Jessica DiDia’s mother found her on a San Francisco street and asked her to come inside. “You know you’re going to die out here?” Laurie Steves said. Jessica’s answer: “So? I’m going to die one day anyway.” She walked away. Nobody stopped her. Nobody was supposed to.

That exchange, recorded by journalist Heather Knight, sits at the centre of a wider argument Marvin Olasky makes in Christianity Today: that harm reduction harms the homeless, not despite its intentions but because of them.

Where detox gave way to something else

For decades, the standard approach to drug addiction was detox: get the substance out of a person’s system and give them a real shot at a different life. Harm reduction, the practice of reducing the dangers of drug use without requiring someone to stop, has largely replaced that model in homeless services, particularly on the West Coast. Whether that shift actually helped anyone is the question Olasky went looking to answer.

What one Washington clinic director learned the hard way

Olasky’s first guide on this subject was Marsh Ward, clinical director of Clean and Sober Streets in Washington, DC, whom he met on a cold night in 1995. Ward had arrived in the city in 1987 planning to run a program with no rules at all. “They’re all adults, aren’t they?” he reasoned at the time.

Within a year, he’d reversed course completely. Bringing people in off the streets and simply feeding them, he realised, wasn’t helping them get their lives back together. “You’re enabling them to stay with their disease,” he told Olasky. Rules followed: no violence, no sex, no stealing, no progress means you’re out. Ward admitted he’d bent those rules out of sympathy more than once, and regretted it every time. “It’s hard to kick people out,” he said, “but you have to think of the effect on the honest people.”

What Olasky saw on the ground in San Francisco

Nearly three decades later, Olasky travelled to San Francisco’s Tenderloin district to see how harm reduction actually played out in practice. Ten dollars bought a dose of fentanyl reportedly fifty times more potent than heroin. Fentanyl was killing two people a day across the city in 2022 and 2023.

What he witnessed went beyond simple tolerance. City-funded harm reduction workers pushed a wagon of foil, glass pipes and needles down sidewalks lined with people using in public, calling out “Harm reduction, need anything?” as they passed. He watched people locked in what he called the “fentanyl fold,” half-crouched with arms bent at odd angles, some missing teeth, some without pants, some frozen in that position for twenty minutes at a stretch.

Clean needles and naloxone, the overdose-reversal medication also sold as Narcan, made up most of what these programmes distributed. Naloxone genuinely saves lives in the moment of overdose. What it doesn’t do is answer a harder question: how many people never made it into detox or recovery programmes that harm reduction’s rise pushed to the margins.

The numbers behind the argument

The scale of the shift is hard to miss. Roughly 5.6 million Americans were dependent on or abusing illicit drugs in 2001. By 2020, 24.9 million had some kind of illicit drug use disorder. The two figures come from different survey questions, so they aren’t a clean before-and-after, but even taking the more conservative reading, addiction in America grew sharply over the same period harm reduction became the dominant public health approach to it.

San Francisco’s own numbers moved too, just not in the direction anyone wanted. Overdose deaths hit 810 in 2023, the year Olasky visited. The Tenderloin, meanwhile, remains the neighbourhood with more children per acre than anywhere else in the city, kids walking to school past scenes no city should consider normal.

San Francisco changes course

By 2025, the city had elected a new mayor, Daniel Lurie, who ran explicitly against the harm reduction status quo. “We’ve been too laissez-faire,” he said. As mayor, Lurie pushed through a Fentanyl State of Emergency Ordinance barring city-funded workers from handing out fentanyl paraphernalia at all. Overdose deaths had already dropped to around 630 in the two years since Olasky’s visit, and the city’s stated drug policy goal shifted to the cessation of illicit drug use rather than managing it indefinitely. City supervisor Matt Dorsey, himself a former drug user, described the old approach as years of perverse incentives that made the problem worse, not better.

What the shift actually argues

Nobody in this story claims recovery is easy, or that rules and consequences work for every single person. Ward said as much about severe mental illness: some walls really don’t come down. But he also came to believe most people trapped behind what feels like a brick wall are actually facing cardboard, something a person can push through given sobriety, structure and support, rather than something that traps them permanently.

Harm reduction harms the homeless because handing out supplies feels like help but skips the harder work of actually getting someone out. Care isn’t the problem here. What passes for care is. San Francisco’s own reversal suggests a growing number of people, including the people who run the city, have started to notice the difference.

Source: dbrecoveryresources