Incarceration is antithetical to any meaningful response to the overdose crisis—and may exacerbate it. Yet communities across the country continue to face challenges in moving away from criminalization, punishment, and incarceration and toward the implementation of health and harm reduction centered responses to substance use. Urgent action is needed to save lives and support communities.

Below is a set of recommendations and principles for local jurisdictions to consider in their efforts. These are based on lessons from ongoing efforts in Bernalillo and Rio Arriba Counties in New Mexico, Haywood and Durham Counties in North Carolina, and broader movements for harm reduction, drug policy reform, and racial justice from across the country:

1) Local jurisdictions that are serious about rethinking their responses to drug use must center the principles of anti-racism in their programmatic and policy responses.^[]In his 2019 book, "How to Be an Antiracist" Dr. Ibram X. Kendi has defined anti-racist policies as "any measure that produces or sustains racial equity between racial groups" Ibram X. Kendi, How to be an Antiracist (New York: Random House, 2019), 18. In the drug policy and harm reduction movements, advocates have outlined principles for anti-racism and reparative justice through calls for acknowledgement of- and atonement for- the harm done to communities of color by punitive drug policies. They also call for action to advance non-punitive, health-oriented reforms. For more on anti-racism principles among drug policy and harm reduction policy leaders, see Color of Pain, www.colorofpain.org; Drug Policy Alliance, “Race and the Drug War,” http://www.drugpolicy.org/issu...; National Harm Reduction Coalition, “Harm Reduction Commission's North Star Statement,” https://perma.cc/P7HS-HCV7; and Jason Tan de Bibiana, Charlotte Miller, Leah Pope, et al., Changing Course in the Overdose Crisis: Moving from Punishment to Harm Reduction and Health (New York: Vera Institute of Justice, 2020), https://perma.cc/W4RG-ASX4. This can be a first step to undoing and repairing the harms of policies and practices that have disproportionately criminalized people of color for drug-related offenses. Criminal legal system and drug policy reform efforts should also align themselves more closely with broader health, social, and racial justice movements.

a) Jurisdictions should divest from criminal legal system-based responses to the overdose crisis and invest in community-based services and supports. Policies and practices that criminalize substance use have exacerbated inequities for communities of color, and steps must be taken to repair these harms.

b) Policymakers must center racial justice and equity in all policies and practices related to substance use and responding to the overdose crisis.^[]For more on jurisdictions that have implemented mechanisms for racial and ethnic impact analyses in policymaking, see Color of Pain, “Racial and Ethnic Impact Statements,” https://perma.cc/DM95-X52T ; and Nicole D. Porter, “Racial Impact Statements,” The Sentencing Project, September 30, 2019, https://perma.cc/6BZ6-VZND. In addition to moving away from and minimizing the harms of criminal legal system responses to the overdose crisis, policies and practices should address inequities in access to health care, harm reduction, and substance use treatment services and take a race equity and reparative justice-informed approach to reinvestment.

2) Responses to drug use that are based in the criminal legal system—including enforcement and arrest, detention and incarceration, and court-mandated treatment—can be tremendously harmful. Criminalization can stigmatize people who need help and support, and the available options for treatment in criminal legal system settings often force people into abstinence. This can result in untreated withdrawal and an increased likelihood of overdose upon release from jail or prison. Resources and responsibility should be removed from the criminal legal system and reinvested in non-punitive, health-oriented harm reduction and treatment services located in and led by communities.

a) Jurisdictions must develop responses that address the underlying causes of problematic drug use. This includes expanding affordable and low-threshold housing options, addressing barriers to employment, and providing responses that promote healing from trauma.

b) To move the responsibility for responding to drug use away from the criminal legal system, legislators should enact regulatory frameworks to decriminalize drug use. Laws and policies that advance health and harm reduction should be strengthened, including naloxone distribution, syringe services programs, and medication-assisted treatment (MAT). Additionally, legislators should ensure that people have access to health care coverage through efforts such as Medicaid expansion.

c) The participation of people who use drugs should be prioritized in policymaking spaces, decision-making about funding, and the development and implementation of interventions in local jurisdictions. Long-term, sustained funding for initiatives supported and led by local community members who are most directly impacted is of vital importance.

3) Until resources and responsibility are moved to the community, the harms of criminal legal system involvement must be minimized.

a) To minimize unnecessary enforcement and coercion while improving well-being, criminal legal system settings and related programs—including jails, prisons, detention centers, court-mandated treatment, diversion programs, and community supervision—must reject abstinence-based treatment requirements and implement principles of harm reduction. This includes offering all forms of medication-assisted treatment in correctional facilities, with connection to post-release care and naloxone distribution at all points of the system.

b) To ensure continuity of care, there must be coordination between criminal legal system and community-based health providers, housing, and social supports.

c) Legislators should strengthen Good Samaritan laws to ensure comprehensive protections for people who seek assistance in the event of an overdose.