​What Harm Reduction Reveals About Our Failures (and Our Future)

By Chandler Esslinger

Across North Dakota right now, a familiar conversation is resurfacing. We hear the argument that harm reduction “enables” people, that syringe access encourages drug use, that naloxone keeps people addicted and that meeting people where they are somehow protects them from the “necessary” consequences of their actions. These programs are under fire not because they fail. They are under fire because they expose a worldview that worships punishment over connection. And who, exactly, decided that was the moral high ground?

The tension beneath this debate isn’t technical, it’s cultural. It’s the old, persistent belief that if we design laws strict enough, punitive enough, moral enough, behavior will fall in line. It’s the conviction that if people make “bad choices,” our systems should tighten, not soften. It’s the lingering puritanical idea that pain teaches, punishment reforms and withholding care somehow builds character.

The idea that this is some brave new debate is an illusion. We have run this experiment for decades and its outcome has never changed. Laws do not move human behavior on their own, not in the realm of substance use, not in the midst of crisis, not in the shadows where stigma forces people to survive. If they did, our deepest social problems would have resolved themselves by now and the courts and jails and fines we rely on would be relics of a past we had outgrown.

Whether we choose to believe it or not, people’s behavior does not change because something is illegal, because it’s unhealthy, or because someone insists it’s wrong. We respond to conditions. To whether we’re safe. To whether we’re housed. To whether we have options. To whether the system gives us anything to work with.

That’s the part we shy away from naming: so much of what we call “behavior” is actually adaptation. People adapt to the circumstances that define their material reality.

And that’s why harm reduction exists, not as a philosophy of permissiveness, but as a pragmatic intervention invented by people who refused to let bad policy write their obituaries. Harm reduction wasn’t created to make anyone comfortable. It was created to keep people alive in systems that were never built to care for them. Naloxone. Syringe access. Safe consumption. These are tools forged in the gap between how we think society works and how it actually works for people on the margins.

And if we’re being honest with ourselves, harm reduction is everywhere: seatbelts, life jackets, bike helmets, sunscreen, safety rails, speed limits. These measures are the everyday proof that harm reduction is not radical at all. It is how we create safety in a world where people are human and where policy should respond to reality, not wishful thinking.

Which brings me to homelessness, because the same logic shows up there too. Our homelessness response system is one of the most extensive harm reduction structures we’ve ever built, not because we used that framing specifically, but because it’s the only thing standing between thousands of people and preventable death. Outreach, warming centers, hotel vouchers, emergency shelter, food pantries, blanket drives, wellness checks: these exist because the conditions leading to homelessness have gone unaddressed for too long. They exist because rents outpace wages, because a medical event can shatter a household’s safety net, because violence or discrimination or illness can topple someone’s stability overnight.

These services aren’t indulgent. They are infrastructure for survival in a society that has not yet done the harder work of making sure people never fall this far. And the idea that “if you build it, they will come” misunderstands this landscape entirely. People are already in crisis. These services simply keep that crisis from costing our neighbors their lives.

This is why North Dakota’s ongoing debate about harm reduction mirrors our debate about homelessness; it’s a struggle between two visions of human behavior. One believes behavior is a moral choice that must be corrected. The other recognizes behavior as a response to the environment we’ve collectively built.

I know which vision aligns with reality. I see it every day.

When people finally get into stable housing, their behavior shifts, not because someone lectured them, but because the ground beneath them changed. When people have support, their capacity expands. When they have none, their options collapse. This isn’t ideological. It’s observable. Predictable. Repeatable.

If we want to reduce crisis — whether that’s overdose, homelessness, violence, or the ripple effects of untreated trauma — we have to stop pretending that consequence is stronger than circumstance. It isn’t. It never has been.

North Dakota has the tools and knowledge to build conditions that stabilize rather than punish. We have harm reduction programs that save lives, housing programs that create stability and community partnerships that chip away at the gaps our policies leave behind. The question is whether we will scale what works or sink deeper into a worldview that confuses suffering with accountability.

If we choose stability, housing, support, evidence-based care and harm reduction, we can build a future where fewer people fall through the cracks and more people can recover. That future is within reach. The only real question is whether we will build the conditions that make it possible.

Chandler Esslinger is Executive Director of Fargo-Moorhead Coalition to End Homelessness. Reach out at chandler@fmhomeless.org.