Harm Reduction or Bust

Joshua Bennett-Johnson
9 minutes ago
5 min read

White mobile overdose prevention unit van parked on a city street, logos.

Harm Reduction Series

June 22, 2026

Joshua Bennett-Johnson, Author, LADC-II, Licensed Counselor

Tom O'Connor, Publisher

Total abstinence or failure! That's what 9 out of 10 traditional programs, specialists, and addiction treatment "experts" will tell us. However, while the accidental overdose crisis reaches epic proportions (at least 100,000+ Americans dying annually), it is incumbent that we shift the paradigm of treatment toward more compassionate, evidence-based strategies.

Broadly defined as "Harm Reduction".

It is finally, increasingly, being recognized as the most effective treatment modality, and we're at a breaking point. We have been since the scourge of fentanyl and its analogs and other horrifying contaminants poisoning the "illicit, street drug supply. That said, the sea change has been slow. Too slow.

As an avowed harm reductionist in practice, I've been watching and waiting for the tide to truly turn so that we can seriously start helping our clients heal. Sadly, that antiquated traditional approach of drug and alcohol treatment in the industry persists in pushing back.

I love the work I do — helping people & families reshape & relearn & rebuild themselves, learning to live and maintain healthy stability in ordinary life is…amazing…But I hate the freaking industry.

Harm reduction safety kit graphic with naloxone, fentanyl test strip, safety guide, and support resources.

You might also like: Why I Support Harm Reduction

Harm Reduction Philosophy

The core philosophy of Harm Reduction is to hell with the "zero-tolerance" model. I'm all for abstinence. Abstinence is harm reduction, too. The ultimate safety net, objectively. But for many individuals, abstinence is not the desired goal, and even if it is, it can be a hard task to achieve.

Us treaters? When I was a student, being trained in the dance of this work, it was driven home to me that we uphold radical autonomy in our clients' preferences and we always meet them where they are — all the time, every time. Full stop. Non-negotiable.

Harm reduction honors this approach to recovery — a spectrum of treatment that is anything but rigid and punitive. This includes:

Helping individuals reduce the amount and/or frequency of what they use.

Providing safety tools like fentanyl test strips, sterile syringes, supervised consumption sites, wound care kits, and direct-contact outreach to help substance users mitigate the risk of overdose and infection.

Removing the requirement of immediate abstinence to access recovery housing and mental healthcare services.

By focusing on ANY positive change, we can help establish a sense of self-confidence in clients who have been repeatedly marginalized by "stay sober or hit the highway" treatment programs.

To help people better understand, a comparison: kicking someone out of drug treatment for using drugs is like kicking someone out of a cardiac unit for having a heart attack.

That's it. Why? They. Are. In. Treatment. To. Begin. With.

Hello?

The goal of Harm Reduction is to preserve people's lives and prevent disease. Based on those metrics? Harm Reduction efforts are among the most successful in modern medicine by a wide margin. Seems a no-brainer if the goal is to help people not die, eh, truly?

The distribution of Naloxone (Narcan), an overdose-reversal nasal spray, has become the cornerstone of overdose prevention. I have personally administered Narcan 4 times in my 14-year career. Those four individuals remain alive and breathing today. Fentanyl poisoning was the prelude to respiratory arrest and their faces turning blue.

In the year 2024, nearly 2 million naloxone kits were dispensed in the country, significantly contributing to the first notable decline in overdose deaths in years. Further, newer tools like access to drug testing kits provided users the ability to identify whether or not their pills and powders were poisoned.

IV drug use has historically driven the epidemic of big drug danger and the spread of infectious diseases. Beyond the risk of overdose, when a user starts injecting drugs, it's typically that lifestyle of needles that creates such mayhem. Harm reduction programs, specifically Syringe Service Programs (SSPs), have only helped:

Hepatitis C (HCV): Infections rose 124% between 2013 and 2020 due to unsafe injection practices. SSPs provide sterile equipment that helps to prevent this.

HIV: One in fifteen new HIV cases is acquired through unsafe IV drug use. Communities with SSPs have significantly lower rates of new & accidental infection.

This is all backed by science, data, and peer-reviewed research, btw, yet the mainstream treatment industry, as a business, doesn't want to acknowledge it. It's not immediately helpful to their bottom line.

I say, "And?"

Human Services Career = Wealth?

If you go into the field of human services to become obscenely wealthy? To build an empire? Shame on you. Find a different venue—one in which the stakes aren't life and death.

My first college course, the first night, the director of the licensing program said to us, "If there is anyone in this classroom who is motivated to do this work to become rich, you can gather your belongings and leave. We're not in the business to get rich. We're in the business of helping people."

Joe. Absolute badass.

Ironically, with respect to government spending, the total economic hit of the opioid epidemic in the U.S. was estimated at $2.7 trillion (Yeah. Trillion. With a "T") in 2023, respectively, with respect to healthcare costs.

Return on Investment

Harm reduction services? In addition to, you know, keeping people alive, they also provide a substantial return on financial investment to our country's economy, maybe not for the private companies in the treatment industry, but for our actual society of humans.

In some jurisdictions, every $1 spent on harm reduction delivers $10 in societal benefits. I'm no mathematician, but that seems like a pretty healthy return on an investment.

Reduced ER visits. Prevention of infections, abscesses, and endocarditis because users can inject themselves using sterile supplies (they 100% will inject themselves with whatever option is available, so…). Fewer 9-1-1 calls. Decreased Crime. Job creation. The list goes on & on.

The conventional "Sober or Failure" crowd will tell you that harm reduction "enables" or even encourages drug use. I've got breaking news. Americans use drugs. We always have, and we always will, despite prohibitions or discouragement. But guess what! Harm Reduction actually, and sometimes accidentally, nudges users in the direction of the hardline abstinence-only model. Funny, that.

Harm reduction-oriented programs are significantly more likely to help people towards detox or long-term care than those that are not. It's because Harm Reduction upholds the appropriate model of autonomy, respect, belief, and rapport between treater and client to build real trust and goodwill.

Simple arithmetic: When you treat a human with dignity rather than shame for using, they are more likely to seek help when they are ready. They know love. Feeling seen, heard, known, encouraged, and cared for by the so-called "experts", and often for the first time, enables self-belief.