Community groups ran syringe exchanges before they were legal. Congress barred federal funding for syringes in 1988, and that ban on purchasing syringes remains largely in place.
The approach treats drug use as a health issue, not a crime. Naloxone, which reverses opioid overdoses, became available over the counter in 2023. New York City opened the first publicly recognized overdose prevention centers in the US in 2021.
It is also a racial justice issue. The War on Drugs punished Black communities, while the opioid crisis among white Americans was more often framed as a health crisis. According to CDC provisional data, overdose deaths fell from about 110,000 in 2023 to about 70,000 in 2025.