New data from the Centers for Disease Control and Prevention confirm that the United States is experiencing an epidemic of drug overdose deaths that spans the nation and affects people of all backgrounds. Between 2000 and 2015, the overdose death rate increased 163 percent including a 246 percent increase in deaths involving opioids (which include both prescription opioid pain relievers and heroin).1 In particular, the surge in drug overdose deaths is a major driver of rising death rates among young white adults—a trend that resembles the rise in death rates  during the H.I.V. epidemic in the late 1980s and early 1990s.2 With overdose deaths now overtaking motor-vehicle accidents as the leading cause of injury-related death in the United States, there are budding bipartisan efforts to respond to this urgent public health problem.3 Notably, in 2016, Congress passed the Comprehensive Addiction and Recovery Act (CARA), which was co-sponsored by both Republican and Democratic senators and expands people’s access to treatment, prevents overdose deaths, and increases community prevention efforts.Several of these strategies move away from traditional, abstinence-based approaches—and those that criminalize drug use—toward incorporating principles of harm reduction—a public health philosophy and set of practical strategies that seeks to reduce the negative consequences associated with drug use.

While communities increasingly are adopting harm reduction approaches, criminal justice actors have been slow to incorporate strategies proven to help mitigate the damage caused by drug use. Police, courts, and corrections agencies are well-suited to use these comprehensive approaches because of the sheer volume of contact they have with people who use opioids. (Indeed, law enforcement is often on the front-lines of this crisis, and in many cases have taken the lead in fighting it.) Drug offenses are the most common reason for arrest in the United States, accounting for nearly 14 percent of all arrests in 2015.5 It is also estimated that up to 65 percent of incarcerated people meet the criteria for substance abuse or dependence.6 Faced with spiraling rates of overdose and the reality that abstinence-based enforcement approaches have so far failed to stem the tide of drug use, justice professionals are increasingly considering approaches that incorporate harm reduction principles. Even so, most justice professionals have limited training and experience in how to adopt these approaches, resulting in limited use among most law enforcement agencies, courts, jails, and prisons.

Public health and human rights organizations in states from Indiana to Connecticut have been advocating for further uptake of harm reduction practices in the United States for decades, but have only recently targeted efforts toward integrating such interventions in the U.S. criminal justice system. Indeed, there is a need for materials that specifically address the concerns of criminal justice stakeholders and approaches that are attuned to justice settings.

 To bridge these gaps, this brief describes several harm reduction strategies currently being implemented in the criminal justice system and draws on interviews with 14 stakeholders in law enforcement, the court system, corrections agencies, drug policy, and the community in four geographically diverse jurisdictions: New Mexico, New York, North Carolina, and West Virginia. The goal is to help capture current attitudes about the place of harm reduction in the criminal justice system, the feasibility of its widespread use, and what it will take to establish harm reduction as a viable alternative to enforcement-based responses to drug use.  

Harm reduction definition

Harm reduction refers to a set of evidence-based public health practices focused on reducing the harms of drug use.This umbrella term encompasses a wide range of strategies, such as nicotine replacement therapy (such as nicotine gum), methadone maintenance treatment for opioid dependence, and supervised injection facilities, among others. What these strategies have in common is an emphasis on promoting personal and community health without an insistence on abstinence. A common critique regarding harm reduction, which has invited resistance to the term, is the belief that non-abstinence-based approaches encourage or condone drug use. However, robust scientific evidence supports the effectiveness of these interventions.b As jurisdictions grapple with how best to address overdose deaths, public health, law enforcement, and corrections officials are increasingly recognizing that these interventions are important aspects of the solution. 

a The principles of harm reduction have also been applied to other potentially harmful behaviors, such as sex work. See, for example, North Carolina Harm Reduction Coalition, “Safer Sex Work,” 2017,; and Michael L. Rekart, “Sex-work harm reduction,” The Lancet 366, no. 9503 (2005): 2123-2134.

b A. Ritter and J. Cameron, “A Review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco, and illicit drugs,” Drug and Alcohol Review 6, no. 25 (2006): 611-624. J.C. Veilleux, , P.J. Colvin, J. Anderson, C. York, A.J. Heinz, Heinz, “A review of opioid dependence treatment: Pharmacological and psychosocial interventions to treat opioid addiction,” Clinical Psychology Review 30 (2010): 155-166.