A social services worker in Minnesota has asked a question that many in her field would rather avoid. Where does reducing the harm of drug use end, and where does helping someone use drugs begin?

Cally Proctor raised it in an essay published on 19 September 2026. She has spent years in shelters, street outreach and housing programmes, and she does not dismiss harm reduction. She says it can save lives. However, her concern is that the movement has grown into what she calls the harm reduction industrial complex, where keeping people alive has become the finish line rather than the first step.

A five dollar gift card and a hard lesson

On her first day at a new job, Proctor sat behind a table covered in sterile syringes, glass pipes, filters, tin foil and rubber bands. Beside them lay a stack of $5 grocery store gift cards. They were handed out as “incentives” for engagement, so if somebody said hello or took supplies, they got one.

The first man to approach took handfuls of supplies. Proctor offered him a card. He asked how much it was worth, heard the answer and threw it back. It bounced off her face.

Earlier that day, she had congratulated a senior outreach worker who said she came to Minnesota for treatment and stayed. The reply was a scoffed “thanks”. Proctor writes that it was the kind of thanks that told her she had said something naive. She did not yet understand why congratulating someone on recovery was embarrassing. She soon would. That small scene was her introduction to what she would later call the harm reduction industrial complex.

Where harm reduction works

Before she questioned the harm reduction industry, Proctor credited the parts that worked. She had no objection to needle exchanges, and she notes that research has consistently linked sterile injection equipment with lower transmission of blood borne infections.

She also describes an older man who lived on the streets with severe alcoholism. Each month his SSI cheque arrived, and he drank heavily for days. Other people on the street knew the pattern. He was assaulted, forced to reveal his PIN and robbed. Then came the emergency room, detox, jail and minor charges, and the cycle began again.

Permanent housing with a representative payee protecting his income could break that loop, even if he kept drinking. That version of harm reduction made sense to her.

When the definition of harm keeps stretching

Then the meaning of the word began to stretch. Proctor sat through training on advising people how to inject drugs into their genitals when other veins were no longer usable. She was also encouraged to hand out materials on how to administer drugs rectally, and how to do it more safely.

The money behind this was not small. At organisations serving people in desperate poverty, she heard leaders describe having more harm reduction funding than they knew how to spend. Entire departments grew up around the work, with directors often earning more than $100,000 a year. In her view, the result was a harm reduction industrial complex of funded positions, conferences, trainings, travel, supplies and client incentives.

Minnesota’s own opioid response spending data shows more than $24 million in awards categorised as “harm reduction”. Proctor is clear that this does not mean $24 million went on pipes and syringes, because the grants also pay for naloxone, testing, salaries, outreach, training and referrals. Even so, she suspects most taxpayers have no idea what some of that spending looks like once it reaches the ground.

Her concerns echo those raised for many years by the Dalgarno Institute, an Australian drug and alcohol prevention advocacy group that has long challenged the misuse of harm reduction. Proctor’s examples show how far the harm reduction industry can drift when the hope of recovery drops out of view.

Advocates do have a serious reply to critics of the harm reduction industrial complex. People with severe addictions rarely stop because a worker withholds a clean syringe, so refusing supplies may raise the risk of infection, injury or death without ending drug use. A nonjudgmental relationship can also keep someone connected to medical care. Small incentives, they say, are meant to make contact rather than reward drug use. Proctor understood that argument because she had worked inside it. She simply began to wonder where it ended.

Masks on, needles out

Her doubts deepened during the early COVID period, when she worked at a hotel converted into a shelter. Staff enforced a mask policy. She recalls reminding residents to pull their masks over their noses while handing out bags of syringes. Sometimes she walked past someone slumped in a chair, barely conscious, with a needle in his arm. It was a needle the shelter had just supplied. At least he had his mask on. For her, the scene captured the contradiction inside the harm reduction industrial complex.

She saw a contradiction. When authorities judged COVID dangerous enough, autonomy had limits, and adults were told what to wear and where to stand. With addiction, however, she felt the professional’s role had shrunk to making whatever the person chose somewhat safer, without directing, discouraging or even voicing alarm.

The stakes rose when children were involved. She met women near the end of pregnancy who were using dangerous drugs, and the response stayed the same: supplies, engagement and no alienation. Twice she met mothers whose infants had been exposed to fentanyl at home. Both babies overdosed and, thankfully, survived.

Whose harm are we counting?

Proctor recalls a tribal elder who described what Native children in his community carry into school. On the way there, they pass people who are deeply intoxicated, discarded needles and the visible damage of addiction. By the time they arrive, they have put on armour. A teacher may spend six hours trying to get through it, but then the bell rings and the child walks home along the same street.

That conversation led her to a wider question. The person using drugs matters, and so does the child stepping over the syringe. The pregnant woman matters, and so does the child she carries. The intoxicated man on the train matters, and so does the tired mother a few seats away, quietly deciding whether to move her children to another carriage.

Her verdict on the harm reduction industrial complex is measured. Naloxone saves lives. Sterile syringes prevent deadly infections. Keeping someone alive is sometimes the only achievement possible in a day. Yet she argues that a philosophy built on reducing harm should stay curious about which harms it is reducing, and which it is creating, tolerating or refusing to count. Recovery is better than staying trapped in addiction, she adds, and saying so should not be heretical.

Her closing advice is simple. Meet people where they are, keep them alive and treat them as human beings. Just do not forget to ask where they might go next. For anyone watching the harm reduction industrial complex grow, that may be the question that matters most.

Source: dbrecoveryresources