Harm Reduction Awareness and Attitudes Among Adults In the United States: Results from a National Survey

Background:
Public awareness and perceptions of harm reduction (HR) strategies influence their availability and utilization. These strategies help prevent drug-related overdoses, but little is known about how adults within the United States perceive them. Existing national data suggest that a substantial proportion of adults have been affected by addiction through friends and family. This study examined awareness and attitudes toward HR among U.S. adults, with a focus on those with friends or family members with drug problems.

Methods:
We conducted a national survey of U.S. adults recruited through a Qualtrics panel in 2025. We used quota sampling based on 2021 U.S. Census benchmarks for age, gender, region, race, ethnicity, education, and income. Measures assessed relationships with people who use drugs (PWUD), familiarity with HR, perceived community availability of HR, and attitudes toward specific HR strategies. Attitudes were also assessed using the Harm Reduction Acceptability Scale (HRAS). Analyses included descriptive statistics, bivariate tests, and hierarchical linear regressions.

Results:
Among 1,187 participants, 48.2% reported having a friend or family member with a substance use problem or substance use disorder (SUD). Participants were classified by exposure: 50.5% reported no friends or family with SUD; 26.5% reported friends or family who used substances other than opioids; 20.6% reported friends and family who used drugs including opioids; and 2.4% who chose not to respond.

Participants were most familiar with naloxone (40.6%), followed by safe injection practices (37.7%), methadone treatment (34.6%), drug checking test strips (30.9%), buprenorphine treatment (27.8%), and naltrexone treatment (26.1%). Except for naloxone, “I don’t know” was the most common response when asked about community availability.

Most (60.4%) agreed with providing take-home naloxone to PWUD, providing test strips (59.8%), and providing safe injection supplies (53.3%). Participants were more supportive of short-term MOUD than long-term. HRAS scores indicated favorable attitudes (M = 3.16, SD = 0.48) on a scale from 1 to 5. However, stigmatizing beliefs were common across exposure categories, including beliefs that increasing naloxone access encourages riskier drug use and that HR is acceptable only if it leads to abstinence.

Respondents with opioid-related exposure tended to be more familiar with and supportive of HR than those in other exposure categories, even after controlling for other factors. The regression model explained 30.7% of the variance in familiarity, with exposure contributing 2.6% (p < .001). Familiarity was associated with younger age, higher educational attainment, higher household income, identifying as religious, mental health history, and SUD history. The model explained 13.7% of the variance in HRAS scores, with exposure contributing 1.7% (p < .001). Support for HR was associated with younger age, higher educational attainment, geographical region, mental health history, and SUD history. Religious identification was associated with less favorable HRAS scores.

Conclusions:
Although participants with opioid-related exposure were generally more familiar with and supportive of HR, abstinence-oriented beliefs remained common across exposure groups. Findings highlight the need for public education that normalizes HR, addresses misconceptions, and increases awareness of availability. Friends and family of PWUD represent an important target for education and engagement efforts.