The Cities That Said Yes to Drugs - The Atlantic

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Late last year, I walked roughly a mile from downtown Seattle to the working-class neighborhood of Little Saigon and came upon a montage of human despair. An open-air drug market stretched along the intersection of 12th and Jackson: about 250 people, many smoking fentanyl or bent over in the thrall of the drug, tilting as if mid-fall. Three women lay passed out on the sidewalk, their chests slowly rising and falling, while fellow addicts stepped over them and dealers made sales. Young boys, schoolbags on their backs, stood on a far corner and watched.<br>Explore the September 2026 Issue<br>Check out more from this issue and find your next story to read.

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I walked around the block to the Hoa Mai playground, named for a Vietnamese flower that signifies rebirth. City workers had installed gates to keep drug users away, but at 4 p.m. on a Wednesday, I counted 27 people smoking drugs and nodding off. No children were in sight.<br>Half a mile to the south, in the Beacon Hill neighborhood, I visited a 10-acre park named after the Filipino nationalist Jose Rizal. It has a playground and the remnants of an apple orchard, and at night you can peer downtown and see the city lights. As I arrived, a drug user squatted next to a child’s slide and relieved himself. Others had set up tents and colonized the park pavilion, where they heated fentanyl on tinfoil and inhaled the fumes with glass pipes. A few went old-school and injected it.<br>Across the street, I spoke with Angelina Monsegur as she waited at a bus stop. When she was a kid, she told me, she and her father ate candied apples in the park and watched Fourth of July fireworks. A few weeks earlier, she and her 6-year-old daughter had gotten on the bus and seen a man smoking fentanyl on board. “Are you serious?” she’d shouted at him. “My daughter has asthma.” I asked if she had called the police, and she smiled at my naivete. “All the city does is send out teams who hand out aluminum foil and fentanyl pipes.”<br>Seattle is one of the wealthiest and best-educated cities in the world. It can afford to try various strategies to address its drug epidemic and high rate of fatal overdoses. Yet many of the city’s leaders, apparently supported by voters, view enforcing bans on the open sale and use of narcotics, and forcing addicts off the streets and into treatment, as akin to an act of state repression.<br>Seattle, like a striking number of other liberal American cities, has embraced a radical form of “harm reduction,” which is more a philosophy about treating addiction than a scientific approach to it. Harm reduction’s adherents hold that police and outreach workers should “meet the addicted where they are,” which is to say without judgment. The New York State Department of Health, a bastion of harm reduction, describes it as a “social movement” committed to “building leadership” among drug users. In these places, de facto and sometimes legal restrictions on narcotics use have been greatly loosened; cities fund teams of workers to hand out drug paraphernalia, and in some rare cases they’ve created dedicated spaces for addicts to shoot up. Meanwhile, police departments struggling with staffing shortages and budget cuts have stopped devoting resources to sweeping users and dealers off the streets or out of parks and playgrounds.<br>Harm reduction was born 50 years ago of an admirable humanitarian impulse. Its most basic ideas, such as providing clean needles to users, deservedly draw broad support. There’s a debate to be had, though, about whether this approach has saved lives or added to the carnage of America’s terrible drug epidemic. From 2014 to 2024, roughly 862,000 Americans died of drug overdoses, more than twice the toll of the previous decade. Several studies have shown that addicts who shoot up at official injection sites are far less likely to die of overdoses than those who use drugs in, say, alleyways and parks. Over the past decade, however, overdose-death rates climbed sharply in nearly every city where the strongest harm-reduction policies were in place, and even with declines in the past two years, the rates remain well above those of previous decades. From 2016 to 2025, 7,089 people died of overdoses in King County, which includes Seattle—seven times the number of homicides in that period.<br>Harm reduction isn’t just a problem for addicts. In many cities, the autonomy of drug users has taken precedence over nearly everything and everyone else, not least working-class families like Monsegur’s who must live alongside addicts and accept dystopian decay. Keith Humphreys, a Stanford psychiatry and behavioral-sciences professor and a former adviser to President Obama, supports needle exchanges and opposes the widespread jailing of users. But when he argues that drug policy must take into account the impact on communities, he told me, some critics dismiss him as a reactionary. Their arguments, he...