Your Guide to Harm Reduction, With John Oliver

On a local news report, a doctor describes three patients admitted to his needle-exchange clinic in a single day. All three said they were taking the opioid oxycodone; none had any trace of it in their urine samples. Instead, they had unknowingly taken the stronger, potentially deadly fentanyl, which is frequently disguised as, or mixed into the supply of, other substances.

Cut to “Last Week Tonight” host John Oliver: “The only time you should be surprised by what is in your urine is when you forgot you ate asparagus earlier that day, or — worst-case scenario — the shrunk-down Magic School Bus comes out after a biology lesson gone horribly wrong.”

Oliver brought his signature mix of serious issues and occasional irreverent asides to the topic of harm reduction on his HBO show earlier this year, in a comprehensive and compassionate segment. The host laid out the latest effective techniques in helping people who use drugs stay safe and, hopefully, find a way to treatment.

Oliver also directed plenty of ire and exasperation toward the challenges, both legal and societal, that hamper the adoption of harm reduction tools and services like drug-checking equipment, naloxone and overdose prevention centers. “The problem with all harm reduction programs is that people are so angry with those who use drugs, they want to try to punish them into abstinence. But that’s not how any of this works!”

He ended with a plea: “We all need to get on board here. Our ingrained stigmas around drugs and the people who use them run really deep.”

Tell Me More About Harm Reduction. How Can I Help?

The Centers for Disease Control (CDC) reported a record-breaking number of overdose deaths between May 2020 and April 2021 — more than 100,000 deaths.

The culprit of most overdose deaths, around two-thirds, is substances laced with fentanyl or other synthetic opioids, largely the result of an increasingly contaminated drug supply.

Outdated ’80s-era policies and messaging like “Just Say No” and zero-tolerance laws aren’t cutting it — if anything, they do more harm than good. The harm reduction movement proposes radical changes in attitudes and tactics, to protect people who use drugs, reduce unnecessary deaths, and ultimately promote treatment and recovery. It accepts that people will use illegal drugs and focuses on ways to keep them safe.

Harm reduction has many aspects. Some require professional oversight: Needle-exchange programs provide clean, unused syringes to those who inject drugs, and dispose of used ones. Overdose prevention centers offer discreet sites with sterile equipment where people may use under the supervision of trained professionals.

But there are other harm reduction practices that anyone can participate in, which can be equally vital in keeping people alive and safe.

Drug-checking is the process of testing an illicit substance someone is about to use to make sure they know what is in it. If someone unknowingly purchases fentanyl-laced cocaine, for example, and checks it prior to use, it could save their life. You can purchase drug-checking equipment like fentanyl-testing strips and drug reagent kits through services like the Bunk Police or Dance Safe. But note: In many states, it is illegal to possess these tools, a policy Oliver rightly called “ridiculous.”

Another harm reduction approach is to carry naloxone on you (the nasal-spray version is sold under the brand name Narcan). Naloxone quickly reverses the effects of opioids on the brain and restores breathing function in someone who has overdosed. Even if you do not use, you should think about carrying this life-saving medication — “we all need to get on board” — as overdoses happen quickly and unexpectedly. Fast access to naloxone can save someone’s life.

While there has been a recent national shortage of naloxone, there are many nonprofit organizations that can provide it to people free of charge. Two to check out for more information on how to get, store and use naloxone are Next Distro and Harm Reduction Circle.

As Oliver concluded, “We need to meet people where they are, help them transition into safe drug use to stay alive, and remove barriers for those seeking addiction treatment.”