Vera Institute of Justice

The United States is experiencing an epidemic of drug overdose deaths that cuts across economic, racial, and geographic boundaries—and, despite a fraught election season, even political boundaries. In 2015, an average of 144 people died each day from drug overdoses, including 91 people who died from overdoses on opioids (prescription opioid pain relievers and heroin). In the midst of this devastation, people are struggling to find ways to save the lives of their community members. During the recent presidential campaign, one of the few areas of agreement between the candidates was the need to approach drug use differently, including the use of overdose prevention drugs such as naloxone.

Four decades ago, the U.S. government declared a “war on drugs” with the aim of reducing drug use through tough enforcement policies that mandated long sentences for drug convictions. Defining drug use primarily as a criminal issue helped create a bloated justice system in which up to 65 percent of incarcerated people meet criteria for a substance use disorder but where few people have access to the types of support needed to address their substance use, rebuild their lives, and prevent recidivism.

There is increasing momentum, however, for a smarter, effective, and more compassionate approach to people who use drugs that is grounded in the evidence by incorporating a range of public health strategies, such as alternatives to incarceration, medication-assisted treatment, and overdose prevention. The public health community has long used these approaches—collectively referred to as “harm reduction”—as tools for addressing substance use, but justice-system stakeholders have been much slower to incorporate them into their practice.

This report describes how some jurisdictions—both red and blue—are implementing harm reduction strategies in order to reduce overdose deaths, improve the well-being of justice-system-involved people, and advance the health and safety of their communities. It shares perspectives from stakeholders in law enforcement, the court system, corrections agencies, drug policy, and the community about what strategies are being implemented, how they have overcome barriers, and what work remains to be done.

Communities and government can no longer ignore the harsh realities of the overdose epidemic. This brief aims to facilitate a wider discussion about how we can build a justice system that is equipped to address the harms associated with substance use. We highlight police departments, courts, jails, and prisons around the country that are already applying these principles. Expanding these harm reduction programs to serve more people in more places will strengthen communities and save lives.