Harm Reduction Programs and "Flying Under the Radar"

"Although harm reduction interventions for substance use disorder have been repeatedly shown to reduce the risk of overdose, mortality, and drug-related crime [1, 2], the journey to their acceptance and implementation has been fraught with challenges. This is especially true in many US Appalachian and Midwestern regions that are profoundly affected by the epidemic [3, 4]. The unique demographic and cultural tapestry here—characterized as rural, impoverished, conservative, and religious—has been connected to not only harder access to services but also community resistance to their implementation [5,6,7]. Because stigma is persistent concerning both people who use substances and the harm reduction measures themselves [8,9,10], community authorities and harm reduction advocates tread cautiously, often opting for discretion over advocacy, fearing backlash from a conservative populace. “We flew under the radar,” as one harm reduction service provider interviewed in a 2023 study put it. According to the interviews in a study of the region, one-third of the harm reduction practitioners from Appalachia chose to stay ‘under the radar’ rather than broadcasting their services in anticipation of the stigma of harm reduction within the community [11]."