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Substance Use Prevention and Harm Reduction

The national opioid epidemic began with widespread addiction to, and misuse of prescription painkillers. More recently, illegal drugs such as heroin and illicitly manufactured fentanyl are responsible for a majority of fatal overdoses. As well, a growing number of states are legalizing marijuana, still considered an illicit drug at the federal level, for medical and adult recreational use. Law and policy can help or hinder harm reduction and overdose prevention measures.


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A Closer Look at Substance Use Prevention and Harm Reduction


The United States remains in the grip of an unprecedented epidemic of drug-related harm. In 2017, over 70,000 Americans were killed by drug overdose, surpassing the number lost at the height of the HIV/AIDS crisis. Opioids, both prescription painkillers and illegal drugs such as heroin and illicitly manufactured fentanyl, are responsible for most of these deaths.

States and localities have implemented a number of legal and regulatory interventions to address this epidemic. These include the creation and strengthening of prescription monitoring programs (PMPs), drug take-back programs and initiatives to increase access to naloxone, a medication that effectively reverses opioid overdose. States are also taking measures to increase access to evidence-based substance use disorder treatment, improve prescriber training, and evaluate whether existing programs are having the desired effect.


Marijuana, which is still considered an illicit drug at the federal level, is legal in 11 states for adults over the age of 21 for recreational use, and legal for medical use in 33 states as of January 2020. A broad spectrum of policy variables must be considered in the legalization of recreational marijuana, including advertising restrictions, personal cultivation regulations, social consumption sites, delivery services, local authority to limit or prohibit recreational marijuana enterprises within their communities, and social equity measures. For medical marijuana, policy questions include how to regulate its recommendation and dispensing, as well as how to register patients approved for medical marijuana use.

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