What we need is a harm-reduction strategy. If shortages of personal protective equipment exemplified a fatal shortcoming at the start of the pandemic, I feel that we’re now dangerously low on meaningful dialogue.

I remember how skeptical I was years ago about intentional harm reduction approaches to substance use. These focus on the many contributing psychosocial factors that make abstinence difficult and aim to improve the harmful consequences of substance use by partnering with patients. I initially resisted the then-radical strategy of giving take-home naloxone kits to overdose patients with opioid use disorder that could be used to revive them should they overdose again. Then, one morning, my colleague and prominent opioid researcher Dr. Liz Samuels, who spearheaded this now-national model, happened to stop by my office. I expressed my concern: providing an overdose-reversal agent felt like tacit permission to continue a life-threatening behavior. “But Jay, we can’t help a person with their substance use if they’re dead,” she responded.

Samuels reframed my understanding and, once I implemented it, this harm-reduction approach provided other benefits beyond the purpose of rescuing people from avoidable deaths. By meeting patients’ daily challenges without judgment, more of them shared with me their struggles with addiction and sobriety. By being open and curious, I was trusted enough to take a step or two into their lives, which often was enough to change my perspective and connect with them in unexpected ways.