Often, advocates like Malish must navigate a maze of state and local laws, fierce local opposition, and hostile law enforcement. In Houston, as in many parts of the country, harm reduction programs operate on the fringes of legality and with scant budgets. But the $30 million plan faces a complicated reality on the ground. President Joe Biden wants to expand harm reduction programs like the one Malish works for as part of a broader strategy to reduce drug overdose deaths, which surged to more than 107,000 nationwide in 2021. Meanwhile, drug overdoses killed 1,119 people in the city last year, according to the Houston Police Department. Malish - a 31-year-old who said he had a problem with alcohol and opioid pills and then heroin before giving them all up nearly 10 years ago - estimated he can reach only about 20 people like Hess a month. His full-time job is as a research assistant at the University of Texas Health Science Center at Houston. But the Houston Harm Reduction Alliance, which tax records show operates on less than $50,000 annually, can afford to pay Malish only a couple of thousand dollars every now and again. Malish drives city streets handing out needles, naloxone, cotton balls, and condoms from the trunk of his sedan. Subscribe to KHN's free Morning Briefing.
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