Over the past 18 months, the United States has been besieged by overlapping health challenges, stressing pockets of our health system to the point of failure and shining light on the need to balance public health with individual liberty. In 2020, roughly 93,000 people died from a drug overdose, 480,000 due to combustible cigarettes, and 375,000 of COVID-19. It’s tempting, as a society, to want to prevent these deaths by restricting individuals’ risky behaviors. And we’ve certainly seen some of that, with the overcriminalization of fentanyl and its analogs, bans on flavored tobacco products and rapid increase of COVID-19-related lockdowns early in the pandemic. However, such constraints run counter to the United States’ mandate to preserve individual freedoms, including our right to a joyful life. The philosophy of harm reduction represents an alternative approach that can preserve individual freedom while mitigating health risks.
Policies that try to restrict risky behaviors via prohibition and overcriminalization are often followed by unintended consequences. For example, a recent study found that after San Francisco banned flavored tobacco products, underage high school students’ odds of smoking combustible cigarettes doubled compared to youth in neighboring areas that lacked such a policy. Similarly, while lockdowns aimed at flattening the COVID-19 curve saved lives, they are not sustainable and come with their own set of harms to psychological and economic well-being. And when it comes to illicit drugs, incarceration itself appears to increase risk for overdose and infectious disease. These trade-offs make the net benefits of severe restrictions difficult to quantify.
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