An ambitious cohort of cities across the US and Canada has moved ever closer to legalizing drug use—with tragic results. Towns once recognized as safe places to raise a family are now characterized by homeless encampments and “open-air” drug markets. Overdoses and crime rates, both supposed to decline in the wake of liberalized drug laws, have increased in many jurisdictions. Residents in a lot of these communities have been left to deal with the fallout alone as their leaders remain committed to so-called harm-reduction policies intended to make illicit drug use safer. “Harm reduction isn’t just a problem for addicts,” Atlantic staff writer Michael Powell noted recently. “In many cities, the autonomy of drug users has taken precedence over nearly everything and everyone else, not least working-class families …who must live alongside addicts and accept dystopian decay.”
Seattle and similar cities illustrate the pattern. Public fentanyl use, addicts collapsed on sidewalks and schoolchildren observing drug deals have become routine where policies prioritize “meeting users where they are.” Distributing clean needles can reduce HIV and hepatitis transmission among participants, yet this narrow benefit has been overshadowed by increasing disorder and the normalization of addiction in residential neighborhoods.
Portugal’s more structured harm-reduction approach is often cited as a model for the US to follow, yet their strategy retained police involvement and treatment pressure. Perhaps more importantly, drug distribution is still a crime. The policies put in place by state and local officials in the US lack these defining features, usually intentionally. Oregon’s Measure 110 decriminalized possession of small quantities of drugs and produced sharp rises in overdoses and public use before a rapid public backlash and partial reversal. The arrival of fentanyl intensified the death toll, but the policy’s removal of consequences and enforcement made open-air markets and visible addiction far worse.
The reality is that widespread drug use is not inevitable. Heroin-addicted Vietnam veterans largely quit upon returning home, after being removed from a drug-saturated environment, and smoking rates fell dramatically in the US after sustained stigma and restrictions. These examples are strong evidence that norms, consequences and limited supply—all variables harm reduction excludes as “judgemental”—shape demand.
“Safe supply” experiments, in which addicts are given a taxpayer-funded ration of opioids, and the elevation of active users’ autonomy above the interests of children and working families have delivered measurable social decay rather than the promised reductions in harm. Two decades of expanding harm-reduction show the same result: the welfare of families and functioning neighborhoods has been subordinated to enabling public addiction.
Join Dr. Liza Lockwood and Cam English on this episode of Facts & Fallacies as they critique the case for drug legalization.
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Dr. Liza Lockwood is a medical toxicologist and the medical affairs lead at Bayer Crop Science. Follow her on X @DrLizaMD
Cameron J. English is the executive vice president at the American Council on Science and Health. Follow him on X @camjenglish
