The erosion of harm reduction

Summary This perspective explores the unprecedented political and administrative attack on harm reduction in the United States during 2025. Defined not by bureaucracy but by a set of evidence-based practices and philosophies that aim to reduce harm from drug use and punitive drug policies, harm reduction encompasses interventions such as syringe service programs (SSPs), naloxone distribution, overdose education, overdose-prevention centers, and decriminalization efforts. Traditionally underfunded and leaderless, the movement has found itself a direct target of federal and state authorities. In early 2025, major funding cuts hit US federal agencies central to harm reduction, starting with the closure of HIV-prevention offices and the dismantling of the Office of Infectious Disease and HIV/AIDS Policy. These actions immediately curtailed critical data collection on overdose and HIV risk, limiting the ability of public health practitioners to respond effectively. Simultaneously, reductions in resources for the Overdose Data to Action program handicapped state and local capacity to...