My pager beeps as I walk through the hospital doors. It is a familiar message, “Your patient wants to leave.” We admitted John four days ago for opioid withdrawal and he is not yet ready to stop using opioids. When I walk in the room, I see him packing his bags. “So, John,” I say. “When you leave, your body cannot tolerate the same amount of opioids because you have lost some of your tolerance. When you use opioids again, you have to start at a lower dose to avoid an overdose.” I hand him naloxone, a medication that can reverse deadly overdoses, and talk through how to use it. I remind him that he is always welcome to come back to the hospital when he needs care or if he is ready to stop using opioids. He thanks me for my time and goes. I hoped my harm reduction counseling would allow him to return for addiction treatment in the future, rather than be another statistic of death caused by overdose.
As physicians, we use harm reduction every day for many diseases. For patients with diabetes, we counsel on decreasing foods high in carbohydrates to control blood sugar. For patients who smoke, we advise them to cease or at least cut down on the amount to reduce the risk of lung cancer and chronic lung disease. Pediatricians use harm reduction principles when they discuss the importance of wearing seatbelts and age-appropriate car seats with families. Harm reduction, as it relates to substance use disorder, is defined by the National Harm Reduction Coalition as a set of practical strategies and ideas aimed at reducing negative consequences associated with high-risk behaviors, such as drug use. It helps create a trusting patient-physician relationship, decrease harmful use, and develop safer use practices to reduce risks of injury, preventable disease transmission, and death.
The Great American Recovery Initiative and its limitations
In February 2026, President Trump and Secretary Kennedy of the Department of Health and Human Services (HHS) announced an executive order titled The Great American Recovery Initiative (GARI). A statement released by the HHS on February 2 pledged $100 million for evidence-based programs to help millions of Americans, like John, who are living with substance use disorder. Money pledged by the HHS will be essential in funding vital services that can both save American lives and decrease health care spending on hospital stays related to substance use disorder.
While GARI will provide much needed funding for recovery programs, the HHS in its same statement referred to harm reduction strategies as “non-effective” and “enabling future drug use.” As physicians, we know that harm reduction works and The Great American Recovery Initiative needs to use evidence-based public health programs like harm reduction to help Americans. People who suffer from the disease of addiction may continue to use drugs despite counseling and treatment options. Harm reduction is a realistic and cost-savings approach to helping patients with substance use disorders (SUDs).
Evidence-based public health programs save lives
One life-saving and economically beneficial harm reduction practice for SUDs are syringe service programs (SSPs). These are evidenced-based public health programs that provide sterile syringes to people who inject drugs and have been shown to decrease the rates of human immunodeficiency virus (HIV) and hepatitis C virus infections by 50 percent. A 2021 study by Des Jarlais found that an annual budget of $500,000 for SSPs would need to prevent only three new HIV infections to be cost-saving for the health care system. Harm reduction saves lives and money.
Another effective harm reduction practice is the distribution and prescription of naloxone (Narcan), an opioid receptor blocker that serves as an opioid overdose reversal agent. As health care providers, we prescribe this medication to all patients who are given a prescription for opioids and to patients who actively use opioids as a preventative safety measure. From an economic perspective, the annual health care cost of overdoses in the United States is estimated to be $1.94 billion. In essence, any strategy that reduces overdoses leads to health care savings.
America has been fighting the opioid epidemic for decades. Due to continued stigma, The Great American Recovery Initiative currently does not support harm reduction funding. GARI must invest portions of the $100 million grant into harm reduction because it will reduce the risk of disease complications from injection drug use, prevent hospitalizations, and save billions of dollars in health care costs.
Amanda Perez is an internal medicine resident. Mary Finedore is a medical student. Alyssa Lambrecht is an internal medicine resident.
