Introduction

The deeply problematic histories of homelessness and drug policy in the United States

are not mutually exclusive of each other, and work in tandem to oppress and criminalize

vulnerable and marginalized community members. In order to more effectively address the

human rights issues caused by problematic policies and rhetoric around people experiencing

homelessness and people who use drugs, it is essential to take an evidence-based intersectional

approach that acknowledges the ways these systems of oppression are connected. In this paper, I

will explain the ways harm reduction and housing-first policies take similar approaches to

creating systemic change for the people most affected by working to meet their basic needs in

compassionate, nonjudgmental ways, and why this mindset is crucial in addressing homelessness

in the United States. I will also explain how negative and stigmatizing biases and legislation go

against these evidence-based and social-justice oriented approaches, and what can be done to

overcome some of these barriers.

I have been volunteering for The People’s Harm Reduction Alliance, a local program that

provides anonymous, low-barrier services and safer-consumption supplies for people who use

drugs, since February of 2023. Many of the program’s participants are dealing with substance

use-related issues, housing and financial instability, physical and mental health problems, and

many other forms of discrimination, oppression, and trauma. Harm reduction is an invaluable

asset to public health and social justice alike, and meets these community members where they

are without leaving them there. Programs like PHRA are vital resources that provide life-saving

resources to anyone who needs them in a way that honors their agency and privacy.

This paper will include interview excerpts from Sam Neer (He/Him) and Chloe

Rigler-Gryj (She/Her), two people who I have grown up with who are very important to me.
They are both incredibly empathetic and intelligent, and offered so much valuable insight that it

became extremely difficult for me to narrow down my talking points for this project. I am deeply

appreciative of the time they took to contribute to this paper.

Chloe is my 18-year-old sister, and is currently a college freshman pursuing a B.F.A. in

Acting. We grew up in a middle class family of four in Northeast Seattle, but she is going to

school in New York City. Having lived in two major cities, she was able to compare and contrast

her observations of homelessness between both of them. However, most of our conversation

focused on popular misconceptions and problematic practices surrounding homelessness, and

ways we can challenge public perceptions and create positive change.

Sam is a 22-year-old college senior at the University of Washington who also grew up in

a middle-class family of four in Northeast Seattle and coincidentally also happens to be a theater

kid. We are close family friends who have known each other our entire lives, so he is kind of like

a cousin to me. Both of us have been volunteering at PHRA for a while now, so I wanted to get

his perspective on how his time there has influenced his perspectives on homelessness and

substance use issues. Sam discussed what led him to become more interested in harm reduction,

stating that, “I was at the time just reading a bunch of stories about the history of drug policy in

America, and ethically I think… drugs can certainly cause problems for the people around the

people using them, but I think we have a big stigma around drug use, that associates it with, it’s

bad behavior and like, ethical failing to be using drugs.” He also spoke candidly about his

reasons for choosing to volunteer with PHRA: “I think, just being real about it, I kind of just

wanted something to do and it aligned with my values… it was less about making a difference,

but I’d feel better if, personally, if I spent some of my time once a week helping people that I

don't know that really need help.”

What is The Intersection Between Homelessness and Substance Use in The United States?

Not all people who use drugs are homeless, and not all people who are homeless use

drugs. However, there is significant overlap, and either one can be a contributor or a

consequence of the other. Additionally, members of the homeless population who experience

substance use-related issues are at a higher risk of being unsheltered and having co-occurring

mental and physical health complications (Rankin, 2019). Members of this population are also

more likely to experience chronic homelessness (Tsemberis, 2010), which occurs when an

individual or head of household both has a disability, and has either continuously experienced

homelessness for a year or more or has experienced at least four episodes of homelessness

adding up to twelve months or more in the last three years (de Sousa et al., 2023).

According to the 2023 Annual Homelessness Report to Congress, an estimated 653,100

people in the United States experienced homelessness on a single night of January in 2023 (de

Sousa et al., 2023). Continuum of Care data from the same year found that 108,035 people, or

16.5 percent of the total national homeless population, reported chronic substance use issues

(U.S. Department of Housing and Urban Development, 2023). The total homeless population

reported for Washington State’s 2023 Point-In-Time Count was 28,036 people (U.S. Department

of Housing and Urban Development). However, results from a cross systems homelessness

analysis suggest that this number is likely much higher, with at least 40,871 people experiencing
homelessness at some point in 2020 in King County alone (King County DCHS, 2021). Of those

included in Washington’s 2023 Point-In-Time count, 7,762 people, or 27.7 percent of the

statewide homeless population, identified as having chronic substance use issues (U.S.

Department of Housing and Urban Development, 2023).

What is Harm Reduction?

Harm reduction involves a spectrum of empirically-based, non-coercive services for

people who use drugs. A major facet of harm reduction is the acknowledgement that drug use

comes with risks, and that some methods of consumption are objectively safer than others. For

example, sharing needles, pipes, and snorting tools can cause infection and illness, so it is

important to provide accessible sterile supplies for personal use. Furthermore, punitive

regulations and supply problems have led to an increasingly unsafe drug market and substantial

rise in overdoses, with many street drugs being laced with highly potent and unregulated

substances such as fentanyl and xylazine (Cohen et al., 2022). These numbers can be

substantially decreased with access to supplies like naloxone, which can quickly and effectively

reverse opioid overdoses, or content-checking tools such as fentanyl test strips that easily and

accurately detect the substance’s presence.

Harm reduction philosophy acknowledges that drug use is a complex issue that extends

beyond individuals and into larger sociopolitical structures. As such, it follows an intersectional

framework in its understanding of structural inequities and the ways in which different aspects of
people’s identities contribute to their lived experiences. Harm reduction would not exist without

the direct involvement of the people it aims to serve, and people who use drugs are active

contributors to input, outreach, services, and advocacy (National Harm Reduction Coalition,

2024). Sam discussed how this kind of solidarity work is mutually beneficial for everyone

involved, saying, “I kind of got a new perspective of addiction and what people are looking for

and what they actually believe would be worthwhile with their time, what would actually help

them.”

While there have been many attempts to criminalize drugs and people who use them

throughout history, none of them have been successful at keeping people from using them. While

some of these policies have limited overall consumption by the general public, they often do

more harm than good and lead to increased stigma and risk for those who continue to use them.

Harm reduction acknowledges that it is unrealistic to ban drugs, and instead focuses on keeping

people safe and providing them with the supplies that help them achieve this.

Harm reduction also acknowledges that recovery looks different for everyone, and is

often not a linear process. Maintaining complete sobriety and abstinence from substance use is

not a realistic expectation for people, particularly when they cannot meet basic survival needs.

Unfortunately, many resources in place either mandate or unfairly judge participants for not

adhering to sobriety. People do not need to be sober to access or contribute to harm reduction

services, nor do they need to have sobriety in mind as an end goal. Judgment, coercion, and cost

can all prevent people from seeking treatment, so it is important to give people the agency to
improve their quality of life on their own terms. For some, this can look like safer consumption

methods, while other people may choose to cut down on, and others may decide complete

abstinence is the best option for them.

What Does This Look Like In Practice?

Direct provision of material relief to people who use drugs in a way that respects their

wants and needs minimizes many of the negative consequences associated with drug use, and

harm reduction services provide free and anonymous supplies that help minimize drug-related

injury, overdose, and infectious disease. Programs like PHRA assist participants to the best of

their abilities while maintaining a nonjudgmental and caring environment. PHRA has a

distribution site in Seattle, as well as mobile outreach and sites that operate throughout the King

and Kitsap Counties. There is also a mail-order program to deliver supplies anywhere in

Washington state. All of the services and resources are anonymous and low-barrier for anyone

who comes in.

While there are some part- and full-time staff at PHRA, the vast majority of people,

including Sam and I, are volunteers. Tasks vary depending on what needs to be done on certain

days, but Sam describes our overall responsibilities as, “Making things that you can give out to

people for free, just making sure they’re centralized because there’s no, like, companies that’ll

make a lot of this kind of stuff for distribution…And then handing stuff out and just helping

people find what they need.” One of the ways this is done is through the distribution of safer use

supplies for a variety of consumption such as injecting, smoking, and snorting. In order to

prevent overdoses, PHRA has injectable and nasal naloxone kits, fentanyl testing strips, and a

drug-checking spectrometer. Additionally, there is a nurse on the staff who offers free on-site

suboxone treatment, a medication for opioid addiction that decreases withdrawal severity and
reduces dependence in the long-term. Many participants cannot reliably access other basic needs

such as shelter, food, and healthcare, so the organization also does what they can to address some

of these issues by providing wound care, hygiene, and safer sex supplies, as well as clothing,

blankets, and other outdoor survival gear. There is also food, water, and coffee, and bathroom

access. PHRA also offers pamphlets for other organizations and resources that can provide

different types of support, such as shelter, food, and medical care.

Another important aspect of these services are the social connections that are formed at

harm reduction sites. Sam describes the reciprocal trust and support in his interactions at PHRA,

noting, “They know that it’s a place that you're like, ‘Oh you want this thing? Yeah, go ahead,

here it is’… There’s people who hang out, there’s people who want to talk, too. It’s having a

place where you’re not told to get out… Just having somewhere where you can exist and not be

scrutinized and victimized is important.”

Harm reduction initiatives are very effective ways of improving the quality of life for

community members in vulnerable situations. Using an approach that is guided by scientifically

accurate information, direct input from the population it aims to serve, and a social justice lens

that identifies and challenges human rights issues, programs like PHRA can assist people in

meeting some of their basic needs. Additionally, these programs provide important sources of
connection, empathy, and safety, and their prioritization and expansion is crucial to addressing

structural inequities at their roots (National Harm Reduction Coalition, 2024).

How does harm reduction apply to housing?

Homelessness looks different for everyone who experiences it, and everyone has unique

things they need to remain housed and live their lives. Effectively addressing homelessness can

be achieved through evidence-based solutions that give people access to basic needs before

moving on to secondary things like getting a job, reconnecting with family, gaining financial

literacy, and addressing substance use issues. Despite this, many housing facilities continue to

use treatment-first approaches, which are not in line with basic survival priorities that emphasize

safety and security, and are not informed by the perspectives of the population they intend to

serve. Sam brought up some of the challenges posed by treatment-based philosophies, stating

that while, “it’s very helpful for people to have something to do, that they wake up for every day,

and they spend their energy doing, and then later in the day they can come back somewhere, just

having routine and purpose,” it is extremely difficult for someone to do this if their basic survival

needs are not being met and they are “...spending the whole night worrying about that instead of

relaxed and sleeping, reenergizing.”

 Contemporary methods of addressing homelessness recognize the substantial overlap

between mental health conditions, substance use, and homelessness. The traditional approach has

been linear residential treatment, a process that begins with outreach, progresses to temporary

transitional housing and support services, and ideally ends with permanent housing (Tsemberis,

2010). LTR implements a variety of methods, including outreach work, drop-in facilities,

shelters, safe havens, six month to two year transitional housing settings, and permanent

supportive housing programs. Many LRT facilities combine housing and treatment on one site,

and tend to take a one-size-fits-all approach that requires all participants to adhere to psychiatric

treatment programs and maintain sobriety in order to reside there.

Both Chloe and Sam discussed the ways in which these expectations are unrealistic and

exclude some of the most vulnerable members of the homeless population. Chloe felt as though

they were contradictory to evidence-based substance-use treatments such as harm reduction,

stating that, “People can't just detox on the street most of the time, that's just not how it works.

It's not safe. If not, it's almost impossible… but it's also not an option for most people to go into

one of these facilities.” Sam echoed these sentiments, commenting that, “It’s hard if you are sick

with an addiction, where you have to engage in behaviors that the people housing you… don’t

find acceptable... I can very easily believe that you can see a place where you can’t deal with

your addiction as somewhere that’s not an option.”

 Offering housing as a reward for treatment and sobriety is inherently coercive, and

evidence suggests that this practice does not lead to enhanced compliance (Tsemberis, 2010).

Additionally, many of these facilities combine housing and treatment in the same facility, which

can jeopardize housing stability for residents. Research on substance use disorders and addiction

supports the idea that recovery is not always linear, and that relapse is a normal occurrence (The

National Harm Reduction Alliance, 2024). However, residents who relapse at these sites are

often evicted, which results in the loss of both shelter and treatment. This leads to a significant

number of residents being abruptly cut off from help and returning to homelessness (Tsemberis,

2010). Additionally, it is ableist to assume that people with mental health conditions and

substance use disorders must prove that they are “deserving” of basic human decency, and that

they are unable to do this with significantly limited agency, privacy, and flexibility. Harm

reduction is successful because it is designed by and for this population, and people are more

likely to adhere to treatments that give them greater choices and let them decide what their

priorities are (National Harm Reduction Coalition, 2024). This idea is not exclusive to safer-use

supplies; giving participants agency in deciding which housing and supportive services work best

is essential to the success of keeping them housed. Resources are more effective when recipients

voluntarily and enthusiastically engage in them and do not need to have it all figured out before

having their basic needs met (Rankin, 2019).

The Pathways' Housing First program is an evidence-based practice that was initially

developed in 1992 for people experiencing chronic homelessness and mental health conditions.

People in these living situations are the most predisposed to severe health issues and substance

use disorders. This model does not require sobriety or participation in treatment for participants

to keep their housing. Instead, people are moved from the street into private apartments, where
they are provided with low-barrier support services of their choice. It operates on the belief that

housing is a basic human right rather than something that is earned, and that people who are

homeless and have mental health conditions should have control in their goals, housing, and

services (Tsemberis, 2010).

Harm reduction philosophy is integrated into Pathways’ Housing First program in many

different ways which positively influence participant adherence and success. The first component

is consumer choice, which allows residents to take control over their lives and recovery

processes. Informed by participant goals, staff can provide relevant support and evaluations to

help improve their living conditions and wellbeing as needed. Another essential component of

the model is separation of housing and services. Residents are put in affordable, rent-controlled

apartments of their choice. Because these apartments are owned by local landlords, residents can

still be evicted for lease violations. However, this will not result in the loss of treatment, support,

and housing, as the program will continue to provide the resources they need and work to

rehome them. The program also takes a recovery orientation approach, which allows participants

to create and pursue their own treatment goals with a harm reduction approach. This encourages

reciprocal trust and honesty, which allows residents to ask for help when it is needed. Lastly, the

community integration aspect helps and helps participants form social connections with the

people around them (Tsemberis, 2010).

Both the Pathways’ Housing First model and harm reduction demonstrate that once

people have their basic needs met in ways that work for them, they can then begin to address

other areas of their lives. This approach is highly successful, with the vast majority of

participants remaining housed five years after entry (Tsemberis, 2010). Not only that, but it is

also more cost-efficient. Chronic homelessness has increased significantly since the first
Point-In-Time Count in 2007 (U.S. Department of Housing and Urban Development, 2023) and

while it is not the most common form of homelessness, the people who experience it are

typically the vulnerable. Due to its visibility, chronic homelessness receives a significant amount

of public attention and scrutiny. Additionally, chronically homelessness populations have

disproportionately high use of emergency services and hospitals, as well as interactions with

police and the criminal justice system (Rankin, 2019). Housing-first approaches significantly

curb the use of these institutional services, and are significantly less costly overall than allowing

the situation to continue as it is (Tsemberis, 2010).

How Does Current Rhetoric and Legislation Concerning Homelessness and Substance Use

Compare to Evidence-Based Practices Like Housing First and Harm Reduction?

If harm reduction and housing-first approaches work so well, why are they not the norm

for addressing homelessness and drug policy in the United States? Unfortunately, a myriad of

systemic issues frequently leave these programs and the values they advocate for undervalued,

underfunded, and undermined. Our highly individualistic culture tends to view poverty and

substance use issues as personal failures, and expects the people experiencing them to work in

exchange for fundamental human wants and needs. These sentiments can make the public

resistant to non-punitive options despite high success and adherence rates, which are frequently
scrutinized for “enabling” or “rewarding” so-called bad behavior. Consequently, common

rhetoric and legislation surrounding homelessness and drug policy are both rooted in highly

subjective and punitive ideologies rather than in science and empathy, which leads to people

experiencing homelessness and people who use drugs being disproportionately stigmatized and

criminalized.

Criminalization tactics only exacerbate the cycle of homelessness and poverty, and

falsely associate the people experiencing these adversities with illicit activity. Many of the things

Chloe recounted being told about people experiencing homelessness throughout her life follow

along the lines of, “‘Don't give them your money, what if they spend it on drugs?’ Or like, ‘they

could be scamming you…’ Just the whole, like, ‘stranger danger,’ but mostly for homeless

people and like, ‘be careful walking around in this park alone, it's really dangerous because of

the homeless people,’ etc. Nothing that, you know, would make anyone want to interact.” Sam

also talked about the discrimination he has observed against people experiencing homelessness:

“I used to work at a big retail place, and I know the security guard, who he’d always keep his eye

on and follow.”
 Contrary to these harmful stereotypes, people experiencing homelessness are no more

likely to commit violent crimes than housed people, but are significantly more likely to be

victims of violence, abuse, and hate crimes (Rankin, 2019. Homelessness in and of itself is a

punishment, and the trauma that accompanies it is both a cause and a consequence of not having

a reliable, safe, and private place to stay along with other basic needs. Physical and mental health

problems, emotional, physical, and sexual abuse, isolation, drug use, resource and food

insecurity, and lack of healthcare can all contribute to a person becoming homeless, and are all

more likely to be experienced during homelessness (Rankin, 2019).

A major contributor to the criminalization of homelessness is the widespread and deeply

ingrained negative implicit bias toward stereotypical images of poverty. In response to this,

anti-homeless legislation is largely motivated to remove visibly impoverished and struggling

people from public spaces through incarceration, involuntary commitment, and displacement

(Rankin, 2019). While it is true that criminal records for people experiencing homelessness are

disproportionately high, this is mainly due to nonviolent and often minor misdemeanors related

to living and surviving outdoors that can be remedied with access to shelter, privacy, and basic

human needs (Rankin, 2019).

Practices such as sweeps and the aforementioned “public nuisance” laws often restrict the

ability to engage in necessary activities such as sitting, standing, sleeping, eating, using the

bathroom, asking for help, and protecting oneself from the elements in public spaces even when
realistic alternatives are not provided. Chloe was highly critical of these policies throughout our

conversation, noting that, “A lot of the people who are passing these judgments have had a safety

net their entire lives… For some people, living in these encampments, or asking for money, et

cetera, is the best that they can be doing to survive… or to, you know, have some fulfillment in

their day to day lives.” She expressed a lot of concern over sweeps, asking, “how can people

possibly think this is a good idea? Especially during the pandemic, and when the weather would

get super harsh.”

Not only are punitive policies such as sweeps and public nuisance laws costly and

ineffective, they are often successfully challenged as unconstitutional. To date, numerous court

cases have ruled against actions such as preventing people from giving or receiving help,

confiscating and destroying personal property, and displacing people without providing adequate

living accommodations. For example, 75 percent of cases surrounding sweeps cite that

unauthorized seizure and destruction of personal property is in violation of the Fourth

Amendment. Sweeps are frequently carried out illegally, and cause significant and lasting

damage for people experiencing homelessness. Many people who have lived in encampments

have trauma associated with the loss of important documents such as identification cards,

essential items like medications, clothing, and tents, and sentimental or valuable items as a result
of sweeps. These practices displace communities without providing realistic alternatives, which

sends a message that people experiencing homelessness are not welcome or safe anywhere.

Unfortunately, sweeps are common in cities like Seattle, which spent twenty million dollars on

the practice in 2018. To put this number into perspective, if this money had been reallocated into

permanent supportive housing, it could have helped end homelessness for approximately 37

percent of the city’s chronically homeless population (Rankin, 2019).

Punitive Drug War legislation has a similar legacy of being rooted in stigmatization rather

than fact, which causes many human rights violations and undermines established public health

initiatives that are effective in their understandings of drug use and treatment. Studies done in

countries which have expanded their harm reduction efforts to safe injection sites and heroin

assisted treatment have supported positive outcomes, but have not yet been widely implemented

in the United States (Cohen et al., 2022). Existing programs in the United State that distribute

safer use supplies and meet participants where they are at are vital tools in reducing many

negative consequences associated with drug use, yet continue to be limited by Drug War rhetoric.

These policies frequently depict drug use as an individual issue and fail to get to the root cause of

the issue. As a result, many people cannot access compassion, privacy, and resources they need

and are instead subjected to criminalization and stigmatization. Because possession and public

drug use are criminalized, it makes sense that people who do not have a private space to store
their belongings and live their lives would be disproportionately targeted by rhetoric and

legislation that perpetuates the War on Drugs and continues to vilify, stigmatize, and oppress

people who use drugs.

What Does This Look Like in Washington State?

Washington state has been instrumental in the fight against the War on Drugs for decades,

and notably established the nation’s first publicly approved needle exchange in Tacoma in 1988.

Until July of last year, statewide drug policies operated under the 2021 Blake decision, in which

the Washington Supreme Court found the felony drug possession laws in place at the time to be

unconstitutional. Under these provisions, illegal drug use and possession did not qualify as

punishable offenses, and law enforcement was required to refer people to treatment twice before

making an arrest. Unfortunately, this law was replaced by vastly different policies after its

expiration. Current Washington state drug policy is rooted in the very ideologies that have

allowed the War on Drugs to continue for decades despite the massive systemic failures it has

caused. This bill enables further oppression toward people who use drugs and threatens effective

public health initiatives that aim to address structural injustices at their core.

Last year, Washington state passed Senate Bill 5536, or the so-called “Blake Fix,”which

reversed many decriminalization efforts of prior years by making possession and public drug use

gross misdemeanors that can be punished separately. Law enforcement can now arrest violators
upon encounter without referring them to treatment first. People on their first or second

possession or public-use charge can face up to 180 days of jail time and a fine of up to one

thousand dollars. Upon their third conviction, people can face a sentence of up to 364 days and a

fine of up to five thousand dollars (Withycombe, 2023). This legislation increases discrimination,

stigma, and violence toward people in Washington who are already in highly vulnerable

situations, and has the potential to prevent them from accessing necessary, life-saving care.

Critics of the so-called “Blake Fix” include the ACLU of Washington, who released a

statement in response to the bill reminding policymakers of the human rights violations and

systemic failures which the War on Drugs has enabled for the last 50 years. Drug War rhetoric

and legislation disproportionately impact low-income people of color, while perpetuating white

supremacy and capital gain (2023). Of the 1.1 million drug-related arrests made in 2020, the

majority were due to simple personal possession. People who are most likely to experience legal

issues under punitive policies are already overpoliced, and are often in circumstances where they

do not have private spaces to store or use substances. This statistic is heightened for low-income

communities and people of color, particularly among Black and Indigenous populations. Black

people are overrepresented in both drug-related arrests, as well as national and statewide

homeless populations. Despite only making up 13 percent of the national population, 24 percent

of people arrested for drug-related offenses in 2020 were Black (Cohen et. al). In 2023, 37

percent of the overall homeless population identified as Black (U.S. Department of Housing and

Urban Development). This statistic is heightened in Washington, with Black people making up

4.6 percent of the overall state population but 16.7 percent of the homeless population (U.S.

Department of Interior, 2023)

 This recent decision is a dismaying return to inaccurate, stigmatizing policymaking that

goes against established modes of addressing substance use issues. As long as these rules are in

place, vulnerable and marginalized members of our community will continue to be prevented

from having their needs met and receiving the compassion and autonomy they deserve.

Final Thoughts: Reframing Narratives and Solutions to Drug Policy and Homelessness

Throughout my analysis, I aimed to examine the relationship between homelessness and

substance use, and explain some of the essential steps that must be taken to better meet the wants

and needs of community members affected by the stigma and criminalization that is attached to

both of these populations. Harm reduction and housing-first practices are some of the most

effective ways to do this, which is in part because they employ many of the similar

non-judgmental and customizable approaches that promote high adherence and long-term

success rates in a more cost-effective manner than more conventional treatment-based

approaches.

Despite the many benefits of practices such as harm reduction and affordable housing,

there is considerable dissonance between these empirically supported models and actual public

opinion, corresponding policymaking, and resources which must be overcome to make more

realistic and effective options more widely available and accepted. Some of the ways this can be

achieved is through accurate public awareness and education on homelessness and substance use

and effective treatment approaches that are directly informed by affected community members

and their lived experiences. This will foster a more empathetic and evidence based public

opinion around these community members, and minimize negative bias and stigma around them.

When I asked Chloe what steps she would like to be taken in addressing homelessness

and substance use-related issues, she provided an extensive list of changes, such as “Building
more affordable housing, doing some basic things to make the cost of living lower, making it

free, or at least a little more affordable to ride public transit,” as well as, “... taking away the

funds that are criminalizing things or enforcing these laws that make it just so expensive for

people to live their day to day lives, and putting them towards making those things less

expensive. Or investing them in programs for people who can't afford them, so that they don't

have to pay as much for them.” Sam had similar sentiments, noting the importance in “... giving

them the things they need, making sure they have medical care, somewhere to sleep, something

to eat, things that everyone needs to feel okay.” Positive changes in public opinion and

awareness have the potential to carry over to policymaking and resource allocation that would

make effective resources more accessible.

Harm reduction and housing-first programs have changed so many lives for the better,

and increased prioritization, funding, and acceptance will allow them to do this on an even wider

scale. While a lot of collective action and work needs to be done for this to happen, we can look

to the philosophies these approaches take in order to expand and normalize evidence-based and

social justice informed practices that directly involve the communities that face disproportionate

criminalization and stigmatization under current punitive approaches to issues such as

homelessness and drug use.

 Bibliography

ACLU of Washington. (2023, May 16). ACLU-Wa Statement on Bill that increases criminal

penalties for drug possession. ACLU of Washington.

https://www.aclu-wa.org/news/aclu-wa-statement-bill-increases-criminal-penalties-drug-

possession

Cohen, A., Vakharia, S. P., Netherland, J., & Frederique, K. (2022). How the war on drugs

impacts social determinants of health beyond the criminal legal system. Annals of

Medicine, 54(1), 2024–2038. https://doi.org/10.1080/07853890.2022.2100926

King County Department of Community and Human Services, Performance Measurement and

Evaluation (2021). Integrating Data to Better Measure Homelessness.

https://kingcounty.gov/~/media/depts/community-human-services/department/documents/

KC_DCHS_Cross_Systems_Homelessness_Analysis_Brief_12_16_2021_FINAL.ashx?l

a=en

National Harm Reduction Coalition (2024). Principles of Harm Reduction.

https://harmreduction.org/about-us/principles-of-harm-reduction/

The People’s Harm Reduction Alliance. Home. https://phra.org/

Rankin, S. K. (2019). Punishing Homelessness. New Criminal Law Review, 22(1), 99–135.

https://digitalcommons.law.seattleu.edu/faculty/810

de Sousa, T. et al. (2023). The 2023 Annual Homeless Assessment Report (AHAR) to Congress.

https://www.huduser.gov/portal/sites/default/files/pdf/2023-AHAR-Part-1.pdf
Tsemberis, S. (2010). Housing First: Ending Homelessness, Promoting Recovery, and Reducing

Costs. In I. G. ELLEN & B. O’FLAHERTY (Eds.), How to House the Homeless (pp.

37–56). Russell Sage Foundation. http://www.jstor.org/stable/10.7758/9781610447294.7

U.S. Department of Housing and Urban Development (2023). 2023 CoC Homeless Populations

and Subpopulations Report - All States, Territories, Puerto Rico and District of

Columbia.

https://files.hudexchange.info/reports/published/CoC_PopSub_NatlTerrDC_2023.pdf

U.S. Department of Housing and Urban Development (2023). 2023 CoC Homeless Populations

and Subpopulations Report - Washington.

https://files.hudexchange.info/reports/published/CoC_PopSub_State_WA_2023.pdf

Withycombe, C. (2023, May 15). WA lawmakers unveil deal on proposed drug possession law.

The Seattle Times.

https://www.seattletimes.com/seattle-news/politics/wa-lawmakers-unveil-deal-on-propos

ed-drug-possession-law/

Withycombe, C. (2023, May 16). WA raises penalties for drug possession, criminalizes public

use of drugs. The Seattle Times.

https://www.seattletimes.com/seattle-news/politics/wa-senate-votes-to-raise-penalties-for

-drug-possession-criminalize-public-use-of-drugs/