I’ve been thinking a lot lately about why it feels like everything has changed. As these issues have become more visible, I notice how quickly people reach for simple explanations. One policy, one decision, one moment in time that can supposedly explain addiction, homelessness, or public drug use in our communities.
I’ve been struggling to write lately. It happens. Over the past month or so, I’ve found myself becoming increasingly frustrated for a variety of reasons, but more than anything I’ve been sitting with that question of what has actually changed over the past decade.
People often reach for a single explanation for what we’re seeing today. One policy, one decision, one shift such as harm reduction, decriminalization, safer supply, housing policy, prescribing practices, or mental health services. After working through the opioid crisis from the beginning, I don’t think the answer is nearly that simple.
Over time, I’ve noticed how uncomfortable complexity can be. As these issues have become more visible, there has also been a growing pull toward certainty and toward clear causes, clear villains, and clear solutions. The reality is that none of these things exist in isolation.
There have certainly been times in my career when I’ve written things I later wished I’d worded differently. I’ve always tried to be mindful of what I put into the world. I don’t identify clients and I write in general terms to protect privacy. More than that, the stories I share are not about individuals but about what emerges from years of sitting with people in some of the hardest moments of their lives. The public too often hears only the most negative versions of those stories. I have always tried to offer another perspective, one that reflects complexity rather than caricature.
In the decade I’ve worked in this field, beginning around the onset of what became known as the opioid crisis, one of the central public health priorities was reducing stigma around substance use. The belief was straightforward. If we could shift public narrative and reduce fear and judgment, people would be more likely to access care, treatment, and harm reduction supports.
Harm reduction itself was not new. Its principles had existed for decades. What changed was scale, including its visibility, its integration into policy, and its role within the healthcare system during a rapidly evolving crisis.
It is understandable that many people now focus on harm reduction when trying to make sense of what has changed. It became more visible at the same time drug use itself became more visible in public spaces. When two things shift together, it is natural to assume one caused the other. But correlation is not causation.
I hear often that drug use used to feel hidden. People recall a time when it happened behind closed doors rather than in parks, on sidewalks, or in plain view. That perception of change is real. I agree that drug use has become more visible. At times I have wondered whether harm reduction played a role in that perception. However, the longer I do this work, the more I believe we are describing the most visible change rather than the most important ones.
The reality is that so much has shifted at once. Mental health needs have increased alongside rising social isolation and changes in how people connect and communicate. Housing and affordability pressures have left more people without stability. Community structures that once held people in place have weakened.
At the same time, the illicit drug supply has become more toxic and unpredictable than anything we have seen before. What was once considered recreational use now carries a level of risk that is fundamentally different. People are increasingly warned not to use alone because even a single use can be fatal.
Healthcare has also changed. As concerns about opioid prescribing grew, practices shifted quickly and dramatically. While these changes were intended to reduce harm, some patients living with chronic pain or dependence experienced abrupt changes in care and were left navigating systems without consistent supports. None of these shifts exist on their own. They overlap, interact, and compound one another.
That is part of why these conversations feel so difficult. We are often trying to compress decades of social, economic, and healthcare change into a single explanation and it rarely fits.
As we move into another election year, I find myself thinking about how easily complexity gets reduced to slogans. I have learned that if a solution to addiction, homelessness, or public safety can be explained in a thirty second campaign line, it is probably leaving something important out.
These are not simple problems. They never have been. They deserve conversations that can hold uncertainty without rushing to certainty and policy responses that reflect how many forces have brought us to this point.
If there is one thing this work has taught me, it is that certainty is usually the most misleading answer of all.
Leave a comment