August 2025 Newsletter: What Works to Combat the Overdose Crisis? Harm Reduction.

A participant came up to say thank you and introduce himself following a recent training we offered. He shared that he identified as a long-time harm reductionist and then said, “but harm reduction doesn’t work for fentanyl; abstinence is the only way it won’t kill people.”

It’s not the first time we’ve heard someone identify themselves as a harm reductionist and then look to exclude some people, or people who use certain drugs, from harm reduction approaches. It’s not the first time someone has misunderstood that abstinence can absolutely be a harm reduction goal. And the messaging around fentanyl, and fentanyl users, has become exponentially stigmatizing and othering.

OF COURSE harm reduction approaches apply to fentanyl use as they apply to all substance use—they must. We continue to lose too many people to overdose death to not look to measures that engage and offer life-saving interventions to people who are increasingly marginalized. Naloxone is a harm reduction intervention and its use saves thousands of lives each day. This may seem obvious to the average person with a basic understanding of the overdose crisis, but political structures have attempted to separate naloxone from harm reduction. And even people that are fervently against harm reduction agree that naloxone is necessary and works. This alone situates harm reduction as the primary public health intervention to combat opioid overdoses.

Furthermore, Harm Reduction Therapy (HRT) must be the primary treatment intervention for people using fentanyl. HRT aims to keep people as healthy as possible, as safe as possible, and alive so they can consider what they want in their future. Any serious treatment provider, whether or not they agree with harm reduction principles and practices, would agree that these three things are essential in the provision of any treatment. But HRT also deepens the treatment relationship by offering options: support for safer use, moderation and/or abstinence. HRT considers each person’s story along with knowledge of human psychology, physiology and development to tailor integrated care that treats the whole person. Research shows the following two things to be true: 1) people are more successful at achieving change goals when they make their own choices and, 2) a therapeutic relationship rooted in mutual respect retains people in treatment and helps them achieve their goals.

At HRTC we don’t just follow the research, we use the research to inform us as we listen deeply to each person and plan how best to assist with their stated needs. As one example, over the last year a young woman has repeatedly presented to one of our service sites to get coffee and use the restroom, engaging with our team a little more each time. In the span of a few months, she survived at least 3 fentanyl overdoses (that we knew about), revived each time by a community member carrying naloxone. She also began taking suboxone prescribed through her contact with a city outreach team. But after more than one attempt to do a full suboxone start resulted in such distress and severe withdrawal that she disappeared from housing and medical care, she shared with an HRTC clinician that she had experienced the death of a close family member due to an opiate overdose and blamed herself for not having the naloxone with her to revive the person. She shared that, “everytime I try to get away from fentanyl, all those feelings come back like a trucker who lost control of their truck–and it’s aimed right at me.” We listened, we validated, we redirected sometimes when feelings became too painful and overwhelming, we encouraged her to talk with her provider about microdosing suboxone as an alternative to a full start of the medication. We kept talking, engaging, providing naloxone, and being happy to see her. And we are so glad that we still get to!

-HRTC’s Director Team: Maurice Byrd, Nancie Jann, Anna Berg