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Debates about drugs often set harm reduction against treatment, as if a community had to choose. The evidence points the other way: care works best as a continuous path, from keeping someone alive tonight to supporting them years into recovery, and people move along it at different speeds. The sections below follow that path.

Staying alive

In the United States, an estimated 69,973 people died of drug overdoses in 2025, down almost 14% on 2024 and the third yearly fall in a row, according to provisional CDC figures; opioid-involved deaths fell to about 44,600. Several states, including New Mexico, Arizona and Colorado, saw increases. In Canada, 7,146 people died of opioid toxicity in 2024, about 20 a day. Researchers are still debating why deaths have fallen, and it would be wrong to credit any single cause.

Naloxone, a medicine that reverses opioid overdoses, is the most direct way to prevent these deaths. In a 2013 study of 19 Massachusetts communities, published in the BMJ, places where many people were trained and given naloxone had overdose death rates about 46% lower than places with no programme; trained bystanders reported 327 rescues. The study was observational, not a trial. The Opioid Overdose Prevention Fund pays for naloxone kits and training.

The risk is highest for people who use alone, for people whose tolerance has dropped after time in prison, detox or hospital, and for people who unknowingly take counterfeit pills containing fentanyl.

Reducing harm

Harm reduction means services that reduce death and disease among people who use drugs without requiring them to stop first. The most common objection is that it “enables” drug use, so it is worth looking at the evidence service by service.

• Supervised consumption sites. After Vancouver’s Insite opened, overdose deaths within 500 metres fell by 35%, compared with a much smaller, non-significant change in the rest of the city (The Lancet, 2011; a before-and-after study). Over its first 20 years Insite recorded more than 4.6 million visits, reversed 11,856 overdoses and had no deaths on site. A 2023 study of New York’s two sites found no significant rise in crime or emergency calls nearby. Sites are still contested locally, and public disorder near some of them is a real community concern. The Harm Reduction Services Fund supports Insite.
• Needle and syringe programmes. A 2017 Cochrane review found that high-coverage syringe programmes combined with opioid substitution therapy cut the risk of hepatitis C by about 74%. On their own, syringe programmes had less certain evidence: European studies of high-coverage programmes found reductions of more than half, while North American studies, which measured coverage differently, found little effect.
• Drug checking. In a small 2019 Rhode Island study, half of the young adults who used fentanyl test strips got a positive result, and about half of those said they changed how they used. There is not yet good evidence on whether they prevent deaths.
• Peer outreach. People with lived experience can reach those who distrust services. The Community Recovery Support Network and the Community Recovery Support Fund are both peer-led.

On the evidence available, the best-studied services save lives without the feared side effects, though most of the studies are observational rather than randomized.

Treatment

Medication is the best-evidenced treatment for opioid addiction. A 2017 review in the BMJ found that people in methadone treatment died at about a third of the rate of those out of treatment: 11.3 against 36.1 deaths per 1,000 person-years, with similar benefits for buprenorphine. Risk was highest in the first four weeks of starting methadone and in the first four weeks after leaving treatment, which is why close follow-up early on, and keeping people in treatment, matter so much.

Treatment is also where people are most often exploited. In the United States, “patient brokers” have been paid up to US$2,000 a head to steer people, sometimes with free flights, into sober homes offering little or no real treatment, and to re-enrol them after relapse. Florida passed an anti-kickback law in 2017, and a 2018 federal law targets kickbacks in addiction treatment. Before choosing a programme, check that it is licensed, that its clinicians are qualified, that it offers or allows approved medications, that it gives clear costs, and that it plans aftercare. Be wary of free travel or cash offers, pressure to decide on the phone, and promises of a guaranteed cure. In the US, the official locator at FindTreatment.gov lists licensed services. The Community Addiction Treatment Fund pays for outpatient treatment for people who cannot afford private rehabilitation, and the Veteran Substance Use Recovery Fund supports addiction treatment for veterans.

Recovery

Recovery is a long process, and peer support plays a growing part in it. A 2019 review of peer recovery support services found signs of reduced drug use and relapse and better retention in treatment, but also many studies with no clear effect, and called the evidence promising rather than settled. Housing, work and family relationships matter at least as much as any single programme.

What Portugal actually did

Portugal is often cited by both sides of the drug debate. In July 2001 it made possessing up to ten days’ supply of any drug an administrative offence rather than a crime, and referred people to local panels that can warn, fine or direct them to treatment. Selling drugs remained a crime. Alongside this came a large expansion of treatment: the number of people in treatment rose from about 23,700 in 1998 to about 38,500 in 2008, and drug-related HIV fell sharply. Drug use did not rise beyond trends in comparable countries, and in 2019 Portugal had the lowest drug-related death rate in Europe.

Since then, problems have returned in some cities. Overdose rates had hit 12-year highs and almost doubled in Lisbon from 2019 to 2023, according to a Washington Post report in July 2023, which linked this to the decentralization of drug services in 2012 and deep funding cuts that followed. The fair conclusion is that decriminalization worked as part of a well-funded health response and is not self-sustaining without one, though there has been little rigorous evaluation of the recent period.

Terms people often misunderstand

• Harm reduction: keeping people alive and healthier, including those not ready to stop. It is not giving up on recovery.
• Naloxone: reverses opioid overdoses only, and does no harm if given to someone who has not taken opioids.
• Medication for opioid use disorder: treatment with methadone or buprenorphine. Being dependent on a stable, prescribed medicine is not the same as addiction.
• Supervised consumption site: a place where people use drugs they bring themselves, with staff on hand to respond to overdoses. Staff do not supply drugs.
• Fentanyl test strip: shows whether fentanyl is present, not how much, and not whether a drug is safe.
• Decriminalization: removing criminal penalties for personal possession. It is not the same as legalizing sale.
• Peer worker: a person with lived experience employed to support others. Not a replacement for clinical care.
• Tolerance loss: after a period without using, the same dose can be fatal, which is why release from prison, detox or hospital is a high-risk time.

Every Addiction & Recovery cause we list

Each cause names the organization that receives the grants and when our team last verified it. Open a cause to see what it pays for, or donate directly.

Common questions

Does funding harm reduction encourage drug use?

The best-studied services, such as naloxone, supervised sites and syringe programmes, have not been found to increase drug use or crime, though most studies are observational. They can keep people alive long enough to reach treatment.

Do these causes fund abstinence-based treatment too?

Some fund counselling and outpatient treatment. Others focus on keeping people alive and healthy. Together they cover different points on the same path.

I am worried about someone close to me. Where should I start?

If they are in immediate danger, call your local emergency number. Otherwise, a doctor, a local helpline or, in the US, FindTreatment.gov can point you to licensed services. Many services also support families.